Research in Developmental Disabilities 34 (2013) 695–709

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Research in Developmental Disabilities

The effects of a Special Olympics Unified Sports Soccer trainingprogram on anthropometry, physical fitness and skilledperformance in Special Olympics soccer athletes andnon-disabled partners

Funda Baran a, Abdurrahman Aktop a, Dilara Ozer b, Sibel Nalbant b, Ece Aglamıs a,Sharon Barak c, Yeshayahu Hutzler d,e,*a Akdeniz University, School of Physical Education and Sport, Antalya, Turkeyb Gedik University, Sport Science Faculty, Istanbul, Turkeyc The Edmond and Lily Safra Children’s Hospital, the Chaim Sheba Medical Center, Israeld Zinman College of Physical Education and Sport Sciences, Netanya, Israele Israel Sport Center for the Disabled, Ramat-Gan, Israel

A R T I C L E I N F O

Article history:

Received 13 August 2012

Received in revised form 4 October 2012

Accepted 4 October 2012

Available online 5 November 2012

Keywords:

Inclusion

Intellectual disability

Sport

Motor tests

Exercise

A B S T R A C T

The study investigated the effects of a Special Olympics (SO) Unified Sport (UNS) soccer

program on anthropometry, physical fitness and soccer skills of male youth athletes with

and without intellectual disabilities (ID) who participated in a training group (TRG) and in

a comparison group (CG) without specific training.

Youth with ID (WID) were randomly selected out of all the students between the ages

12 and 15, with a diagnosis of educable mental retardation and no secondary disabilities,

who were attending a special education school. Participants without ID (WoID) were

randomly selected from a regular secondary school out of the same age groups of male

students. All participants were given permission by their parents or guardians to

participate in the study. Participants in the TRG included 23 youth WID and 23 youth

WoID. Mean ages were = 14.1 (SD = 1.1) and 13.2 (SD = 0.79) respectively. Fifteen WID, and

15 WoID comprised the CG. Mean ages were 14.51 (SD = 0.81) and 13.78 (SD = 0.49)

respectively. Prior to and following the program measurements were conducted, and data

were collected on students’ anthropometric and fitness components of the Brockport

physical fitness test as well as a soccer skill performance based on the SO soccer skill test.

Participants in the TRG trained 8 weeks, 1.5 h per session, three times per week, in an after-

school soccer program. CG did not participate in any sports program outside of the school

physical education class.

Dependent t tests and effect size calculations revealed that SO athletes and non-

disabled partners scored significantly higher with regard to physical fitness and football

skills in most variables compared with their CG.

This Unified Program was successful in increasing fitness and soccer skill performance

of youth WID as well as of those WoID.

� 2012 Elsevier Ltd. All rights reserved.

* Corresponding author at: Zinman College of Physical Education and Sport Sciences, Wingate Institute, 42902 Netania, Israel.

E-mail address: shayke@wincol.ac.il (Y. Hutzler).

0891-4222/$ – see front matter � 2012 Elsevier Ltd. All rights reserved.

http://dx.doi.org/10.1016/j.ridd.2012.10.003

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709696

1. Introduction

Compared to the typically developing population, persons with intellectual disability (ID) have been reported to exhibit avariety of health concerns including (a) higher BMI and obesity values (Bell & Bhate, 1992; Frey & Rimmer, 1995; Frey, 2004;Frey, Stanish, & Temple, 2008; Graham & Reid, 2000; Kelly, Rimmer, & Ness, 1986; Pitetti & Campbell, 1991; Rimmer,Braddock, & Fujiura, 1993); (b) lower cardiovascular fitness measured through their maximal oxygen consumption (Fernhall,1993; Fernhall et al., 2001; Fernhall, Tymeson, Millar, & Burkett, 1989), and (c) reduced muscle strength and power (Croce,Pitetti, Horvat, & Miller, 1996; Fernhall & Pitetti, 2000). These health risks appear to increase over the years, particularly aftergraduation from school (Emerson, 2005; Graham & Reid, 2000; Lahtinen, Rintala, & Malin, 2007). However, in contrast to theflourishing research on exercise programs for adults with ID (see reviews in Andriolo, El Dib, Ramos, Atallah, & da Silva, 2010;Dodd & Shields, 2005; Heller, McCubbin, Drum, & Peterson, 2011), very few studies have involved youth with ID. One pilotprogram was conducted in a community based setting for a period of 8 weeks with a group of 18 adolescents, predominantlywith ID and autism. The participants significantly improved their performance in curl-up, but not in other measures of thePresidential Fitness Test (Oriel, George, & Blatt, 2008). Another study in the USA examined the impact of a peer-guidedYMCA-based exercise program lasting 15 weeks, for twice a week, on fitness and body composition of participants (Stanish &Temple, 2012), and one study in Turkey studied the impact of an inclusion school-based program on fitness of children withmental challenges (Berktas et al., 2011). There is a need for collecting further data to evidence the impact of sport activityprograms on fitness and skill performance on adolescents with ID. Special Olympics (SO) Unified Sport (UNS) is a year-roundactivity in a variety of competitive and recreational sports, which includes mixed groups of SO athletes and non disabledpartners at a ratio of 50–60% athletes and 50–40% partners (Dowling, McCornik, & Hassan, 2009; Siperstein & Hardman,2001). UNS is intended to provide children with and without ID continuing opportunities to develop physical fitness, skillsand friendship with other SO athletes, their partners and the community (Special Olympics International, 2003). With theEuropean Union and commercial enterprises as partners, SO Europe launched the Youth Unified Sports Development Projectwith UNS basketball and soccer programs for young people between the ages of 12–25 years, resulting in 2837 new youngpeople joining the program, with 251 Unified soccer and basketball teams spread through 113 communities in 10 Europeancountries (Special Olympics Europe/Euroasia, 2012).

