Development of Assessment Standards for Health-Related … · Development of Assessment Standards...

Passing from Freedom to Happiness • 351

| Oral Presentation |

Development of Assessment Standards for Health-Related

Physical Fitness in Persons with Intellectual Disability

Min Kyu HAN (Korea National Sport University)

Won Kyung KIM (Korea National Sport University)

Dae Yeon KIM (Kookmin University)

Oral Presentation - 2.3.1

Ⅰ. Introduction

1. The signifi cance of the study

1) The needs of the studyObesity is a risky factor having negative effects on cardiac diseases, type 2 diabetes mellitus, and cancer, and was

reported to show higher prevalence rate in person with disability than person without disability(Hu et al., 2005). In case

of adult above 18 years old, morbidly obese which BMI is over 30 appeared to be 16.5% in person without disability,

while it appeared to be 27.4% which was higher 1.7 times than that in person with disability(CDC; Centers for

Disease Control and Prevention, 2002). In addition, obesity appeared to be higher in person with intellectual disability

among several types of disabilities(Son, Sang-Hyeon, Lee, In-Kyeong, 2007). With this reason, persons with intellectual

disability didn’t properly harmonize thinking with movement, so that they felt strong desire to eat in state of lacking

of activity(Pitetti, Yarmer, & Fernhall, 2001), and also due to the lack of social and practical adaptive behavior, they not

only had low interests in integral class including physical education but also their activity level appeared to be lower

than people without disability. Consequently, it was revealed that this phenomenon caused the lack of basic motor skill,

and fi nally brought about the lack of spontaneous physical activity(Jeon, Jong-Gwui et al., 2004).

Physical strength is divided into the health fitness and the physical fitness. Factors of health fitness includes

cardiorespiratory endurance, muscle strength, muscle endurance, fl exibility, and body composition, whereas factors of

physical fi tness includes burst power, agility, equilibrium, coordination, power, speed(Harris, 2001). Special Fitness Test

was developed as a physical measurement tool for people aging between 8-18 years old by Alliance for Health, Physical

Education, Recreation and Dance(AAHPERD) with the support of Kennedy Foundation in 1968, which was remodeled

as tool for Motor Fitness Test for children with intellectual disability by AAHPERD in 1976. And Physical Best and

Individuals with Disabilities including physical fi tness test for children with disability was developed in 1995(Han, Min-

Gyou, Kang, Sang-Jo, 2008).

In case of Korea, various physical fi tness testing tools for people without disability has been developed and used.

Recently, Physical Activity Promotion System(PAPS) which is a customized tool for each student has been implemented

in nationwide to evaluate student’s physical strength. However, actually and unfortunately, current physical measuring

tools for person with disability were developed only for certain types of disabilities not for all type of disabilities.

352 • The 20th Asian Conference on Intellectual Disabilities


Accordingly, the development of PAPS for person with disability will be required taking into consideration of various

types of disabilities and its grade(Kim, Dong-Man, 2010).

The assessment for the performance level of physical fitness test is divided into norm-referenced standards and

criterion-referenced standards. In Norm-referenced standards, the relative rank of individual score or measured value

are decided based on standards of comparison group and this standard has been popular to set standards of various

test tools. If the assessment standards for health fi tness will be set, they will have good effect on not only the health

promotion but also the performance enhancement(Han, Min-Kyou, Kang, Sang-Jo, 2008). In the other hands, the

criterion-referenced standards is a measuring method to diagnose how much testees know characteristics to be

measured compared to absolute criterion or how much they can do. The studies on the setting of criterion-referenced

standards in physical fi tness test was initiated by Pate’s study(1933) and then Fit Youth Today was developed by the

association of Health Fitness in America in 1986, and FITNESSGRAM by Aerobic Institutes in 1987, and Physical Best

Program by AAHPERD in 1988. As the necessity for the physical fi tness test based on absolute ratings has been raised

in Korea, studies on the setting and of criterion-referenced standards and its validity were performed(Kang, Sang-Jo,

1997), and for PAPS, criteria of baseline health status which are minimum standards for student’s health fi tness were

set(Kim, Mi-Ye et al., 2008).

By setting standards and criteria of Health Fitness or baseline health status, individual current health fi tness level can

be assessed and the Fitness Enhancement Program can be developed too. However, unfortunately, most of studies

on Physical strength for people with intellectual disability so far were to verify the fi tness promotion effects on certain

specifi c exercises(Kim, Eun-Soon, 2003). The study to set norm-referenced standards and criterion-referenced standards

was performed by Kim, Dong-Man(2010), and standards for physical fi tness test and motor function examination for

student with intellectual disability in elementary, middle, and high school were developed by Kang, Sang-Jo(2008).

