Individuals with Down syndrome (DS) display significantly earlier symptoms of Alzheimer's disease (AD) beginning around age 35. Because AD-like symptoms tend to be ever present in those with DS, it is difficult to accurately evaluate those with DS for earlier onset of AD. It has been suggested that physical activity and sleep are potential measures to monitor for manifestations of early AD-like symptoms in people with DS. Our lab has previously shown remarkable improvements in physical activity, cognition, and motor control while using Assisted Cycle Therapy (ACT) for adolescents with DS, Parkinson's disease (PD), and stroke populations. This novel exercise intervention is suggested to mediate improvements in cerebral activation through upregulated neurogenesis, angiogenesis, and neuro-plastic mechanisms. Despite prior research, there remains to be limited studies behind these concepts in adults with DS and sleep, which is suspected to be an accurate metric for AD-like manifestations. Fifteen older adult participants with DS were assigned to one of two cycling interventions: ACT or VC. All participants were provided Fitbit HR devices for sleep and physical activity tracking. Only five adults had viable continuous collection of data for both sleep and physical activity. While none of our results reached conventional levels of significance, there were trends towards significance in the VC group for total steps taken and in the ACT group for sleep-onset latency (SOL). Individual cases of improvement were noted but it globally can be supported that Fitbit devices are not optimistic for adults with DS due to poor long-term compliance. It comes to no surprise to those involved with these groups that cooperativity tends to be low with long term interventions in research design. In spite of this significant barrier, Fitbit devices offer to be a reliable and inexpensive record keeper of physical activity and sleep. Future research should lean to investigate the viability of Fitbit devices within younger populations, the role of heart rate variability on sleep efficiency and sleep onset latency in DS, and utilize more extensive compliance reinforcement to obtain volume of data collection needed to establish significant measurements of physical activity and sleep in populations with DS.

Individuals with Down Syndrome (DS) are subject to a spectrum of behavioral, cognitive and physical impairments. This population is more predisposed to comorbidity and typically has an increased risk of inactivity resulting in a lower level of fitness. Previous studies on physical activity have shown that routine exercise has similar health benefits for those with DS as those individuals without a disability and in turn progresses their balance ability. Due to limited exercise program opportunities and studies that intentionally investigate the benefits of specific modes of exercise on the DS population, a community-based Exercise Program for Adults with DS (ExDS) was created with the goal of improving their physical and mental health and measuring changes in their balance capabilities throughout the program. ExDS partnered with Arizona State University (ASU) students to create biweekly customized workouts, that followed exercise prescription guidelines, consisting of an aerobic warm-up, main aerobic exercise bout, resistance training, balance training, and stretching for each participant with DS. Participant dynamic and static balance ability was measured using the Berg Balance Scale (BBS) during program pre- and post-assessments. The BBS composite score did not change and no significant improvement was seen in the p-values for each line item of the BBS from pre- to post-testing. For follow-up analyses, the participants with low treatment fidelity were removed. Follow-up analyses showed significant increases in BBS composite score and line item 13 from pre- to post-testing. Treatment fidelity was a limitation in this study and future studies should aim to increase fidelity and consistency of tester for pre- and post-testing. In conclusion, holistic exercise programming for adults with DS appears to benefit balance as long as treatment fidelity is high. It is unclear which mode of exercise had the greatest impact on changes in balance.

Adaptive behavior consists of the social, conceptual and practical skills an individual must execute to function independently in their everyday life. Individuals with Down syndrome have limitations in their adaptive behavior due to cognitive and physical deficits. The aim of this study was to examine if an exercise program would improve the adaptive behavior skills in persons with Down syndrome. The exercise intervention, Exercise for Adults with Down Syndrome (ExDS), was a semester long program where adults with Down syndrome participate in twice weekly workouts planned and executed by Arizona State University students. The workouts consisted of an aerobic warm up, aerobic exercises, resistance exercises, balance exercises and stretches. The participants' adaptive behavior and cognitive planning ability were assessed before ExDS and after ExDS. The Adaptive Behavior Assessment System Second Edition (ABAS-II) was used to measure adaptive behavior. The ABAS-II consisted of a forum that addressed the Social, Conceptual and Practical domains of adaptive behavior and was filled out by the participants' caregiver. The Tower of London (ToL) was used to measure cognitive planning ability. The change in the ABAS-II scores from pre- to post-testing were statistically insignificant. The change from pre- to post-testing in the ToL scores approached statistical significance. Limitations included bias caregiver perception and respondent inconsistency. There is a need for further research on the effect of exercise on the adaptive behavior in adults with Down syndrome.