Research conducted on UNS athletes and partners has mostly dealt with psycho-social aspects of the athletes with ID (Baranet al., 2012; Castagno, 2001; Dowling et al., 2009; Gencoz, 1997; Gibbons & Bushakra, 1989; Riggen & Ulrich, 1993; Rosegard,Pegg, & Compton, 2001; Wright & Cowden, 1986). In addition, Riggen and Ulrich (1993) also reported on the progress inbasketball skills achieved over a period of 8 weeks. Another integrated environment for athletes with ID was investigated byNinot, Bilard, Delignieres, and Sokolowski (2000) where groups of athletes with ID were integrated in an interscholasticcompetition program and tracked for a period of 8 months. Their research indicated that basketball and aquatic sports skillsimproved for individuals who participated in Integrated Scholastic Sport (ISS) similar to those who participated in a non-integrated program. Yet no information is available comparing the fitness or skill outcomes of athletes and partners in the sameenvironment. This aspect of integrated sport training and competition is of particular interest, because many practitionerswould argue that the integrated participation environment is less effective for the non-disabled partners than a regular sportenvironment (Aufsesser, 1991; Block & Zeman, 1996; Lavay & DePaepe, 1987; Walker & Bullis, 1991).

Therefore, the purpose of the present study was to examine the effect of participation in a UNS soccer training program onfitness and skilled performance compared to the fitness and skilled performance of a control group in soccer for youth withand without intellectual disability. Since soccer is the most popular sport activity worldwide, it is believed that outcomes ofsuch a study may provide important conclusions for the target group of participants with ID and their partners.

2. Method

A randomized comparative intervention design was incorporated in this study, across two types of population (with andwithout ID) who were matched and selected in equal numbers into a training group (TRG) and a comparison group (CG).

2.1. Participants

Participants were recruited from a regional special education school and a secondary school from a large urbancommunity in Turkey. Inclusion criteria for participants with and without ID were: (a) age between 12 and 15, and (b) male,Exclusion criteria were: (a) health problems preventing the youth from participation in sports training, (b) having asecondary disability such as physical or visual impairment, psychiatric diseases, brain injury, or Down Syndrome, and (c)having been previously trained in soccer, that is answering ‘‘yes’’ to the question ‘‘Did you participate in any soccer programbefore?’’. The total number of participants recruited to this study was 46 with ID and 30 without ID. The disability diagnosiswas acquired from special school records, which did not provide the intelligence quotient (IQ). However, all SO athletes andtheir comparison group were reported as having an educable mental retardation, which corresponds to mild ID of an IQ of 50and above. All participants regularly attended physical education lessons twice a week for 45 min at their schools.

Randomization was employed 1 week before the study in the participating special and regular schools, using a computergenerated table of random numbers by a person without any knowledge about the study and its purpose. Half of theparticipants with ID (ID) and without ID (WoID) were allocated into each of the TRG, which included participation in an UNS

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709 697

program as athletes and partners, and the other half as a the CG. One UNS athlete did not follow the training program afterthe third week. Four youth with ID in the CG dropped-out of the study after randomization. Five children with ID in the CGdid not complete the post tests. Therefore, in the final sample 23 participants (mean age = 14.46; SD = 1.19 years) formed theID-TRG, and 15 participants (mean age = 14.51; SD = 0.81 years) formed the ID-CG.

Forty-eight youth without ID were initially selected out of 200 students attending classes in the 7th and 8th grades in theregular school, and half of them were allocated into each of the UNS Partners and their control group. However, one boy ofthe Partners did not attend the training program after the third week. Six boys in the CG left the study after randomization.Three boys in the CG did not complete the post tests. Therefore, 23 youth without disability (mean age = 13.22; SD = 0.79years) were allocated to the training group as Partners (WoID-TRG) and 15 youth without disability (mean age = 13.78;SD = 0.49 years) were allocated to the control group (WoID-CG).

2.2. Instruments

2.2.1. Brockport physical fitness test

Fitness was measured in this study by means of test items recommended in the Brockport physical fitness test manual (BPFT;Winnick & Short, 1999), which was developed for use with female and male youth ages 10–17 with intellectual disability, visualimpairments, and orthopedic impairments, but may also be used with youth without disabilities. Test items of BPFT werebelieved to have a good validity and reliability for assessing physical fitness of children with and without ID (Winnick & Short,1999). BPFT test items were previously used for reporting the effect of a physical activity program (Kozub, 2003), anddemonstrated significant differences between matched groups with and without ID (Zahng, Piwowar, & Reilly, 2006). Onlythose test items that were relevant to the program content of this study were selected, including body composition, flexibility,and strength. Inter-rater reliability scores during these measurements were obtained, and exhibited satisfactory values. Forexample, the proportion of agreement for the trunk lift was p = .89, and the correlation between skinfold assessments R = .95.Data were collected before and after the program on the following variables: height, measured in cm, weight, measured in kg,and BMI, calculated from the measured height and body weight. Skinfolds were measured as the sum of triceps, subscapula,suprailiac, and biceps in cm: flexibility was measured by the distance obtained in the sit-and-reach item in cm; standing longjump (SLJ) was measured by the distance covered in cm; hand grip was measured in kg; sit-ups and trunk lifts were measured bythe number of repetitions performed; and flexed arm hang was measured by the total elapsed time in seconds.

