Fitness Appraisal in Children with Disabilities: Cardiovascular Endurance
Although laboratory measures of fitness are clearly more accurate for assessing fitness than field-based measures, they are often impractical in school and other community settings.17 Therefore, the focus of this section will be on fitness tests that are relatively easy to administer and can be used in school settings or in recreation programs when there is appropriate staffing available.
The most popular tests of cardiovascular fitness involve running or walking.41 Most children with sensory (blind, deaf) and intellectual disabilities (intellectual disability, learning disorders) can participate in these tests with minor adaptations. However, for children with lower limb disabilities, these tests may not be applicable. Several field-based cardiovascular fitness tests have been developed specifically for persons with physical disabilities. Three of these tests are described below.
12-Minute Wheel Distance Test
The 12-minute Wheel Distance Test is a maximal test based on the relationship between distance covered and peak oxygen uptake (VO2).42 The test description is described in Table 2. The test does not require calculations except for the total distance covered in 12 min. Norms have been developed on adults with physical disabilities.36 Although there are no norms on children with disabilities, comparing pre- and posttest scores on distance and heart rate will provide a general index of improvement in cardiovascular fitness.
|Table 2. Test Directions for Administering the 12-Minute Wheel Distance Test|
Target Aerobic Movement Test
A second cardiovascular fitness test that has widespread application to children with varying levels of disability is the Target Aerobic Movement Test (TAMT).20 The TAMT requires the child to exercise within a recommended target heart rate zone for a sustained period of time. The participants can engage in virtually any physical activity as long as it is of sufficient intensity to raise the heart rate into a target heart rate zone between 130 to 160 minutes beats per minutes (bpm) for a period of 15 minutes. Heart rates and cumulative distance traveled are recorded at 1-minute intervals during the test. If the heart rate is within the designated target heart rate zone at a recording interval (130 to 160 bpm), the child is encouraged to keep going. If the heart rate is either below or above this value, they are encouraged to slow down or go a little faster. Scoring is down on a pass/fail basis. Children who are able to exceed the 130 bpm minimal threshold are given a pass. Although heart rates during testing can be recorded manually at the radial pulse, because of the high level of inaccuracy it is suggested that the child wear a heart rate monitor. A more detailed description of the test can be found in the paper by Rimmer and coworkers.20
Arm Crank Ergometry
Another cardiovascular test that can be used for children with disabilities, especially those who have trouble walking or wheeling, is the use of an arm ergometer. Although there are no criteria or norms for either of these tests on children with disabilities, the therapist can develop a specific protocol that will allow the child to arm cycle for at least 3 to 6 minutes in order to assess cardiorespiratory function. Depending on the severity of the disability, it may require a very low initial resistance (5 to 10 watts) with a gradual increment over the duration of the test (5 to 10 watts). Pre- and posttest scores on heart rate, blood pressure, workload and time can be compared to determine improvements in cardiovascular fitness.