适应性体育活动对智力与发展性残疾儿童功能、活动和参与效益的系统综述

Effect of adapted physical activity on functioning,activity and participation in children with intellectual and developmental disabilities:a systematic review

目的 分析适应性体育活动(APA)对智力与发展性残疾(IDD)儿童身体功能、运动技能、心理健康和社会参与的影响。方法 检索PubMed、Google Scholar、Cochrane Library和PsycINFO等数据库收集2014年1月至2024年5月公开发表的APA对IDD儿童功能和活动效益的相关文献。采用物理治疗证据数据库(PEDro)量表对纳入文献进行质量评价,并进行系统综述。结果 最终纳入9篇英文文献,PEDro量表评分5~8分,质量中等至高。纳入文献来自中国、乌克兰、伊朗、美国、澳大利亚、巴西、土耳其等7个国家,涉及327例IDD儿童,主要来源于智力残疾研究、健康、运动与康复、适应性体育等领域期刊。发表时间主要集中在2018年至2022年。研究对象年龄7~18岁,涵盖多种IDD类型,包括智力残疾、孤独症、注意缺陷多动障碍。APA干预涉及单一类和综合类,其中综合类包括多种类型的APA、运动行为管理、辅助技术应用等,活动由适应性体育教师或教练员基于IDD儿童的兴趣与身体活动需求设计。具体干预方式包括适应性球类运动(足球、体操、篮球、网球、乒乓球等),适应性力量训练(站立举重、胸前传球等),执行功能训练(打鼹鼠、飞盘、击球和投掷等)以及适应性滑雪、步行、平衡训练等,干预频率为每次30~70 min,每周2~3次,干预强度为低~剧烈,干预持续8~36周。不同类型的APA对IDD儿童功能和健康效益体现在4个方面。在身体功能方面,能够提高IDD儿童的心肺耐力(最大摄氧量、心率恢复等),增强肌肉力量与耐力(握力、俯卧撑、仰卧起坐等),提高动作灵活性(动作变化的迅速、准确和协调等)与柔韧性(坐位体前屈、肩关节活动度等),改善平衡与运动协调能力(静态/动态平衡测试、动作协调性评估等)与体成分(体质量指数、体脂率、腰臀比等)。在运动技能与能力方面,能够发展IDD儿童的基本运动技能(如行走、跑步、跳跃、投掷、接球等)以及复杂运动技能(如球类运动、体操、舞蹈等),提高运动能力测试成绩。在心理健康方面,有助于降低IDD儿童的焦虑和抑郁状态,提高自尊水平,改善执行功能。在社会参与方面,有助于提高IDD儿童的身体活动参与度,社交互动频率与质量,提升生活质量。结论 本研究系统综述了APA对IDD儿童功能、活动和参与效益的证据。根据儿童的功能和发展水平设计的多样化APA及其课程,可以提升IDD儿童的身体功能、运动技能、心理健康和社会参与,促进他们的全面发展。

Objective To analyze the effect of adapted physical activity(APA)on physical function,motor skills,mental health and social participation in children with intellectual and developmental disabilities(IDD).Methods Literature on the effect of APA on function and activity of children with IDD were searched in PubMed,Google Scholar,Cochrane Library and PsycINFO databases,from January,2014 to May,2024.The methodological quality was evaluated with Physiotherapy Evidence Database(PEDro)scale,and a systematic review was conducted.Results A total of nine English articles were included,and the PEDro scale scored five to eight,with medium to high quality.Included literature was from seven countries,including China,Ukraine,Iran,the United States,Australia,Brazil and Turkey,involving 327 children with IDD.The articles were mainly from journals in the fields of intellectual disability research,health,sports and rehabilitation,and adapted physical education.They were publicated mainly between 2018 and 2022.The subjects were seven to 18 years old,covering a variety of IDD types,including intellectual disability,autism and attention deficit hyperactivity disorder.APA intervention involved a single approach and comprehensive approaches,the comprehensive approaches included various types of APA,sports behavior management and assistive technology application,etc.,and the activity was designed by adapted physical education teachers or coaches based on the interests and physical activity needs of children with IDD.Specific intervention methods included adaptive ball games(football,gymnastics,basketball,tennis and table tennis,etc.),adaptive strength training(standing weightlifting and chest passing,etc.),executive function training(playing whack-a-mole,frisbee,hitting and throwing,etc.)and adaptive skiing,walking,balance exercises,etc.,with an intervention frequency of two to three times a week,30 to 70 minutes a time,low intensity to strenuous,lasting eight to 36 weeks.The functional and health benefits of different types of APA on children with IDD were reflected in four aspects.In terms of physical function,it could improve cardiopulmonary endurance(maximum oxygen uptake and heart rate recovery,etc.),enhance muscle strength and endurance(grip strength,push-ups and sit-ups,etc.),improve flexibility(rapid,accurate and coordinated movement changes,etc.)and flexibility(sitting body forward bending and shoulder joint range of motion,etc.),and improve balance and movement coordination(static/dynamic balance test and movement coordination assessment,etc.)and body composition(body mass index,body fat percentage and waist-to-hip ratio,etc.).In terms of motor skills and abilities,it could develop basic motor skills(walking,running,jumping,throwing and catching,etc.)and complex motor skills(ball games,gymnastics and dance,etc.),and improve athletic ability test scores.In terms of mental health,it helped to reduce anxiety and depression,improved self-esteem,and improved executive function.In terms of social participation,APA improved the physical activity participation,the frequency and quality of social interaction and quality of life.Conclusion This study systematically reviewed the evidence for the effect of APA on the function,activity and participation of children with IDD.Diversified APA and adaptive physical education programs designed according to children's functional and developmental levels have significantly improved the physical function,motor skills,mental health and social participation of children with IDD,and promoted their overall development.