2.2.2. Football Sports Skills Assessment

The Football Athletes Skills Assessment (FASA; Special Olympics Football Coaching Guide, 2002) has been used by SOInternational throughout the last decade for divisioning purposes during competition. It includes three individual (IS) andthree team (TS) football skills. IS is comprised of dribbling, shooting, and run and kick. TS is comprised of dribbling slalom,control and pass, and shooting. All skill variables were measured by point scores converted from time taken for completingthe task (IS Dribbling, run and kick), or successes in goal scoring, cone or gate crossing, and ball passes (IS and TS shooting,Dribbling, control and pass). Total soccer skill was computed by summing the point scores of the six specific soccer skills.

2.3. Description of the TRG program

The coaches of the TRG were certified, and possessed the necessary experience and qualification for teaching childrenwith ID and for coaching the sport of football. Participants were provided with transportation to the soccer field from theirschools and from the field back to their homes. Participants in the TRG were divided into equal numbers of SO athletes andpartners into four teams; each team was supervised by two coaches. In addition, a head coach directed the entire project.Participants in each group received colored soccer uniforms and accessories. The outline of the TRG program and its contentis presented in Table 1.

The soccer training lasted 8 weeks, comprised of three sessions per week, 90 min each session, as an after school program.Session content followed the general Soccer Skill Instructional Program, and encompassed skill training, soccer rules,sportsmanship, and various team tactics. Sessions started with warm-up exercises, including exercises without the ball suchas stretching, coordination, strengthening, and running, and continued with tactical exercises with the ball and without theball. These exercises and drills lasted 20 min for the first five sessions. The time reserved for warming up gradually decreasedto 10 min as participants improved their skills. After warming up, the participants practiced individual and group soccertechniques, as well as team tactics. After the 8 weeks of training, a soccer tournament lasting 2 weeks was held, with parentsattending as spectators. All attending participants were given first, second, third-, or fourth-place medals, according to theirteam outcomes.

2.4. Procedure

The parents of all youth participating in the study signed written informed consent, and the study was approved by theUniversity Research Ethics Committee. Several meetings were conducted with the parents of the participating childrenbefore the initiation of the UNS program. Verbal and audiovisual information was provided in the meetings with regard tothe content and structure of the UNS program.

Table 1

Outline of the training program.

Preseason

Meeting/individual and team skill evaluation test

Soccer game rules

1st week Soccer techniques without ball

�Running and multi-direction run

�Skipping and jumping techniques

Passing

�Squares up ball, player and target in a straight line

�Makes eye contact with intended receiver

�Follows through in direction of intended receiver kicking foot

�Places kicking foot flat against back of ball

2nd week Shooting

�Approaches ball from side

�Places non kicking foot by side of ball

�Inside/top/outside of foot shooting technique

�Shooting drills

3rd week Dribbling

�Dribbles forward, using the top of foot

�Uses inside of foot to quickly change direction

�Uses outside of foot to shield ball from opponents

�Uses sole of foot to change ball direction

�Dribbles up field with ball while walking and running

4th week Heading

�Heads ball while standing

�Heads ball while jumping

Control-receiving

�Controls ball using inside of foot

�Controls ball using chest

�Controls ball using thigh

�Cushions ball with chest or thigh

5th week Tackling

�Leans upper body into front-block tackle

�Maintains good balance with outstretched leg in side-block tackle

�Tackling drills

Deception and fake

�Deception and fake drills

Throw in techniques

�Throw in drills

Goal keeping

�Maintains concentration when ball is away from the goal

�Gets behind the line of the ball

�Scoops low balls up with legs straight and together

Goes down on one knee and scoops up low balls

6th week Combination of dribbling, passing, shooting, control-receiving, and heading drills

7th week Team tactics

�Defensive team tactics

�Offensive team tactics

8th week Competition (match) tactics

9th and 10th weeks Tournament matches

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709698

The assessments in all teams were conducted prior to (pretest) and after completion (posttest) of the 8-week program.The physical fitness test and the football sports skill test were administered on different days by the investigator, projectassistants and football coaches, who were previously trained in test administration. Administrating the BPFT lasted 30 minand the FASA 40 min for each child.

2.5. Statistical analysis

To answer the main question, as to the effects of US soccer program on physical fitness and soccer skills of male youthathletes with and without ID, four different types of analyses were conducted. First, mean differences from pretest to posttestin each study group were assessed using paired t-tests. In addition, the means of the two ID groups (ID-TRG and ID-CG) and

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709 699

the means of the two groups without ID (WoID-TRG and WoID-CG) in both pretest and posttest were compared using anindependent t-test. Level of significance was set at 0.05 and adjusted to 0.01, 0.07, and <0.01 in anthropometry, physicalfitness, and soccer skill parameters, respectively, using the Bonferroni procedure.

Second, the change from pretest to posttest in the anthropometry, physical fitness, and soccer skills parameters wascalculated. Mean changes were used as the dependent variable in a Multivariate Analysis of Variance (MANOVA). Studygroup was used as the independent variable. An alpha level of 0.05 determined significance.

Third, each study group’s effect size (ES) was calculated using Cohen’s d (mean D/standard deviationaverage from two means)(Cohen, 1977). For within-subjects studies, a correction for the dependence among means was conducted using thecorrelations between the two means following the Morris and DeShon’s (2002) equation. In general, values smaller and equalto 0.20 are considered trivial ES, values between 0.21 and 0.50 as small ES, values 0.51–0.80 as moderate ES, and valuesgreater than 0.80 as large ES (Cohen, 1977).