But there were no studies to suggest standards for health fi tness for people with intellectual disability so far. Thus, as

items developed for people without disability continued to be applied as it is to the health fi tness evaluation for people

with intellectual disability or foreign testing tools which have not clear standards were being used as it is, the reliability

and validity on the measured value were being questioned. Accordingly, standards for exact health fi tness evaluation

suitable for Korean people with intellectual disability should be urgently set.

2) The purpose of the studyThe purposes of this study are (ⅰ) to set testing items for the measurement of health fitness of people with

intellectual disability, (ⅱ) to develop norm-referenced standards and criterion-referenced standards by each testing

item, and (ⅲ) to suggest conformity ratio versus minimum health standards which is a criterion-referenced standards

for people without disability.



Ⅱ. Methods

1. Subjects

To develop norm-referenced standards and criterion-referenced standards for health fitness and to calculate non-

conformity rate of people with intellectual disability versus minimum health standards of people without disability, total

795 people with intellectual disability were selected by cluster random sampling considering ages and gender in Seoul

and Gyeonggi province. The number of sample according to concrete ages and gender is shown in <Table Ⅱ. 1>.

2. Measuring items and tools

To select health fi tness measuring items suitable for people with intellectual disability, the Delphi technique which

integrated expert’s opinions was used. At this time, experts include 2 professors in special physical education, 2 fi eld

instructors having more than 5 years experience, and 2 professors in rehabilitation. As a result, measuring items were

selected as below: grasping power was selected for muscle strength, sit-ups for muscle endurance, standing trunk

fl exion for fl exibility, PEI(Physical Effi cient Index) through Harvard step test for cardiorespiratory endurance, and body fat

scale using skin folder, BMI(Body Mass Index), and WHR(Waist-Hip Ratio) for body composition.

3. Data treatment

1) Norm-referenced standardsTo set standards of health fitness of people with intellectual disability, norm-referenced standards and criterion-

referenced standards were set. Norm-referenced standards was set using the 5 steps percent method in which ratings

were classifi ed according to rate which was shown in <Table Ⅱ. 2>. Mean and Standard deviation(SD) on each variables

was calculated using SPSS program and independent t-test, one-way ANOVA and Post-Hoc test were performed to

verify each hypothesis. At this time, the signifi cance level �� was set to be .05 (��=.05).

<Table Ⅱ. 1> Participants of development of assessment standards for health-related physical fi tness

<Table Ⅱ. 2> Applied degree ratio of norm-referenced assessment standards



2) Criterion-referenced standardsMinimum health standard of people without disability was applied to criterion-referenced standards by each item for

health fi tness of people with intellectual disability <Table �. 3>. At this time, health fi tness criterion which was suggested

in national fi tness survey in 2007 and 2009(student’s percentile score is below 40, adults and the elder’s percentile

score is below 30) and minimum health standards in PAPS were chosen as standards. The reason why we referred to 3

criteria was because items in each criterion were different. In other words, national fi tness survey in 2009 which was

the latest criterion did not provide student’s health fi tness criterion, so we referred to national fi tness survey in 2007 to

get student’s health fi tness criterion. Furthermore, to get PEI index criterion which was not included in national fi tness

survey, we referred to PAPS.

<Table Ⅱ. 3> Evidence of criterion-referenced assessment standards for health-related physical fi tness in persons with

intellectual disabilities

Sources : National fi tness survey(Ministry of Culture and Tourism, 2007 & 2009), PAPS(Physical Activity Promotion System, 2009)



Ⅲ. Results and Discussion

The purpose of this study was to verify differences of muscle strength, muscle endurance, flexibility, cardiorespiratory

endurance, and body fat scale by gender and ages and then set standards by factors in health fi tness which were obtained

from these tests to suggest standards by rates for the health fi tness evaluation. Subjects of this study were 795 people with

intellectual disability and the descriptive statistics result by factors in health fi tness was shown in <Table Ⅲ. 1>.

As a result of the test of the difference of health fitness by factors and gender in <Table Ⅲ. 2>, All factors except

cardiorespiratory endurance appeared to have statistically signifi cant difference.

<Table Ⅲ. 1> Descriptive values of health-related physical fi tness by measure items

<Table Ⅲ. 2> Difference analysis of health-related physical fi tness by test items and gender

*** p<.001



As a result of the test of difference of heath fi tness by factors and ages in<Table Ⅲ. 3>, muscle strength and fl exibility

was not appeared to have statistically signifi cant difference, whereas cardiorespiratory endurance, muscle endurance,

and body fat score appeared to have statistically signifi cant difference.

