Measurement protocols and determinants of peak oxygen consumption in adults with Down syndrome: a systematic review.
Published VO2peak values come almost entirely from young overweight men with Down syndrome, so they likely overestimate the true population average.
01Research in Context
What this study did
Andrews et al. (2024) pulled every paper that measured peak oxygen use in adults with Down syndrome. They looked at how each study ran the test and who joined the study.
The team wanted to see if the same treadmill protocol was used each time and whether the volunteers mirrored real-world adults with DS.
What they found
Almost every lab used the same treadmill ramp test. The people in the studies were mostly young, overweight men.
Because the sample leaves out women, lighter adults, and older adults, the average VO2peak likely paints an overly rosy picture of fitness in DS.
How this fits with other research
Seron et al. (2014) said the same thing nine years earlier, but only for kids: most VO2max tests in DS youth were never checked for validity. The new review extends that warning to adults.
Wee et al. (2015) and Shire et al. (2022) ran valid tests and still found very low VO2peak values. Their careful methods sit inside the 2024 review, proving the treadmill protocol can work when paired with DS-specific safety steps.
Bertapelli et al. (2016) and Kovačič et al. (2020) show obesity is common in DS. The review’s biased sample toward heavier males is therefore no accident — yet it still misses the many adults with DS who are female or older.
Why it matters
If you plan exercise programs or write health guidelines, don’t trust published VO2peak norms until you check who was tested. Treat the numbers as an upper bound, not the average. Add familiarization walks, use DS-friendly safety cues, and recruit a mixed sample before you label a client “low fitness” or set workout intensity.
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02At a glance
03Original abstract
This systematic review aimed to provide an overview of test protocols used to measure peak oxygen uptake (VO2peak) in adults with Down syndrome (DS) and to determine how generalisable the outcomes are for the entire population of adults with DS by describing the sample characteristics of these studies and their impact on VO2peak. A literature search (PROSPERO CRD42022309560) was performed (18 July 2023) using the following databases: PubMed, CINAHL, APA PsycINFO, Web of Science, Embase and SPORTDiscus. For articles to be included, they had to be peer-reviewed pubications, reporting VO2peak or VO2max for individuals with DS separately, with a sample of n ≥ 5 and a mean age ≥18 years. Systematic reviews and meta-analyses were excluded but their reference lists were searched for additional papers to include. Studies were evaluated for risk of bias following the guidelines of Kmet et al. The results were summarised with frequency statistics. Forty-three studies were included in this systematic review. Sample sizes of included adults with DS ranged from n = 4-226, with a total of n = 1498 adults with DS being included. Most studies (29/43) used the same standardised maximal exercise treadmill protocol to measure VO2peak in adults with DS, and 33 out of 43 studies used at least one objective criterion to determine a valid maximal effort. Participants were predominantly male, under 40 years old, and overweight or obese. Additionally, the diversity of study samples was lacking or not reported. The most widely used, standardised, maximal exercise test treadmill protocol is recommended for future use in research and practice, including objective criteria to determine valid maximal effort. The current study samples are not representative of the population of adults with DS in terms of sex, age and diverse backgrounds and therefore likely overestimate VO2peak of this population.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13137