Fourth, the mean changes which were calculated in the second step of the analysis were ranked on each index evaluated.The similarity of the ranks’ ordering was then evaluated by using the Kruskal–Wallis test (H test) (Sheskin, 2004). If theKruskal–Wallis test was positive (p < 0.05), then a test for pairwise comparison of subgroups was conducted according toConover (1999).

3. Results

3.1. Description of the anthropometry, physical fitness and soccer skills tests

Tables 2–4 present the descriptive statistics of anthropometry, physical fitness, and soccer skill variables, respectively.Independent t-tests revealed that the two ID groups and the two groups without ID were similar in anthropometryparameters at the beginning and at the end of the study (see Table 2).

Similar to the anthropometry parameters, no significant differences were observed between the two ID groups in fitnessparameters during the pretest. In addition, from the paired t-test it appears that the ID-TRG exhibited significantimprovements from pretest to posttest in most physical fitness parameters (right-hand grip, t = �3.18; left-hand grip,t = �3.18; standing long jump, t = �4.23; flexed arm hang, t = �2.83; and sit-up, t = �5.02). Conversely, the ID-CG did notexhibit significant changes from pretest to posttest in any of the physical fitness parameters. Despite the numerousimprovements of the ID-TRG in physical fitness, an independent t-test showed that in posttest ID-TRG performed better thanID-CG only in the standing long jump (ID-TRG = 145.71 � 26.67, ID-CG = 112.89 � 19.89).

In pretest the two groups without ID (WoID-TRG and WoID-CG) differed in one physical fitness parameter, namely, thestanding long jump (WoID-TRG = 166.09 � 20.7; WoID-CG = 145.00 � 10.21). In addition, WoID-TRG exhibited significantimprovement in the sit-up (t = �4.05), whereas WoID-CG exhibited significant improvements in flexibility (t = �3.89) and the sit-up (t = �3.57) (see Table 3).

All participants achieved 60 points that is the maximal score in the individual dribbling test during both pre- and theposttests, representing a ceiling effect. Therefore, the results of this test were not included in the data analysis.

From the paired t-test it appears that the four study groups improved from pretest to posttest in numerous soccer skillparameters. An independent t-test shows that in the soccer skills component, youth with ID in pretest differed only in theslalom task (ID-TRG = 73.7 � 17.07, ID-CG = 59.67 � 15.17). However, in posttest the ID-TRG performed better than the ID-CG innumerous soccer skill indexes, namely run and kick, slalom, dribble and shoot, and total soccer score. Children without ID weresimilar at baseline in all the various parameters. Similar to the ID group, WoID-TRG performed better than WoID-CG in numerousposttest assessments (i.e. shooting, control pass, dribble and shoot, and total soccer score) (see Table 4).

3.2. Mean change from pretest to posttest MANOVA

3.2.1. Anthropometry

A MANOVA revealed no statistically significant difference in the mean change in height, weight, or total skinfold acrossthe four groups (for additional results, see Fig. 1).

3.2.2. Physical fitness

No significant differences were observed between the four groups in trunk lift mean change. However, MANOVA revealedsignificant differences between the groups in mean gain of the other physical fitness parameters. For instance, the mean gainchange in left and right hand grip of ID-TRG (gain in right hand-grip = 2.914 � 4.25 kg, gain in left-hand grip = 2.848 � 4.29 kg)was greater than the mean gain change of WoID-CG (gain in right-hand grip = �0.147 � 2.404 kg, gain in left-handgrip = �0.133 � 3.08 kg). For a complete description of physical fitness mean gain changes, refer to Fig. 2.

3.2.3. Soccer skills

No significant differences were observed between the four groups in run and kick mean change. However, ID-TRG, ID-CG,and WoID-TRG improvements in control pass, dribble and shoot, and total soccer score were significantly greater than thoseobserved in WoID-CG. Finally, ID-TRG also exhibited a greater improvement than WoID-CG in shooting and slalom (seeFig. 3).

Table 2

Descriptives of anthropometry in special Olympic athletes, partners, and comparison groups before and after the Unified Soccer Program.

Anthropometry parameters Children with intellectual disabilities Children without intellectual disabilities

Training group

(n = 23)

Control group

(n = 15)

Between groups

comparison

Training group

(n = 23)

Control group

(n = 15)

Between groups

comparison

Mean SD Mean SD Pre-test Post-test Mean SD Mean SD Pre-test Post-test

Height Pretest 158.52 5.69 159.46 10.78 160.78 6.36 161.13 6.24

Posttest 159.73 5.73 160.8 10.81 162.18 6.67 162.00 6.32

t 7.93* 6.33* 0.35 0.39 5.81* 4.52* 0.16 �0.06

Weight Pretest 54.44 14.54 54.29 11.46 44.75 11.63 45.94 9.69

Posttest 55.34 14.49 54.21 12.13 45.31 11.52 46.94 9.95

t 3.11* �0.20 �0.03 �0.25 2.05 4.89* 0.32 0.45

Body mass index Pretest 19.66 4.77 20.45 2.40 18.27 3.46 18.03 2.9

Posttest 19.70 7.82 20.05 2.44 18.21 3.42 18.22 2.93

t 0.34 �2.73 0.59 0.25 �0.51 2.07 �0.04 0.00

Total skinfold Pretest 38.28 25.04 38.77 21.73 36.56 23.01 27.92 13.61

Posttest 40.1 29.60 37.40 20.95 35.37 23.68 26.33 11.66

t 1.30 �1.14 �0.25 �0.30 �1.57 �2.57 �1.30 �1.37

Notes: The level of significance (p< 0.013) was obtained after Bonferroni adjustment (0.05/4 = 0.0125). Variables that reached significance are displayed in bold. SD, standard deviation.