Extended Angoff Method(Hambleton & Plake, 1995) was applied to set standards. Angoff method is to judge the

performance level which is expected to be accomplished by participant who has a minimum ability through the

repetitive round by panel which is composed of experts group. Norm-referenced standards except body fat score in

physical fi tness test items for the health fi tness evaluation by gender and ages of people with intellectual disability were

suggested in <Table Ⅲ. 4> and <Table Ⅲ. 5>.

*** p<.001, ** p<.01, * p<.05

<Table Ⅲ. 3> Difference analysis of health-related physical fi tness by test items and age group



<Table Ⅲ. 4> Norm-referenced assessment standards by gender



<Table Ⅲ. 5> Norm-referenced assessment standards by age group



3. Criterion-referenced standards for health fi tness of people with intellectual disability

<Table Ⅲ. 6> and <Table Ⅲ. 7> show minimum health standards which is criterion-referenced standards of male and

female with intellectual disability as well as the non-conformity rate versus standards respectively.

<Table Ⅲ. 6> Incongruity judgement ratio for minimum health standards in persons with intellectual disabilities(male)



<Table Ⅲ. 7> Incongruity judgement ratio for minimum health standards in persons with intellectual disabilities(female)

PEI(Physical Effi ciency Index), BMI(Body Mass Index)



Ⅳ. Conclusion and Suggestion

Health fitness norm-referenced standards of muscle strength, flexibility, muscle endurance, and cardiorespiratory

endurance by gender and ages were suggested in this study. In addition, non-conformity ratio of people with

intellectual disability to minimum health standards based on criterion-referenced standards of people without disability

was calculated. Research problems and conclusion suggested in this study were as below:

First, health fitness testing items were selected taking into consideration of physical and mental characteristics of

people with intellectual disability, and its testing method was discerned. Health fi tness testing items for people with

intellectual disability were decided after reviewing the necessity and the availability of health fi tness through the analysis

of domestic and abroad literature and Delphi method based on experts’ opinion.

Second, health fi tness norm-referenced standards for people with intellectual disability were developed. As a result

of health fi tness test for people with intellectual disability, norm-referenced standards for muscle strength, fl exibility,

cardiorespiratory endurance, and muscle endurance were developed by gender and ages using 5 steps percent method.

Third, health fi tness criterion-referenced standards for people with intellectual disability were developed. Because of

the result from the expert group meeting that there is no other special reason that health fi tness value of people with

disability or criterion–referenced standards to minimum health standards will be different in judging people without

disability and health conditions, national fi tness survey and student fi tness evaluation system data which were set for

people without disability were used. In addition to these, non-conformity rate for minimum health standards on each

health fi tness item was calculated.

In this study, health fi tness items for people with intellectual disability were composed and the concrete contents of

analysis on the setting of standardized standards which can be easily utilized on-site were described. Based on results

of this study, suggestions related to norms-referenced standards and criterion-referenced standards by gender and ages

for the health fi tness evaluation for people with intellectual disability as well as non-conformity rate for minimum health

standards were as below:

First, standardization research to raise the reliability of physical fitness test standards for people with intellectual

disability should be continuously performed. And the improvement of health fi tness should be accomplished through

the subdivision and the setting of standards based on disorder grades and the customized application according to

gender and ages as well as disorder grades.

Second, the study on validation of test which was developed as standards for health fi tness evaluation should be

performed. To overcome differences in expertise between inspectors, not only actual test methods should be informed

in detail but also the study to verify the concordance of various test results between inspectors should be followed up.

Third, due to the lack of cognitive ability which is a characteristic of people with intellectual disability, it is really diffi cult

to make exact measurement. Therefore, in follow-up study, in order to get exact measurement, some items related

to health fi tness measurement should be exercised 2-3 times in advance by testee, so that data which can reduce the

missing value and enhance reliability should be obtained.



References

Kang, S-J. (1997). Development of physical fi tness and motor function tests in persons with intellectual disabilities.

Korea Disabled Welfare Sports Association. Seoul: Yuyeong Publishing.

Kim, D-M. (2010). Development of norm criterion standards for health-related physical fi tness assessment for persons

with spinal cord injury. PhD thesis, Korea National Sport University.

Kim, M-Y., Kim, Y-Y., Cho, Y-I., & O, S-H. (2008). Setting criterion for the fi tness test in physical activity promotion

system. Korean Society for Measurement and Evaluation in Physical Education and Sports Science, 10(1), 59-68.

