{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T04:43:56Z","timestamp":1784349836156,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Alzheimer\u2019s disease is prevalent in persons with Down syndrome (DS) as early as their 30s and presents as decreased social interaction, coordination, and physical activity. Therefore, changing attitudes and beliefs about exercise is key to increasing motivation for physical activity especially in middle-age adults with DS. The aim of this study was to examine the effects of Assisted Cycle Therapy (ACT) on self-efficacy and exercise perception in middle-age adults with Down syndrome (DS) following an exercise intervention three times a week for 8 weeks. Twelve participants were in the ACT group in which a motor assisted their cycling to be performed at least 30% faster than voluntary cycling (VC), 10 participants were in the voluntary cycling group, and two participants were in the no cycling (NC) group. The results showed that both exercise groups (i.e., ACT and VC) improved in their self-efficacy after the 8-week intervention. In addition, exercise perception improved following ACT, but not VC or NC. Our results are discussed with respect to their future implications for exercise in the DS population. The results can be attributed to differences in effort required by each intervention group as well as the neurotrophic factors that occur when muscle contractions create synaptic connections resulting in improvement in cognition and feelings of satisfaction.<\/jats:p>","DOI":"10.3390\/brainsci13121719","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T03:16:33Z","timestamp":1702610193000},"page":"1719","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Assisted Cycle Therapy (ACT) Improved Self-Efficacy and Exercise Perception in Middle-Age Adults with Down Syndrome"],"prefix":"10.3390","volume":"13","author":[{"given":"Shannon D. R.","family":"Ringenbach","sequence":"first","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel E.","family":"Arnold","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kori","family":"Tucker","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miya K.","family":"Rand","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5124-0384","authenticated-orcid":false,"given":"Breanna E.","family":"Studenka","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stockton B.","family":"Ringenbach","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6963-3795","authenticated-orcid":false,"given":"Chih-Chia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,15]]},"reference":[{"key":"ref_1","first-page":"33","article-title":"Influence of long-term training on submaximal and peak aerobic capacity and locomotor economy in adult males with Down\u2019s syndrome","volume":"15","author":"Mendoca","year":"2009","journal-title":"Med. Sci. Monit."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ridd.2014.10.002","article-title":"Impact of obesity and Down syndrome on peak heart rate and aerobic capacity in youth and adults","volume":"36","author":"Wee","year":"2015","journal-title":"Res. Dev. Disabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1097\/00005768-200110000-00007","article-title":"Prediction of maximal heart rate in individuals with mental retardation","volume":"33","author":"Fernhall","year":"2001","journal-title":"Med. Sci. Sports Exer."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1001\/archpedi.154.4.408","article-title":"Clinical and cardiorespiratory assessment in children with Down syndrome without congenital heart disease","volume":"4","author":"Pastore","year":"2000","journal-title":"Arch. Ped. Adol. Med."},{"key":"ref_5","unstructured":"McGuire, D., and Chicoine, B. (2006). Mental Wellness in Adults with Down Syndrome: A Guide to Emotional and Behavioral Strengths and Challenges, Woodbine House Publishing."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1352\/0047-6765(2003)041<0007:ABACFO>2.0.CO;2","article-title":"Adaptive behavior and cognitive function of adults with Down syndrome: Modeling change with age","volume":"41","author":"Hawkins","year":"2003","journal-title":"Ment. Retard."},{"key":"ref_7","unstructured":"U.S Department of Health and Human Services (2023, October 30). 2008 Physical Activity Guidelines for Americans, Available online: http:\/\/health.gov\/paguidelines\/pdf\/paguide.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3104\/reports.1996","article-title":"Parents\u2019 perceptions of health and physical activity needs of children with Down syndrome","volume":"12","author":"Menear","year":"2007","journal-title":"Down Syndr. Res. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.5694\/j.1326-5377.2000.tb139397.x","article-title":"What proportion of Australian children are sufficiently physically active? Recommendations for nutrition and physical activity for Australian children","volume":"173","author":"Booth","year":"2000","journal-title":"Med. J. Aust."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jsams.2006.06.008","article-title":"Compliance with the Australian national physical activity guidelines for children; relationship to over-weight status","volume":"10","author":"Spinks","year":"2007","journal-title":"J. Sci. Med. Sports"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1139\/H10-079","article-title":"Physiological and health implications of a sedentary lifestyle","volume":"35","author":"Tremblay","year":"2010","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1192\/bjp.172.6.493","article-title":"Population-Based Study of the Prevalence and Presentation of Dementia in Adults with Down\u2019s Syndrome","volume":"172","author":"Holland","year":"1998","journal-title":"Br. J. Psych."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1002\/ana.410170310","article-title":"Occurrence of neuropathological changes and dementia of Alzheimer\u2019s disease in Down\u2019s syndrome","volume":"17","author":"Wisniewsky","year":"1985","journal-title":"Ann. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1352\/0895-8017(2004)109<175:AAPOOA>2.0.CO;2","article-title":"Attitudinal and psychosocial outcomes of a fitness and health education program on adults with Down syndrome","volume":"109","author":"Heller","year":"2004","journal-title":"Am. J. Ment. Retard."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/0749-5978(91)90022-L","article-title":"Social cognitive theory of self-regulation","volume":"50","author":"Bandura","year":"1991","journal-title":"Organ. Behav. Hum. Decis. Process."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1123\/jsep.18.3.264","article-title":"Motivation in physical activity contexts: The relationship of perceived motivational climate to intrinsic motivation and self-efficacy","volume":"18","author":"Kavussanu","year":"1996","journal-title":"J. Sport Exerc. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1123\/jsep.20.1.1","article-title":"Relationship between self-efficacy, exercise intensity, and feeling states in a sedentary population during and following an acute bout of exercise","volume":"20","author":"Treasure","year":"1998","journal-title":"J. Sport Exerc. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1080\/02701367.2010.10599683","article-title":"The Influence of Exercise Intensity on Frontal Electroencephalographic Asymmetry and Self-Reported Affect","volume":"81","author":"Woo","year":"2010","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jada.2006.02.011","article-title":"Psychological predictors of physical activity in the diabetes prevention program","volume":"106","author":"Delahanty","year":"2006","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3928\/00989134-20060701-05","article-title":"Exercise self-efficacy in older women with diastolic heart failure: Results of a walking program and education intervention","volume":"32","author":"Gary","year":"2006","journal-title":"J. Gerontol. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2165\/00007256-199111030-00002","article-title":"Meta-analysis on the anxiety reducing effects of acute and chronic exercise","volume":"11","author":"Petruzello","year":"1991","journal-title":"Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1037\/0022-3514.56.3.407","article-title":"Impact of conceptions of ability on self-regulatory mechanisms and complex decision-making","volume":"56","author":"Wood","year":"1989","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_23","unstructured":"Gill, D.L. (1986). Psychological Dynamics of Sport, Human Kinetics."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/JES.0b013e31822cc71a","article-title":"It is not about the bike, it is about the pedaling: Forced exercise and Parkinson\u2019s disease","volume":"39","author":"Alberts","year":"2011","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1002\/jnr.20162","article-title":"Exercise-induced behavioral recovery and neuroplasticity in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-leasioned mouse basal ganglia","volume":"77","author":"Fisher","year":"2004","journal-title":"J. Neurosci. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1123\/japa.19.2.87","article-title":"Changes in executive function after acute bouts of passive cycling in Parkinson\u2019s disease","volume":"19","author":"Ridgel","year":"2011","journal-title":"J. Aging Phys. Act."