* Significant differences in within and/or between subjects analysis.

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Table 3

Descriptives of physical fitness components in special Olympic athletes, partners, and comparison groups before and after the Unified Soccer Program.

Physical fitness parameters Children with intellectual disabilities Children without intellectual disabilities

Training group

(n = 23)

Control group

(n = 15)

Between groups

comparison

Training group

(n = 23)

Control group

(n = 15)

Between groups

comparison

Mean SD Mean SD Pre-test Post-test Mean SD Mean SD Pre-test Post-test

Flexibility Pretest 23.17 9.00 19.06 10.89 24.17 6.71 25.06 5.37

Posttest 23.89 9.57 21.86 9.54 22.39 7.28 28.53 5.51

t �0.85 �2.19 �1.26 �0.63 2.61 �3.89* 0.83 2.78

Right-hand grip Pretest 22.06 7.38 26.28 9.33 24.38 7.48 28.03 7.2

Posttest 24.97 8.13 27.77 10.42 25.21 7.92 28.23 7.15

t �3.18* �2.85 1.55 0.99 �2.44 0.17 1.69 1.28

Left-hand grip Pretest 21.25 6.92 24.42 9.55 22.63 6.88 26.90 6.99

Posttest 24.10 5.25 26.40 9.81 23.40 6.80 26.76 7.77

t �3.18* �2.85 1.18 0.94 �2.44 0.17 1.87 1.40

Standing long jump Pretest 122.13 5.04 117.07 23.8 166.09 20.7 145 10.21

Posttest 145.71 26.67 112.89 19.89 166.17 29.17 156.07 18.59

t �4.23* 1.14 �0.62 �4.07* �0.02 �2.31 �3.65* �1.19

Flexed arm hang Pretest 2.30 3.9 5.32 7.24 11.17 9.33 8.32 8.33

Posttest 6.17 7.42 5.59 8.18 10.62 10.92 12.29 12.83

t �2.83* �0.36 1.67 �0.22 0.36 �2.29 �0.96 0.42

Trunk lift Pretest 27.30 6.46 26.00 10.56 29.48 1.83 30.0 0.00

Posttest 30 0.00 28 7.75 30 0.00 30.0 0.00

t �2.00 �1.00 �0.47 �0.60 �1.37 0.00 1.50 No calculation

Sit-up Pretest 17.26 11.51 20.87 7.45 5.96 8.99 23.33 4.77

Posttest 22.96 10.35 21.6 7.12 32.78 10.52 29.2 4.68

t �5.02* �0.62 1.07 �0.44 �4.05* �3.57* �1.03 �1.23

Notes: The level of significance (p< 0.007) was obtained after Bonferroni adjustment (0.05/7 = 0.0071). Variables that reached significance are displayed in bold. SD = standard deviation.

* Significant differences in within and/or between subjects analysis.

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Table 4

Descriptives of soccer skill components of special Olympic athletes, partners, and comparison groups before and after the Unified Soccer program.

Soccer skill components Children with intellectual disabilities Children without intellectual disabilities

Training group

(n = 23)

Control group

(n = 15)

Between-groups

Comparison

Training group

(n = 23)

Control group

(n = 15)

Between-groups

comparison

Mean SD Mean SD Pre-test Post-test Mean SD Mean SD Pre-test Post-test

Shooting (IS) Pretest 37.83 11.66 41.33 9.9 46.52 4.87 48.67 3.52

Posttest 44.35 7.28 44.67 9.15 49.56 2.08 44.00 7.37

t �2.34 �1.00 0.96 0.11 �2.61* 1.97 1.47 �3.44*

Run and kick (IS) Pretest 40 0.00 38.67 3.52 40.00 0.00 40 0.00

Posttest 69.13 1.94 66.33 2.97 70.00 0.00 69 1.29

t �72.09* �19.04* 0.30 �3.52* No calculation �89.00* No calculation �0.30

Slalom (TS) Pretest 73.7 17.07 59.67 15.17 92.39 8.64 93.67 8.75

Posttest 85.43 14.76 68.33 23.1 99.56 2.08 93.67 10.08

t �4.16* �1.92 �2.58* �2.79* �4.18* 0.00 0.44 �2.73

Control pass (TS) Pretest 39.57 11.07 34.67 7.43 54.35 8.96 62.00 12.07

Posttest 58.7 13.25 56.67 14.9 76.96 12.59 60.67 10.33

t �7.63* �6.21* �1.50 �0.44 �6.77* 0.46 2.24 �4.17*

Dribble and shoot Pretest 30.87 9.85 29.00 7.61 41.09 6.9 38 7.97

Posttest 36.96 9.26 27.67 9.61 45.43 5.62 24.33 11.16

t �2.57* 0.42 �0.62 �2.98* �2.56* 3.54* �1.26 �7.72*

Total Soccer Score Pretest 281.96 34.7 263.33 22.73 334.35 18.48 342.33 23.12

Posttest 354.57 32.22 323.66 38.98 401.52 18.97 352.33 23.89

t �12.60* �6.93* �1.83 �2.66* �13.66* �1.42 1.17 �7.05*

Notes: Total soccer score was analyzed separately with level of significance = 0.05. Variables from pre-to-post test that reached significance are displayed in bold; IS = individual skill; SD = standard deviation;

TS = team skill.

* The level of significance (p< 0.01) in paired t-test was obtained after Bonferroni adjustment (0.05/5 = 0.01).