The purpose of this study was to examine the influence of Assisted Cycling Therapy (ACT) on depression in older adults with Down Syndrome (DS). We predicted that older adults with Down Syndrome would see an improvement in their depressive symptoms after ACT and Voluntary Cycling (VC). However, we predicted there would be a greater improvement in depressive symptoms after ACT in comparison to VC. Depression was measured using a modified version of the Children's Depression Inventory 2 (CDI 2) due to the low mental age of our participant population. Twenty-one older adults with DS were randomly assigned to one of three interventions, which took place over an eight-week period of time. Eleven older adults with DS completed the ACT intervention, which is stationary cycling on a recumbent bicycle with the assistance of a motor to maintain a cadence at least 35% greater than the rate of voluntary cycling. Nine participants completed the voluntary cycling intervention, where they cycled at a cadence of their choosing. One participant composed our no cycling control group. No intervention group reached results that achieved a conventional level of significance. However, there was a trend for depression to increase after 8 weeks throughout all three intervention groups. We did see a slightly slower regression of depression in the ACT group than the VC and control. Our results were discussed with respect to social and cognitive factors relevant to older adults with DS and the subjective nature of the CDI2. This study brings attention to the lack of accurate measures and standardized research methods created for populations with intellectual disabilities in regards to research.

Executive function is a crucial part of daily living and activities for individuals with Down Syndrome (DS). The aim of this study was to examine if Assisted Cycle Therapy (ACT) would improve cognitive planning as measured by the Tower of London (TOL), set switching as measured by the modified Wisconsin Card Sorting Test, and spatial memory as measured by the Corsi Block Test in older adults with DS. Twenty-six participants were randomly assigned to one of three interventions over eight weeks. 1) Thirteen older adults with DS completed the ACT intervention, which is stationary cycling with the assistance of a motor to maintain a cadence at least 35% greater than voluntary cycling. 2) Eleven older adults with DS completed voluntary cycling (VC) and 3) Two older adults with DS were in our no cycling intervention. There were tests administered a week prior to the invention (or no intervention) and one week after their completed intervention (or no intervention). The pre- and post-tests were used to assess different measures, which could have been influenced from the eight-week intervention. The measures analyzed from our study were as followed; Tower of London, Card Sorting Test, and the Corsi Block Test. Our results showed that cognitive planning improved after ACT and VC, but not NC. Cognitive planning was assessed through the TOL task and showed improvements after the eight-week intervention (due to its sensitive nature in analyzing smaller changes pre- and post-intervention). Our results are discussed with respect to upregulation of neurotrophic factors that increase functioning in the prefrontal cortex that accompanies exercise.

The aim of this study was to examine the influence of Assisted Cycling Therapy (ACT) on information processing measured by simple reaction time in older adults with Down Syndrome (DS). Twenty-one participants were randomly assigned to one of three interventions over eight weeks. 1) Eleven older adults with Down Syndrome completed the ACT intervention, which is stationary cycling with the assistance of a motor to maintain a cadence at least 35% greater than voluntary cycling. 2) Eight older adults with Down Syndrome completed the voluntary cycling (VC) intervention and 3) two older adults with Down Syndrome were in our no cycling (NC) intervention. Both exercise groups participated in the eight-week, supervised exercise protocol for at least three, 30-minute sessions per week. None of our results reached conventional levels of significance. However, the greatest improvements in reaction time occurred following the voluntary cycling (VC) intervention. Our results are discussed with respect to physiological differences in older adults with DS that may limit improvements in executive function following exercise. These physiological differences and limitations include muscle atrophy and reduced perceptions, age related latency between motor cortex activation and onset of muscle activity, as well as general age related slowing in reaction time. Although it may be difficult to improve executive function in older adults with DS, we suggest other benefits to exercise which include improving social communication, gross motor skills, and exercise perception. Future research should continue to investigate the effects of exercise on multiple areas in older adults with DS with the hopes of improving quality of life.

