THE FITNESS PRIORITY BY KRISTIN MCNEALUS, PT, DPT
Studies have shown that vigorous exercise is associated with decreased stereotypic (self-stimulatory such as hand flapping or body rocking) behaviors, hyperactivity, aggression, self-injury, and destructiveness.
Exercise is one of the most effective treatments for people with autism! There are a number of reasons why physical exercise should be part of a regular routine for a person with Autism Spectrum Disorder (ASD). We will look at how exercise can have a positive effect on some common impairments associated with ASD, discuss some challenges, and possible options.
Studies have shown that children with autism tend to be less active than those who do not have ASD, which increases their risk for heart disease, diabetes and obesity. Weight gain in these children brings another set of problems. The prevalence of obesity in children with ASD is 30.4% compared with 23.6% in age-matched children without ASD. As a reference, a measured Body Mass Index at the 95th percentile or higher is classified as obese, and a BMI at the 85th percentile or higher are considered overweight. Furthermore, the prevalence of obesity is greater in children with ASDs than in children with other developmental disabilities, including ADHD and learning disability. This is clearly concerning, and could be attributed the inability to perform complex motor activities. Children may prefer simple, sedentary activities such as watching television or using the computer. It will take extra effort to get your children to participate in challenging physical activity, but it will be worth it!
A side note to this obesity statistic before further elaborating on the physical activity factor is that there are other factors that come into play for the population with ASD. These include nutritional issues, as many children with autism avoid healthy foods and will only consume certain items. This limits the nutrients their bodies receive through food. Many children have GI issues also contributing to a poor diet. And lastly, there is the impact of prescription medications that could contribute to weight gain as well as eating habits.
ASD generally exhibits deficits in three areas: social interaction, communication skills, and motor performance. Physical exercise will improve the physical condition as well as reduce maladaptive behavioral patterns of people with ASD. Studies have shown that vigorous exercise is associated with decreased stereotypic (self-stimulatory such as hand flapping or body rocking) behaviors, hyperactivity, aggression, selfinjury, and destructiveness. What constitutes “vigorous?” This is aerobic exercise that lasts 20-minutes or longer, at an intensity that challenges the child’s fitness, performed three to four days a week. The level of intensity is important because mild exercise has little effect on behavior. Since stereotypic behaviors interfere with teaching, an exercise program might improve the student’s attention in the classroom.
When compared to individuals without ASD, individuals with ASD are more likely to have difficulties with balance, postural stability, gait, joint flexibility, and movement speed; all of which may be exacerbated by a lower opportunity to participate in physical activity. Challenging these systems and skills is necessary for improvement.
Here are some ideas on activities:
Engaging the proprioceptive system helps children to understand where their bodies are in space, and is important for coordination. Some activities that stimulate this system include bouncing on a trampoline or a large ball, skipping, or moving heavy objects. This goes hand-in-hand with challenging the vestibular system, which is involved with balance, coordination and eye movements. Activities include hanging upside down, swings, basic gymnastics, and dancing. All these activities involve the head moving in different ways that stimulate the vestibular system. Try introducing any activity slowly to prevent over stimulating.
Swimming, crawling, hopscotch and navigating obstacle courses can help with sequencing movements and using both sides of the body. Hitting a ball with a bat, popping bubbles, throwing/bouncing/ catching balls, beanbags and balloons all help with using both sides of the body, and with hand-eye coordination.
Communication impairments of children with ASDs could significantly impair their abilities to engage in “group” sports and form peer relationships. If you can introduce them into a group activity with structure and predictability, there may be less stress. Some options to consider include swimming, martial arts, track and field, and horseback riding. With swimming, the water provides a soothing sensory input, and kids can compete individually while still being part of a team. Martial arts classes are structured, and advancement is incremental and predictable. Running teams allow children to compete as individuals and as part of a team, with little communication required among teammates. And with horseback riding, balance is challenged in a fun way, and allows your child to communicate with these animals.
Exercise is important for both physical and mental health for all individuals! This goes for parents, as well as all children. A number of studies have shown that vigorous exercise is one of the best treatments for depression. Exercise can reduce stress and anxiety as well as improve sleep, reaction time, and memory. This is equally important for parents as well as children. Ideally you should incorporate time into your lifestyle to exercise with your child.
Since exercise is inexpensive, safe, and healthful, doesn’t it make sense to try an exercise program to reduce behavior problems? It could reduce the need for more expensive and possibly harmful treatments, such as drugs. Although it is often overlooked, exercise should be one of the first interventions for a child on the autism spectrum. •
Kristin McNealus, PT, DPT, ATP received her Masters in Physical Therapy from Boston University then went on to earn her Doctorate in Physical Therapy from MGH Institute of Health Professions. She has been a staff physical therapist on inpatient rehabilitation for people with spinal cord injuries at a number of hospitals in Southern California, as well as Director of a community adaptive gym for people with neurological injuries. She is a member of the International Network Spinal Cord Injury Physiotherapists, and has contributed to the APTA Guidelines for Exercising with a SCI. She as completed 3 marathons, and 25 triathlons, including the Ironman! SCI Total Fitness is designed to promote health and wellness for people with physical disabilities.
