Gonca Ince


Purpose: In this study, it has been aimed to determine the effect of 8-week ball-handling training program on upper-lower extremity muscular strength of individuals with Down syndrome.

Method: In the study, twenty one individuals who had been medically diagnosed with trisomy down syndrome and still attending special education and rehabilitation centres have participated as voluntarily. The participants have been selected randomly and divided into exercise (10 participants) and control groups (11 participants). The exercise group was trained with Ball-handling Training Program for 8 weeks; 2 days a week and a 60 minute per day. However, the control group did not participate in any activities regularly. In the study, Takei hand grip dynamometer was used to measure upper extremity strength. For the measurement of lower extremity strength, standing broad jump–vertical jump, wall squat test and Takei leg dynamometer strength tests were utilized. The statistical analyses of the data were realized by using SPSS 21.0 package program.

Results: The means of after eight weeks, leg strength test (pre:22.47±13.12; post:30.90±13.87; p=.005) wall squat test (pre:23.55±10.95; post:30.92±13.87; p=.005) and dominant hand grip strength (pre:11.35±5.74; post:14.55±7.18; p=.024) were found more significant than the means of baseline in exercise group. But, It was not significant differences between post measurements of exercise and control groups (p>0.05).

Conclusion: The findings of the study have revealed that 8-week ball-handling training program made a positive effect on upper-lower extremity strength of individuals with Down syndrome. However, it is assumed that if the program implemented is maintained for a longer period of time, the positive effect of the training on individuals with DS will increase.


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ball-handling training, upper-lower extremity muscular strength, Down syndrome


Agiovlasitis, S., McCubbin, J.A., Yun, J., Mpitsos, G. & Pavol, M.J. (2009). Effects of Down syndrome on three-dimensional motion during walking at different speeds, Gait & Posture. 30 345–350.

Biçer, M., Özdal, M., Akcan, F., Mendeş, B., & Patlar, S. (2015). Effect of strength training program with elastic band on strength parameters. Journal of Biology of Exercise, 11(2), 111-122.

Bilgiç, M., Biçer, M., & Özdal, M. (2016b). Farklı branşlarda spor yapan 11-13 yaş grubu çocukların 2D: 4D parmak oranlarının sportif performansla ilişkisinin incelenmesi. Gaziantep Üniversitesi Spor Bilimleri Dergisi, 1(1).

Bilgiç, M., Pancar, Z., Şahin, F. B., & Özdal, M. (2016a). Sedanter Çocuklarda İki Farklı Anaerobik Güç Testi Arasındaki Korelasyonun İncelenmesi. Gaziantep Üniversitesi Spor Bilimleri Dergisi, 1(2), 40-48.

Carmeli, E.1, Ayalon, M., Barchad, S., Sheklow, S.L. & Reznick A.Z. (2002). Isokinetic leg strength of institutionalized older adults with mental retardation with and without Down's syndrome. J Strength Cond Res. May;16(2):316-20.

Carmeli, E.2, Kessel, S., Coleman, R. & Ayalon, M. (2002). Effects of a treadmill walking program on muscle strength and balance in elderly people with Down syndrome. J Gerontol A Biol Sci Med Sci. Feb;57(2):M106-10.

Clark, M. P.A. & Westerberg, B. (2009). How random is the toss of a coin? CMAJ. Dec 8; 181(12): E306–E308.

Coutinho, E. L., Gomes, A. R., Franca, C. N., Oishi, J., & Salvini, T. F. (2004). Effect of passive stretching on the immobilized soleus muscle fiber morphology. Braz. J. Med. Biol. Res. 37:1853–1861.

Covelli, V., Raggi, A., Meucci, P., Paganelli, C., & Leonardi, M. (2016). Ageing of people with Down's syndrome: a systematic literature review from 2000 to 2014. Int J Rehabil Res. Mar;39(1):20-8. doi: 10.1097/MRR.0000000000000147.

Cowley, P.M., Ploutz-Snyder. L.L., Baynard, T., Heffernan, K.S., Jae, S.Y., Hsu, S., Lee, M., Pitetti, K.H., Reiman, M.P. & Fernhall, B. (2011). The effect of progressive resistance training on leg strength, aerobic capacity and functional tasks of daily living in persons with Down syndrome. Disabil Rehabil. 33: 2229–36.

Croce, R. V., Pitetti, K. H., Horvat, M., & Miller, J. (1996). Peak torque, average power and hamstrings/quadriceps ratios in nondisabled adults and adults with mental retardation. Archives of Physical Medicine and Rehabilitation, 77, 369–372.

