Programa educativo integral para el desarrollo de la autonomía y condición física vinculada a la salud de estudiantes chilenos con discapacidad intelectual

Abstract

People with intellectual disabilities make up between 1.5% to 2.5% of the world population. In this sense, 20% of the Chilean population presents some degree of disability, with intellectual disability being the most prevalent among children under 18 years of age. UNESCO proposes equitable access to health and welfare services, as well as quality education, as part of sustainable development goals. The majority of people with intellectual disabilities in Chile attend special education centers whose cycle lasts around 20 years. This incorporates students between 5 and 26 years old, who are enrolled in this educational system to guarantee equal access to education, integration, and progress opportunities. The purpose is for students to acquire learning that enables them to perform autonomously in the workforce. After schooling, those who do not obtain employment are usually confined to their homes under the care of their parents and/or guardians. That is why interventions through physical education classes in different stages of special education should focus on providing tools that facilitate autonomy and functionality for different stages of life as a preventive mechanism against chronic diseases. These strategies should consider the evaluation of physical condition and the implementation of physical exercise methodologies based on the characteristics of people with intellectual disabilities. The scarcity of studies on the subject makes it difficult for educators to establish physical fitness programs that work on variables promoting physical-motor perspectives and can be approached from an educational environment. Identified needs drive the present doctoral thesis work in an area that examines intellectual disability in special educational centers, considering exercise evaluation and methodologies for health with sports interventions, while incorporating a gender and equity approach in research. The objective of this doctoral thesis was to assess diagnose the situation of students with intellectual disabilities belonging to special educational centers in Chile and implement an intervention program through playful methodologies to improve the physical condition related to health and functional capacity. To achieve this objective, a compendium consisting of a letter to the editor and eight scientific articles published in Scopus and WoS indexed journals was developed. These articles are presented in a structured manner to respond to the specific objectives related to the general objective proposed for this thesis and not necessarily according to the temporality that they were published. Each article presents the methodology, main results, conclusion, and future projections. The letter to the editor highlights the problems that need to be solved. It emphasizes the potential role that special educational centers can play in the physical and functional preparation for the world of work for people with disabilities, protected by Law No. 21,015 that encourages companies to include people with disabilities in the labor market. This document also raises the gap in responsibility on the part of the Ministry of Education, the current physical education curriculum, and the lack of training for physical education professionals. Articles one and two correspond to original studies. Number two establishes relationships between different manifestations of force (isometric and dynamic) with functional capacity directly in people with moderate intellectual disabilities. Article three establishes comparisons between anthropometric measures of cardiometabolic risk, strength, and functionality among adolescent schoolchildren with intellectual disabilities of both sexes. The deterioration in the previously mentioned variables was greater in females than in males. Article three corresponds to a systematic review carried out under the criteria established in the PRISMA declaration, and it is referred to the effects of multicomponent physical exercise programs on the health-related physical condition of people with intellectual disabilities. The results show the lack of existing studies in this training modality, as well as the orientation of these programs to body composition over other aspects of physical condition that are related to functional capacity. Article four describes the effects of confinement resulting from the COVID-19 pandemic on cardiometabolic risk, muscle strength, and functionality in schoolchildren with intellectual disabilities and their conditions by sex. It reveals significant reductions close to 30% in handgrip muscle strength, as well as a decline in some functional tests in both sexes. This decline is more evident in females than in males. Article five is a descriptive study that presents the reference values of absolute and relative handgrip strength in Chilean schoolchildren with ID of both sexes and age group differences. Differences are established by age groups and sex in the absolute and relative manifestations of manual grip strength. Article six presents a proposal for cut-off points in children, adolescents, and adults for static and dynamic manifestations of muscle strength and its relationship with anthropometric indicators of overweight and obesity in people with intellectual disabilities. Different cut-off points are established by age categories, with the groups of adolescents and adults requiring higher levels of muscle strength for the prevention of overweight and obesity. Article seven proposes the primary validation of a rarely used anthropometric measure, such as the submandibular fold. On this occasion, this anthropometric measurement is proposed as a marker of cardiometabolic risk in people with intellectual disabilities. This is contrasted with other frequently used anthropometric measures, such as body mass index, waist circumference, waist-height index, neck and calf perimeter. Finally, moderate relationships are established between the submandibular fold and BMI in the adolescent population and with the waist-height index in adults. Article eight determines the effects of the intervention of a structured motor game program with concurrent characteristics and its effect on indicators of adiposity in a sample of adults with Down Syndrome. The results show that after ten months of intervention and with the permanent support of the families, significant reductions in adipose tissue and a parallel increase in lean mass were achieved in the participants. The guidelines stemming from the scientific literature regarding evaluation instruments and field tests for assessing physical condition and their validation in people with intellectual disabilities are scarce. Therefore, this thesis contributes to the validation of instruments and establishes relationships between selected variables, such as muscle strength, body composition, and functional capacity, which are additionally linked to health components acting as functional screening measures in the context of special education in Chile. In this same scenario, reference values of absolute and relative handgrip strength are proposed based on the different age groups that attend special educational centers in a representative sample of Chile. This measure is closely related to the functional capacity of schoolchildren. The effects of the COVID-19 pandemic on body composition, muscle strength, and functional capacity were also considered in this thesis. A sample of 132 people participated in this study, allowing for the establishment of the effects of confinement on the aforementioned variables. This served as guidance for addressing priority components to be considered in training programs for people with intellectual disabilities, which is added to the few studies published on this subject worldwide, making it a pioneer in Chile. From the perspective of the methodologies used to approach people with intellectual disabilities and the effect on physical condition related to health, there are also limitations. One of the methodologies used with favorable results is multicomponent physical exercise programs. Its implementation reports benefits in the morphological component related to body composition. However, few investigations report the use of this methodology with functional objectives, as well as the effect on the rest of the fitness components related to health (muscular strength and cardiorespiratory endurance). In addition, the implementation of a training program based on motor games with concurrent characteristics also conferred benefits in the reduction of central adipose tissue and caused a significant increase in brachial muscle area and perimeter, regardless of the nutritional intervention. Some limitations of the previously mentioned articles are related to the COVID- 19 pandemic, as the study population is at high risk and sometimes semi-dependent. Therefore, attendance at the different interventions was carried out intermittently, with reduced capacity, sometimes limiting opportunities for interaction between peers. Additionally, it affected the study designs proposed at the beginning, limiting the possibilities to review and descriptive cross-sectional studies, for the most part, over those of experimental cohorts. However, this doctoral thesis provides relevant and innovative information for special physical education in Chile, specifically in the field of physical fitness related to health and training methodologies for people with intellectual disabilities. In this sense, the structured motor game emerges as a tool for promoting health in school contexts, which, together with collaborative work with families and the educational community, would act as facilitators of adherence to physical activity in schoolchildren with intellectual disabilities.