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Fig. 1. Mean change in anthropometric parameters. Notes: mean change was calculated as posttest–pretest. aSignificantly different than ID-TRG;bsignificantly different than ID-CG; csignificantly different than WoID-TRG; dsignificantly different than WoID-CG. ID-CG = intellectual disability-control

group; ID-TRG = intellectual disability training group; WoID-CG = without intellectual disability-control group; WoID-TRG = without intellectual disability-

training group.

Fig. 2. Mean change in fitness parameters. Notes: mean change was calculated as posttest–pretest. aSignificantly different than ID-TRG; bsignificantly different

than ID-CG; csignificantly different than WoID-TRG; dsignificantly different than WoID-CG. ID-CG = intellectual disability-control group; ID-TRG = intellectual

disability training group; WoID-CG = without intellectual disability-control group; WoID-TRG = without intellectual disability-training group.

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709 703

3.3. Effect sizes—Cohen’s d

Table 4 shows that the ESs of the various parameters differed widely and ranged from trivial (smaller and equal to 0.20) tolarge (greater than 0.80). In physical fitness parameters ID-CG did not exhibit any large ESs. However, the ID-TRG did exhibitlarge ESs in standing long jump and in sit-up (ES = �0.87 and �1.06, respectively). Youth WoID-TRG also exhibited large ES insit-up (ES = �3.33). WoID-CG exhibited large ES in flexibility and flexed arm hang only (ES = �1.30 and �1.32, respectively)(see Table 5).

In the soccer skill parameters ID-TRG exhibited large ESs in all parameters but for in shooting and dribble and shoot.Similarly, ID-CG and WoID-TRG also exhibited large ESs in numerous parameters. WoID-CG exhibited large ESs in twovariables only: run and kick and dribble and shoot (�22.48 and 0.92, respectively) (see Table 5).

Fig. 3. Mean change in soccer skill parameters. Notes: mean change was calculated as posttest–pretest. aSignificantly different than ID-TRG; bsignificantly

different than ID-CG; csignificantly different than WoID-TRG; dsignificantly different than WoID-CG. ID-CG = intellectual disability-control group; ID-

TRG = intellectual disability training group; WoID-CG = without intellectual disability-control group; WoID-TRG = without intellectual disability-training

group.

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709704

3.4. Ranks ordering Kruskal–Wallis test

3.4.1. Training groups

Only in physical fitness were significant differences in rank ordering observed between the ID-TRG and WoID-TRG. Inflexibility, standing long jump, and flexed arm hand the mean gain changes of the ID-TRG were greater than those observedin the WoID-TRG (see Table 6).

3.4.2. Comparison groups

In both the physical fitness and the soccer skill components significant differences in rank ordering were observedbetween the ID-CG and WoID-CG. WoID-CG ranked significantly higher than ID-CG in the standing long jump, flexed armhang, and run and kick. However, WoID-CG ranked lower than ID-CG in control pass, dribble and shoot, and in the totalsoccer score (see Table 6).

4. Discussion

The purpose of this study was to describe the effect of participation of youth with and without ID in a UNS program in thesame soccer training teams on anthropometry (body structure), fitness, and soccer skill variables compared to non-participants. The discussion that follows will address each of the variable groups separately.

4.1. Anthropometry

Due to the similarity of each of the four groups in terms of the anthropometric pre-test and post-test measurements(Table 1), normalization of these variables was not conducted. No group revealed significant changes from pre to post test inBMI and skinfold thickness, meaning that body composition remained the same. This finding is similar to those of anotherstudy performed in Turkey within an inclusive or a separate school program (Berktas et al., 2011), in which no significantdifference between an inclusion and a separate intervention group were observed in BMI or in calf skinfold thickness.Similarly, in an American pilot study of 18 participants in a separate community program lasting 8 weeks no significantchanges in BMI were observed (Oriel et al., 2008). The BMI of all participants (�20) indicated a relatively normal distributionof body weight. A recent study from the America (n = 207) demonstrated that the BMI of adolescents with ID is high, withapproximately 45% of the adolescents with ID overweight (BMI > 25) or obese (BMI > 30) (George, Shacter, & Johnson, 2011).However, only 16.7% of 52 young participants across 18 SO programs in British Columbia, Canada reported a BMI > 25(Gibson, Temple, Anholt, & Gaul, 2011). It can be assumed, that being an SO athlete (50% of our sample of adolescents with ID)has contributed to their body structure. In future studies, in order to enable significant changes in BMI, it is suggestedconducting longer intervention periods (>8 weeks).

Table 5

Cohen’s d for the mean difference (repeated measures).

Chil dren with intelle ctual disabil ities Chil dren without intelle ctual disabilitiesVarıables Training group (n = 23)

Cohen's dCont rol group (n = 15 )

Cohen's dTraining group

(n = 23 ) Cohen's d

Control group (n = 15 ) Cohen's d

Height -1.49 -0.87 -1.07 -0.98

27.0-43.0-40.034.0-thgieW64.0-80.076.040.0-xednıssamydoB

Anthropometry

parameters

52.062.033.0-dlofnikslatoT 0.89

45.085.0-71.0-ytilibixelF -1.30

80.0-82.0-35.0-86.0-pirgdnah-thgiR

40.064.0-27.0-07.0-pirgdnah-tfeL

Stand ıng lon g jump -0.87 0.30 -0.003 -0.63

700.090.0-66.0-gnahmradexelF -1.32

Trunk li ft -0.45*

82.0-72.0-* No calculati on

Physical

fitt ness

parameters

Sıt-up -1.06 -0.15 -3.33 -0.09

25.075.0-52.0-05.0-gnitoohS

Run and kick -15 .01*

-4.92 No calculation -22 .48*

Slalom -0.86 -0.54 -1.13 0.00

Con trol pass -1.60 -1.79 -1.43 0.11

35.0-11.035.0-toohsdnaelbbirD 0.92

Soccer skill

parameters

Total soccer score -2.63 -1.95 -2.83 -0.36

Notes: Cohen’s d calculation: mean D/standard deviationaverage from two means; large differences (Cohen’s d� 0.80) are denoted in gray cells. Cohen’s d was corrected

for dependence between means, using Morris and DeShon’s (2002) equation.