Escamilla, R.F., Zheng, N., Macleod, T.D., Edwards, W.B., Imamura, R., Hreljac, A., Fleisig, G.S., Wilk, K.E., Moorman, C.T. & Andrews, J.R. (2009). Patellofemoral joint force and stress during the wall squat and one-leg squat. Med Sci Sports Exerc. Apr;41(4):879-88. doi: 10.1249/MSS.0b013e31818e7ead.

España-Romero, V., Ortega, F.B., Vicente-Rodríguez, G., Artero, E.G., Rey, J.P. & Ruiz, J.R. (2010). Elbow position affects handgrip strength in adolescents: Validity and reliability of Jamar, DynEx, and TKK dynamometers. J Strength Cond Res. 24(1):272–7, e3181b296a5.

Franciosi, E., Gallotta, M.C., Baldari, C., Emerenziani, G.P. & Guidetti, L. (2012). Basketball ability testing and category for players with mental retardation: 8-month training effect. J Strength Cond Res. Jun;26(6):1524-31. doi: 10.1519/JSC.0b013e318236d0a4.

Giagazoglou, P., Kokaridas, D., Sidiropoulou, M., Patsiaouras, A., Karra, C. & Neofotistou, K. (2013). Effects of a trampoline exercise intervention on motor performance and balance ability of children with intellectual disabilities. Res Dev Disabil. Sep;34(9):2701-7. doi: 10.1016/j.ridd.2013.05.034.

Guidetti, L., Franciosi, E., Gallotta, M.C., Emerenziani, G.P. & Baldari, C. (2010). Could sport specialization influence fitness and health of adults with mental retardation? Res Dev Disabil. Sep-Oct;31(5):1070-5. doi: 10.1016/j.ridd.2010.04.002.

Hamamioğlu, Ö. & Çakmakçı, E. (2011). Examination of adolescents’ responses to the basic basketball training, Ovidius University Annals, Series Physical Education and Sport / Science, Movement And Health, vol. 11, ıssue 1, , Romania, s:7-12.

Ince, G., Sarpel, T., Durgun, B. & Erdoğan, Ş. (2006). The Effects of multimodal exercise program for people with Ankylosing Spondylitis, Phys. Ther. 86: 924-935.

John, R., Dhanve, A. & Mullerpatan, R. P. (2016). Grip and pinch strength in children with Down syndrome, Hand Therapy. Vol. 21(3) 85–89.

John, R., Dhanve, A. & Mullerpatan, R. P. (2016). Grip and pinch strength in children with Down syndrome, Hand Therapy. Vol. 21(3) 85–89.

Juneja, H., Verma, S. K. & Khanna, G.L. (2010). Isometric Strength and Its Relationship to Dynamic Performance: A Systematic Review, Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 60-69.

Karakoc, O., (2016). The investigation of physical performance status of visually and hearing impaired applying judo training program, Journal of Education and Training Studies. Vol. 4, 10-17.

Kocić, M., Berić, D. & Stevanović, M. (2016). Efficiency of ball manipulation in basketball players, Facta Universitatis. Vol. 14, No 1, pp. 23–30.

Kokkonen, J., Nelson, A. G., Eldredge, C. & Winchester, J. B. (2007). Chronic static stretching ımproves exercise performance, Med Sci Sports Exerc. Oct;39(10):1825-31.

Kolber, M.J., Beekhuizen, K.S., Cheng, M.S. & Hellman, M.A. (2010). Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res. 24: 1696–1704.

Krause J.V., Meyer D., Meyer J. (1999). Basketball Skills & Drills, Ballhandling, United Kingdom, Human Kinetics, Versa Press, Second Edition, Chapter 3, p:35-55.

MacDonncha, C., Watson, A.S., McSweeney, T. & O’Donovan, D. (1999). Reliability of eurofit physical items for adolescent males with and without mental retardation. Adapted Physical Activity Quarterly. 16 pp. 86–95.

Mayda, M. H., Karakoc, O., & Özdal, M. (2016). The Investigation of Some Physical, Physiological and Anthropometric Parameters of Visually Impaired and Non-impaired a National Male Judoka. Journal of Education and Training Studies, 4(6), 192-198.

Mclntosh, G., Wilson, L., Affleck, M. & Hall H. (1998). Trunk and lower extremity muscle endurance: normative data for adults. J. Rehabil Outcomes Meas. 2 (4), 20-39.

Mendonca, G. V., Pereira, F. D. & Fernhall, B. (2010). Reduced exercise capacity in persons with Down syndrome: cause, effect, and management, Ther Clin Risk Manag.; 6: 601–610. doi: 10.2147/TCRM.S10235.

Milliken, L.A., Faigenbaum, A.D., Loud, R.L. & Westcott, W.L. (2008). Correlates of upper and lower body muscular strength in children. J Strength Cond Res. 22(4):1339–46, http://

Monfort, S.M., Comstock, R.D., Collins, C.L., Onate, J.A., Best, T.M. & Chaudhari A.M. (2015). Association between ball-handling versus defending actions and acute noncontact lower extremity injuries in high school basketball and soccer. Am J Sports Med. Apr;43(4):802-7. doi: 10.1177/0363546514564541.

