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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.
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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.
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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
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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)
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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
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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
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<Table Ⅲ. 4> Norm-referenced assessment standards by gender
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<Table Ⅲ. 5> Norm-referenced assessment standards by age group
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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)
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<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)
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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.
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