*Cohen’s d is based on a single pooled standard deviation.

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Table 6

Kruskal–Wallis test values for comparison of the amount of mean difference in the study groups.

Variables Kruskal–Wallis test Children with intellectual disabilities Children without intellectual disabilities

Training group (n = 23) Control group (n = 15) Training group (n = 23) Control group (n = 15)

Mean change (SD) Average rank Mean change (SD) Average rank Mean change (SD) Average rank Mean change (SD) Average rank

Anthropometry

parameters

Height p = 0.43 1.22 (0.74) 39.61 1.33 (0.82) 41.73 1.34 (1.11) 40.41 0.87 (0.74) 30.63

Weight p = 0.12 0.90 (1.38) 41.57 �0.08 (1.59) 27.57 0.56 (1.32) 37.83 1.00 (0.80) 45.77

Body Mass Index p = 0.025 0.04 (0.57) 41.80 �0.41 (0.57) 24.80 �0.06 (0.53) 37.63 0.19 (0.36) 48.47

Total skinfold p = 0.14 �2.58 (22.06) 46.30 �1.37 (4.64) 29.80 �1.19 (3.62) 38.52 �1.60 (2.41) 35.20

Physical fitness

parameters

Flexibility p = 0.002 0.72 (4.04) 38.93c 2.80 (4.96) 47.40c �1.78 (3.27) 24.96a,b,d 2.63 (2.62) 49.70c

Right-hand grip p = 0.13 2.91 (4.25) 45.04 1.71 (3.51) 42.07 0.87 (2.71) 36.07 �0.15 (2.40) 28.63

Left-hand grip p = 0.07 2.85 (4.29) 46.37 1.99 (2.70) 42.57 0.77 (1.51) 34.20 �0.13 (3.08) 28.97

Standing long jump p = 0.001 23.59 (26.72) 50.72b,c �4.17 (14.24) 23.20a,d 0.09 (25.33) 33.89a 11.07 (18.55) 42.13b

Flexed arm hang p = 0.003 3.87 (6.54) 46.39b,c 0.27 (2.85) 29.30a,d �0.55 (7.36) 29.15a,d 3.97 (5.24) 49.93b,c

Trunk lift p = 0.08 2.70 (6.46) 43.85 2.00 (7.75) 36.80 0.52 (1.83) 37.20 0.00 (0.00) 34.00

Sit-up p = 0.01 5.70 (5.44) 39.98 0.73 (4.62) 22.13 6.83 (8.09) 44.11 5.87 (6.37) 44.00

Soccer skill

parameters

Shooting p = 0.04 6.52 (13.35) 44.04 3.33 (12.91) 39.27 3.04 (5.59) 41.35 �4.67 (9.15) 24.87

Run and kick p = 0.0008 29.13 (1.94) 38.65b 27.67 (5.63) 24.23a,c,d 30.00 (0.00) 45b 29.67 (1.29) 42.57b

Slalom p = 0.02 11.74 (13.54) 44.74 8.67 (17.47) 45.63 7.17 (8.23) 37.02 0.00 (10.00) 24.07

Control pass p< 0.0001 19.13 (12.03) 40.74d 22.00 (13.73) 44.80d 22.61 (16.02) 47.65d �1.33 (11.25) 14.73a,b,c

Dribble and shoot p = 0.003 6.09 (11.38) 47.80b,d �1.33 (12.17) 34.67a,d 4.34 (8.16) 44.61d �13.67 (14.93) 18.70a,b,c

Total soccer score p< 0.0001 72.61 (27.63) 48.26d 60.33 (33.73) 39.80d 67.17 (23.59) 45.52d 10.00 (27.19) 11.47a,b,c

Notes: Anthropometry parameters: the level of significance (p< 0.013) was obtained after Bonferroni adjustment (0.05/4 = 0.0125); physical fitness parameters: the level of significance (p< 0.007) was obtained

after Bonferroni adjustment (0.05/7 = 0.0071); soccer skill parameters: the level of significance (p< 0.01) was obtained after Bonferroni adjustment (0.05/5 = 0.01). SD = standard deviation.

Variables that reached significance are displayed in bold.a Significantly different than group 1.b Significantly different than group 2.c Significantly different than group 3.d Significantly different than group 4.

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4.2. Fitness

During pretest the fitness abilities of the two groups of children with ID were similar. After training the ID-TRG hadsignificantly improved in most physical fitness variables, including right- and left-hand grip, standing long jump, flexed armhang, and sit-ups. Trunk lift performance did not improve. In contrast, the ID-CG did not demonstrate any changes from pre-to-post test. The efficacy of physical activity programs to improve fitness in adults with ID has been demonstrated in numerousstudies (see recent reviews in Bartlo & Klein, 2011; Heller et al., 2011). The evidence suggesting fitness benefits of sport’sprograms for children and adolescents with ID is by far more scarce. Based on the available evidence, Lotan, Henderson, andMerrick (2006) strongly encourage the establishment of community-based, easily accessible physical activity programs forchildren and adolescents with ID. The findings of our study are the first to suggest that a UNS soccer program is effective inimproving fitness of young participants with ID. These findings are supported by those of Stanish and Temple (2012), whoreported significant improvement in curl-ups and a 6-min walk as a result of a 15-weeks-long YMCA-based, peer-guidedexercise program. Similarly, Berktas et al. (2011), who conducted an inclusive class program dedicated to improving physicalfitness, demonstrated significant improvements in many Brockport test variables. The largest pre-to-posttest difference in theIS-TRG was observed in the standing long jump, which was also the only test item in which the ID-TRG performed better thanID-CG in the posttest. This result suggests that the UNS program was most beneficial for improving lower limb strength in youthwith ID who participated in our study. This finding is of particular functional interest, due to the importance of lower limbstrength in maintaining balance, which is limited in persons with ID across the lifespan (Lahtinen et al., 2007).