Multani, N.K., Bhawna, V. & Amandeep, S. (2013). Level of physical fitness among physiotherapy students. A study of Punjab and Haryana. World Appl Sci J. 21(8):1136–40., DOI: 10.5829/idosi.wasj.2013.21.8.1839.

Oxyzoglou, N., Kanioglou, A., Rizos, S., Mavridis, G. & Kabitsis, C. (2007). Muscular strength and jumping performance after handball training versus physical education program for pre-adolescent children. Percept Mot Skills. Jun;104(3 Pt 2):1282-8.

Özdal, M. (2016). Effect of core training on inspiratory muscle strength in well-trained men. Journal of Biology of Exercise, 12(1), 23-32.

Özdal, M. (2016). Influence of an eight-week core strength training program on respiratory muscle fatigue following incremental exercise. Isokinetics and Exercise Science, 24(3), 225-230.

Phadke, V., Camargo, P. & Ludewig, P. (2009). Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement. Rev Bras Fisioter. Feb 1;13(1):1-9.

Pitetti, K.H., Climstein, M., Mays, M.J.& Barrett, P.J. (1992). Isokinetic arm and leg strength of adults with Down syndrome: a comparative study. Arch Phys Med Rehabil. Sep;73(9):847-50.

Priosti, P. A., Blascovi-Assis, S. M., Cymrot, R., Vianna, D. L. & Caromano, F. A. (2013). Grip strength and manual dexterity in Down Syndrome children, Fisioter Pesq. 20(3):278-285.

Rosety-Rodriguez, M., Camacho, A., Rosety, I., Fornieles, G., Rosety, M.A., Diaz, A.J., Rosety, M. & Ordonez, F.J. (2013). Resistance circuit training reduced inflammatory cytokines in a cohort of male adults with Down syndrome Med Sci Monit. 19: 949–953.doi: 10.12659/MSM.889362.

Rubini, E. C., Costa, A.L.L. & Gomes, P. S.C. (2007). The Effects of Stretching on Strength Performance, Sports Med. 37 (3): 213-224, 0112-1642/07/0003-0213/$44.95/0.

Salaun, L. & Berthouze-Aranda, S.E. (2012). Physical fitness and fatness in adolescents with intellectual disabilities, Journal of Applied Research in Intellectual Disabilities. 25: 231–239.

Sharav, T. & Bowman, T. (1992). Dietary, physical activity, and body-mass index in a selected population of Down syndrome children and their sibling GC. Clin Pediatr. 31(6):341-4.

Shields, N. & Taylor, N.F. (2010). A student-led progressive resistance training program increases lower limb muscle strength in adolescents with Down syndrome: a randomised controlled trial. J Physiother. 56:187-93.

Shields, N., Taylor, N.F. & Dodd, K.J. (2008). Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 89:1215-20.

Shields, N., Taylor, N.F., Wee, E., Wollersheim, D., O'Shea, S.D. & Fernhall, B. A. (2013). Community-based strength training programme increases muscle strength and physical activity in young people with Down syndrome: a randomised controlled trial. Res Dev Disabil. Dec;34(12):4385-94. doi: 10.1016/j.ridd.2013.09.022. Epub Oct 11.

Souza, A., Cynrot, R., Vianna, D., Caromano, F.A. & Blascovi-Assis, S.M. (2012). Síndrome de Down: correlação entre o desempenho funcional com a força de preensão palmar e a destreza manual. Fisioterapia Brasil. 13: 223-27.

Stauber, W.T., Miller, G.R., Grimmett, J.G. & Knack, K.K. (1994). Adaptation of rat soleus muscles to 4 wk of intermittent strain. J. Appl. Physiol. 77:58–62.

Tsimaras, V.K. & Fotiadou, E.G. (2004). Effect of training on the muscle strength and dynamic balance ability of adults with Down syndrome. J Strength Cond Res;18: 343-7.

Wang, W. Y., & Ju, Y.H. (2002). Promoting balance and jumping skills in children with Down syndrome. Perceptual and Motor Skills. 94(2),443–448.

Worrell, T.W., Smith, T.L. & Winegardner J. (1994). Effect Of Hamstring Stretching On Hamstring Muscle Performance. J. Orthop. Sports Phys. Ther. 20: 154–159.

Zeller, S., Abel, T., Rojas-Vega, S., Foitschik, T. & Strueder H.K. (2015). Brain-derived neurotrophic factor concentrations in tetraplegic athletes. Spinal Cord. 53, 791–794.


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