James H. Rimmer, Ph.D., Director

Since the classic work of Rarick and Dobbins, who in the early 1960s reported that children with intellectual disability had lower levels of physical fitness compared to their peers, we haven't had much good news regarding the overall physical health and function of youth and adults with intellectual/developmental disabilities (I/DD). During the past four decades, several published studies have essentially said the same thing: As a group, individuals with I/DD have poor physical fitness that generally becomes progressively worse across the lifespan.

Low physical fitness refers to three essential factors: poor cardiorespiratory endurance, low muscle strength, and a high body fat level leading to obesity. Not too long ago, many people felt that physical fitness was not an important area of health to be overly concerned about unless you were an athlete. Today that attitude has changed as researchers are starting to discover that low strength and high body fat, referred to as sarcopenic obesity, has dangerous implications for older adults in general, and for younger adults with I/DD in particular, given their higher rate of obesity and low physical fitness.

Sarcopenic obesity is a condition that results in reduced muscle mass (sarcopenia) combined with an overabundance of adipose or fat tissue (obesity). These terms are usually discussed separately, but in recent years, scientists have connected the two terms as a dyad. Losing muscle and gaining fat is a deadly combination. In a commentary by Ronenn Roubenoff titled, Sarcopenic Obesity: The Confluence of Two Epidemics, he makes the following statement:

"Although the prevalence and time course of sarcopenia is reasonably well worked out, the impact of obesity on it is only now emerging as an important public health problem. The 'fat frail' have the worst of both worlds as they age - increased weakness due to sarcopenia and a need to carry greater weight due to obesity."

Thirty years ago, no one would have noticed that this was a problem because most adults wouldn't have reached older adulthood. But with the successful efforts among disability rights organizations to transition adults with I/DD from institutional settings to community-based residences, improvements in health care and screening services have led to greater longevity. Unfortunately, increasing the lifespan is not a proxy for increasing the healthspan, and for many adults with I/DD, living longer doesn't necessarily guarantee living healthier.

Decades of physical inactivity and poor nutrition may result in greater levels of sarcopenic obesity at a much earlier age among adults with I/DD. When strength gets too low and obesity levels outpace the growth of new muscle, getting out of a chair or car, climbing stairs, or just walking can become difficult and often insurmountable tasks, often leading to frailty, increased functional limitations, higher risk of falls, and loss of independence.

As we continue to focus (and rightly so) on appropriate health care services, adequate employment and community-based residential placements for adults with I/DD, we must not forget that the fourth leg of the stool is good health. Adults with I/DD may be at an alarmingly high risk of sarcopenic obesity, which could in turn undermine their ability to live independently, work, and recreate. No one is quite sure how much of an impact this condition has had or will have on a new generation of aging adults with I/DD, but one thing is for certain: low strength and high obesity are more prevalent among adults with I/DD living in the community and more research is needed to determine their impact on health, wellness, and function.