The aim of this study was to examine the effects of Assisted Cycle Therapy (ACT) on self-efficacy and exercise perception in older adults with Down syndrome (DS) after a three times a week for 8 weeks intervention. Thirteen participants were in the ACT group in which a motor assisted their cycling to be performed at least 30% faster than voluntary cycling (VC), 11 participants were in the voluntary cycling group and two participants were in the no cycling (NC) group. The results showed that both exercise groups (i.e., ACT and VC) improved in their self-efficacy after the 8 week intervention. In addition, exercise perception improved following ACT and not VC or NC. Our results are discussed with respect to their future implications for exercise in the DS population. It might be that the yielded results were due to differences in effort required by each intervention group as well as the neurotrophic factors that occur when muscle contractions create synaptic connections resulting in improvement in cognition and feelings of satisfaction. In the future, research should focus on the psychological factors such as social accountability and peer interaction as they relate to ACT and physical activity in person's with DS.

Previous research has found improvements in motor and cognitive measures following Assisted Cycle Therapy (AC) in adolescence with Down syndrome (DS). Our study investigated whether we would find improvements in mental health in older adults with DS as measured from the Adapted Behavior Dementia Questionnaire (ABDQ), Physical Activity Self Efficacy Scales (PACES), Children's Depressive inventory, which are early indicators of Alzheimer's disease (AD) in persons with Down syndrome. This study consisted of seven participants with Down syndrome between the ages of 31 and 54, inclusive, that cycled for 30 minutes 3 x/week for eight weeks either at their voluntary cycling rate (VC) or approximately 35% faster with the help of a mechanical motor (ACT). Our results were consistent with our prediction that self efficacy improved following ACT, but not VC. However, our results were not consistent with our prediction that dementia and depression were improved following ACT more than VC. These results were interpreted with respect to the effects of exercise in older adults with DS. Future research should focus on recruiting more participants, especially those with deficits in mental health.

Obesity has been designated as a global epidemic by the World Health Organization since 1998. Over the past 30 years, the prevalence of this epidemic has increased by two-fold in adults and three-fold in children. Let's Move! Active Schools (LMAS) seeks to fight obesity and promote healthy environments in schools. In collaboration with the Community Action Research Experiences (CARE) program at Arizona State University, three elementary schools in the greater Phoenix area were studied to determine factors associated with success or barriers to implementation of LMAS. Interviews were conducted with three physical educators to determine: the initial appeal and reason the school was attracted to LMAS, how leadership buy-in and participation have affected the success of LMAS in each school, how the resources and support provided by LMAS have best ensured the success of LMAS in each school, what LMAS can do to ensured the sustainability and continued success of the initiative, and how each school has implemented the five core principals of the Comprehensive School Physical Activity Program (CSPAP). Results of the interviews demonstrated that programs previously in place in the elementary school resembling LMAS aided in successful implementation as well as leadership buy-in and participation's positive effect on implementation. The resource most used by physical educators at the three elementary and district advocates and more local workshops were two of the resources requested by the physical educators. The five principals of CSPAP were found to be incorporated at each of the elementary schools. The principal at the award winning school was interviewed and expressed the value she saw in LMAS. Suggestions for more successful implementation of LMAS included targeting the administration, pushing the online material, clarifying the availability of local workshops, and promoting movement lab activities.

Upper extremity function is vital for activities of daily living especially in stroke survivors. An innovative way to improve upper extremity function has been shown with Assisted Cycle Therapy (ACT). This is among the first study to examine ACT in stroke survivors. 13 stroke survivors performed ACT, VC, and NC and pre and post measures of upper extremity function were conducted with the box and blocks test (BBT). The results showed that non-paretic upper extremity improved its function after ACT and VC, but not after NC. For the paretic arm, while the results did not reach conventional levels of significance, improvements in upper extremity function following ACT more so than VC or NC. These results were interpreted to suggest that ACT resulted in increased production of BDNF in the motor cortex, which resulted in improvements in global motor function.