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1352\/1934-9556-52.2.124","article-title":"Acute bouts of assisted cycling improves cognitive and upper extremity movement functions in adolescents with Down syndrome","volume":"52","author":"Ringenbach","year":"2014","journal-title":"Intellect Dev. Dis."},{"key":"ref_28","unstructured":"Wallace, K.C., and Ringenbach, S.D.R. (2014). Assisted Cycling Therapy Improves Self-efficacy in Adolescents with Down Syndrome. [Undergraduate Honors Thesis, Arizona State University]."},{"key":"ref_29","unstructured":"Heller, A., Marks, B., and Ailey, S.H. (2001). Exercise and Nutrition Education Curriculum for Adults with Developmental Disabilities, University of Illinois at Chicago, Rehabilitation Research and Training Center on Aging and Developmental Disabilities, Department of Disability and Human Development."},{"key":"ref_30","first-page":"366","article-title":"Cardiorespiratory capacity of individuals with mental retardation including Down syndrome","volume":"28","author":"Fernhall","year":"1996","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_31","unstructured":"Liguori, G. (2021). Guidelines for Exercise Testing and Prescription, Wolters Kluwer. [11th ed.]."},{"key":"ref_32","unstructured":"Pandya, S., Ringenbach, S.D.R., and Coon, D. (2016). Assisted Cycling Therapy in Older Adults with Down syndrome and its Effect on Mental Health. [Undergraduate Honors Thesis, Arizona State University]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4278\/0890-1171-22.2.83","article-title":"Exercise and self-esteem in menopausal women: A randomized controlled trial involving walking and yoga","volume":"22","author":"Elavsky","year":"2007","journal-title":"Am. J. Health Promot."},{"key":"ref_34","first-page":"268","article-title":"Physical Activity, Self-Efficacy, and Self-Esteem: Longitudinal Relationships in Older Adults","volume":"60","author":"McAuley","year":"2005","journal-title":"J. Gerontol. Ser. B Psychol. Sci. Soc. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1177\/1090198114543004","article-title":"How Are Previous Physical Activity and Self-Efficacy Related to Future Physical Activity and Self-Efficacy?","volume":"41","author":"David","year":"2014","journal-title":"Health Ed. Behav."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S0006-3223(01)01328-2","article-title":"Anxiety and affective style: Role of prefrontal cortex and amygdala","volume":"51","author":"Davidson","year":"2002","journal-title":"Biol. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/j.1559-1816.1992.tb01542.x","article-title":"Self-efficacy relationships with affective and exertion responses to exercise","volume":"22","author":"McAuley","year":"1992","journal-title":"J. Appl. Soc. Psychol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1007\/s10875-017-0472-9","article-title":"L Exercise Perception and Behaviors in Individuals Living with Primary Immunodeficiency Disease","volume":"38","author":"Sowers","year":"2018","journal-title":"J. Clin. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1027\/0269-8803.23.3.135","article-title":"The relationship between frontal brain asymmetry and exercise addiction","volume":"23","author":"Gapin","year":"2009","journal-title":"J. Psychophysiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1123\/jsep.31.6.706","article-title":"Affect, exercise, and physical activity among healthy adolescents","volume":"31","author":"Schneider","year":"2009","journal-title":"J. Sport Exerc. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1179\/2047387714Y.0000000055","article-title":"Examining the Davidson\u2019s Model via an exercise variable in individuals with intellectual disabilities","volume":"62","author":"Chen","year":"2016","journal-title":"Int. J. Dev. Disabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1123\/pes.16.2.126","article-title":"Determination of ventilatory threshold in adolescents with mental retardation, with and without Down syndrome","volume":"16","author":"Baynard","year":"2004","journal-title":"Pediatr. Exerc. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/j.1365-2788.2011.01425.x","article-title":"Identifying the barriers and facilitators to participation in physical activity for children with Down syndrome","volume":"55","author":"Barr","year":"2011","journal-title":"J. Intellect. Disabil. Res."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/12\/1719\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:39:12Z","timestamp":1760132352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/12\/1719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,15]]},"references-count":43,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["brainsci13121719"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13121719","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,15]]}}}