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.

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 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.

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.

Lower extremity function is vital for activities of daily living especially in stroke survivors. An innovative way to improve lower extremity function may be Assisted Cycle Therapy. This is among the first studies to examine ACT in stroke survivors. Twenty-three participants post-stroke performed ACT, VC and NC and pre and post measures of lower extremity function were conducted with the Lower Extremity Motor Coordination Test (LEMOCOT). The results showed that the non-paretic lower extremity improved its function after ACT, but not after VC or NC. Lower extremity function in the paretic leg improved after ACT and VC, but not after NC. These results suggest that ACT resulted in increased production of BDNF in the motor cortex which resulted in improvements in global motor function.

Executive function is vital for activities of daily living especially in stroke survivors because it is critical to everyday tasks (e.g., driving, cooking, etc.). An innovative way to improve executive function may be Assisted Cycling Therapy (ACT). This is among the first studies to use a Stroop task to measure inhibition, selective attention, and information processing speed following ACT in stroke survivors. Twenty-three participants post-stroke performed ACT, voluntary cycling (VC) and no cycling (NC). The results showed that there were improvements in the Stroop task following an acute session of ACT but not following VC or NC. These results suggest that ACT resulted in increased afferent information which may have resulted in increased arousal and excitability in regions of the prefrontal cortex. These factors have been shown to improve executive function.

The purpose of this study, originally, was to contribute to the completion of a meta-analysis conducted by Mara Wierstra from the University of Virginia. Wierstra had requested individual participant data from two separate studies conducted in our lab: "Acute bouts of assisted cycling improves cognitive and upper extremity movement functions in adolescents with Down syndrome" and "Assisted Cycling Therapy (ACT) improves inhibition in adolescents with autism spectrum disorder." From the data requested, the participants were required to complete three separate tests (i.e., Tower of London, Trail Making Task and the Stroop Test). After compiling the data and sending it to her, we decided to conduct a small meta-analysis of our own, drawing connecting conclusions from the data from the two studies. We concluded that observationally our data suggest an advantage for ACT over voluntary cycling and no cycling across two separate populations (i.e., Autism Spectrum Disorder and Down syndrome), and across different measures of executive function (i.e., Stroop Test, Trail Making Test, and Tower of London). The data suggest that the ACT interventions may promote the upregulation of neurotropic factors leading to neurogenesis in the prefrontal cortex of the brain.

This study examined upper extremity function, including manual dexterity, in chronic stroke survivors following a 10-week high intensity interval treadmill walking intervention. Six stroke survivors completed two 35-minute high intensity interval treadmill walking sessions based on ventilatory threshold per week. In addition, each participant completed one 30-minute low-intensity walking session at home. Participants completed upper extremity and manual dexterity testing at baseline, acutely, and after the 10-week intervention. Contrary to the prediction made, significant improvements in both paretic and non-paretic upper-extremity function including manual dexterity were not found. While time to complete the Nine Hole Peg Test (9HPB) somewhat decreased and the number of blocks transferred in the Box and Blocks Test (BBT) slightly increased, results were not found to be statistically significant. The results do suggest, nonetheless, that high intensity interval treadmill training may lead to improvements in upper extremity function and potentially daily living in chronic stroke survivors.