Youth without ID also benefited from the program, however, in a more modest degree than those with ID. Morespecifically, the WoID-TRG improved only in one fitness related test (sit-up), whereas the ID-TRG improved in a total offive fitness related parameters (see Table 2). Among children with ID, only the training group exhibited large ESs.However, among children without ID, both the training and the control groups exhibited a large ES in several fitnessvariables (see Table 4).

Several differences in mean gain change were observed between the four study groups. For example, the ID-TRGimproved more than WoID-CG in right- and left-hand grip strength (see Fig. 2). This outcome may be due to a preliminarydeconditioning in the participants with ID.

In the training group, the youth with ID benefited from the training more than those without ID in flexibility, standinglong jump, and flexed arm hang (see Table 5). Nevertheless, the training was equally beneficial for the two groups in gripstrength, trunk lift and sit-ups. Conversely, in the control group, youth without ID improved more than those with ID instanding long jump and flexed arm hang. These outcomes demonstrate for the first time that the inclusive context may notunder challenge the participants without ID, and can lead to health-related beneficial outcomes for typically developingyouth.

Our findings are partially supported by those of a much longer study following fitness variables of adult Track & Field (TF)and Basketball (BB) participants and non-athletes with ID over a period of 9 months (Guidetti, Franciosi, Gallotta,Emerenziani, & Baldari, 2010). This study demonstrated significant differences between athletes and non-athletes in mostfitness variables. However, while both athlete groups improved significantly in items reflecting muscular strength andendurance such as the standing long jump, only TF athletes improved in cardiovascular endurance. The youth enrolled in thecurrent study did not participate in endurance training, due to the relatively short training period and were not tested forendurance. It is recommended that in future studies lasting longer periods of time, the training and measurement ofcardiovascular endurance be included.

4.3. Soccer skills

Compared to the control groups, the participants in the training groups exhibited greater improvements in soccer skillsfrom pre-to-post test. Moreover, the ID-TRG also performed better than the ID-CG in numerous soccer skill variables atposttest. A similar pattern was observed among the participants without ID (see Table 3).

Large ESs in soccer skills were observed in all study groups. Accordingly, no significant differences between the ID-TRGand the WoID-TRG were observed in soccer skills rank ordering (see Table 5). However, WoID-CG ranked significantly higherthan ID-CG in run and kick, and significantly lower in control pass, dribble and shoot and in total soccer score (see Table 5).Moreover, the WoID-CG also did not improve as did the ID-TRG in shooting and slalom (see Fig. 3). These outcomes indicatethat (a) the program improved the ID-TRG performance, enabling them to approach performance levels of typicallydeveloping youth, and in addition (b) typically developing youth in the WoID-TRG were able to benefit from the inclusiveprogram and to improve their skill performance. Our findings regarding soccer skill are supported by previous findingsdemonstrating the effectiveness of inclusive basketball programs (Ninot et al., 2000; Riggen & Ulrich, 1993).

4.4. Limitations

Although the current findings demonstrate beneficial effects in fitness and soccer skills, some caution should be exercisedwhen interpreting and attempting to generalize our findings. First, this study was conducted throughout a period of 8 weeksonly, on account of the UNS program schedule requirement. It may be expected that during longer periods of the inclusiveprogram more changes would take place, particularly in anthropometry.

F. Baran et al. / Research in Developmental Disabilities 34 (2013) 695–709708

Second, the instrument used for fitness measurement was the Brockport test, which was developed as a general physicalfitness test for persons with and without disabilities. An instrument related more to lower limb-related fitness may havedemonstrated greater changes among the soccer training participants.

Third, in this study there was no control for the severity of ID, and therefore we could not conclude whether this aspect ofthe disability had an impact on the results. In a study among 29 trained adult SO athletes (Franciosi, Baldari, Gallotta,Emerenziani, & Guidetti, 2010), it was reported that ID level correlated to motor coordination as well as abdominal muscularstrength and endurance. It is recommended that in future studies the level of ID should be included as a variable.

Fourth, this study focused on the impact of the UNS program on participants’ fitness and skill levels. It did not measure thevery important goal of increasing the degree of participation in such programs.

4.5. Conclusions

The purpose of the present study was to examine the effects of participation in a UNS program compared to noparticipation in extracurricular sports on anthropometry, fitness, and soccer skill of youth with and without mild ID. Thefindings demonstrate the utility of the UNS program for youth both with and without disabilities, suggesting that theprogram was effective in increasing fitness and soccer skill performance of the youth with mild ID as well as that of thosewithout ID. These findings can be used to motivate the coaches, teachers, school managements and administrators toimplement UNS in their programs. Further investigations are needed to study the long-term effects of such programs andtheir impact on self-initiated leisure time physical activity. In addition, it is recommended that these effects be studiedacross participants with a variety of ID levels.

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