Kim, E-S. (2003). Effects of aqua exercise program on the improvement of static balance in children with mental

retardation. Master thesis, Daegu University.

Ministry of Culture Sports and Tourism (2007). 2007 National Physical Fitness Survey. Seoul: Ministry of Culture Sports

and Tourism.

Ministry of Culture Sports and Tourism (2009). 2009 National Physical Fitness Survey. Seoul: Ministry of Culture Sports

and Tourism.

Ministry of Health & Walfare (2008). 2008 Survey on disabled. Seoul: Ministry of Health & Walfare.

Son, S-H. & Lee, I-K. (2007). The effects of climbing as after-school activity on the body composition of obesity

students with mental retardation. Journal of Adapted Physical Activity, 15(2), 71-95.

Jun, J. K., Yeoum, D. S., Cho, B. J., Lee, S. K., Park, H. G., Han, D. S., & Jang, H. Y. (2004). Effects of combined

exercise program for 20 weeks on the body composition and physical fi tness of adults with mental retardation. Journal

of Adapted Physical Activity, 12(4), 55-62.

Han, M-K. & Kang, S-J. (2008). Norm-standard of physical fi tness test for persons with disabilities. Korean Society for

Measurement and Evaluation in Physical Education and Sports Science, 10(1), 82-92.

Study of PAPS building system (2007). Incheon Metropolitan City Offi ce of Education.

American Association on Intellectual and Developmental Disabilities (1976). Special Fitness Test Manual for Mildly

Retarded Persons. Washington, DC.

American Alliance for Health, Physical Education, Recreation and Dance (1980). AAHPERD Health-related physical

fi tness test manual, Reson, Va.: AAHPERD.

Blair, S. N. & Kohl, H. W. (1990). Physical fi tness and all-cause mortality. A prospective study of healthy men. Journal of

the American Medical Association, 262, 2395-2401.



Centers for Disease Control and Prevention (2002). State-specifi c prevalence of obesity among adults with disabilities-

eight states and the district of Columbia. Morbidity and Mortality Weekly Report. 51(33), 805-808.

Fox, R., Rotatiori, A., F., & Burkhart, J. E. (1983). Obesity in mentally retarded and nonretarded populations: assessment

issues. Advances in Mental Retardation and Developmental Disabilities, 1, 125-175.

Freedson, P. S. & Rowland, T. W. (1992). Youth activity versus youth fitness: let's redirect our efforts. Research

Quarterly for Exercise and Sport, 63(2), 133-136.

Frey, G. C. & Chow, B. (2006). Relationship between BMI, physical fitness, and motor skills in youth with mild

intellectual disabilities. International Journal of Obesity, 30, 861-867.

Harris, J. (2001). Health-related exercise in national curriculum. Champaign, IL, Human Kinetics.

Hu, G., Tuomilehto, J., Silventoinen, K., Barengo, N. C., Peltonen, M., & Jousilahti, P. (2005). The effects of physical

activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men

and women. International Journal of Obesity, 29, 894-902.

Jackson, A. S. & Coleman, A. E. (1976). Validation of distance run tests for elementary school children, Research

Quarterly, 47, 86-94.

Paffenbarger, R. S. Jr., Wing, A. L., & Hyde, R. T. (1978). Physical activity as an index of heart attack risk in college

alumni. American Journal of Epidemiology, 108, 161-175.

Pitetti, K. H., Yarmer, D. A., & Fernhall, B. (2001). Cardiovascular fi tness and body composition of youth with and

without mental retardation. Adapted Physical Activity Quarterly, 18, 127-141.

Pollock, J. J., Denepitiya, L., Mackay, B. J., & Iacono, V. (1984). Fungistatic and Fungicidal Activity of Human Parotid

Salivary Histidine-Rich Polypeptides on Candida albicans. Infection and Immunity, 44(3), 702-707.

Sherrill, M. & Renzaglia, A. (1982). Physical fi tness and the mentally retarded: a critical review of the literature. The

Journal of Special Education, 16(3), 269-287.

Siri, W. E. (1956). The gross composition of the body. In J. H. Lawrence & C. A.Tobias(Eds.), Advances in biological and

medical physics(pp. 239-280). New York: Academic Press Inc.

Winnick, J. P. & Short, F. X. (1999). The Brockport physical fi tness training guide. Champaign, IL, Human Kinetics.

World Health Organization (2001). International Classifi cation of Functioning, Disability, and Health. - ICF. Geneva:

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