New One in 54 children in the U.S. lives with autism spectrum disorder (ASD), according to the Centers for Disease Control and Prevention (CDC). While no cure exists, research shows that physical activity can positively impact the quality of life for those living with the world’s fastest growing developmental disability. Parents even rate exercise as the No. 1 treatment for autism.

“Exercise goes beyond health-related benefits and increased levels of fitness for those with autism,” said David Geslak, an American College of Sports Medicine (ACSM) certified exercise physiologist and president of exercise connection in a press release. “Research shows that exercise can increase focus, improve academic performance, reduce stereotypical behaviors and build confidence.”

One study, published in ACSM’s flagship journal “Medicine and Science in Sports and Exercise,” shows that just 10 minutes of low-intensity exercise reduced verbal repetition of phrases or words and hand-flapping — two common behaviors associated with autism. A recent study from Oregon State University found that to help kids with autism maintain physical activity, targeted exercise programs should take place between ages nine and 13, as that’s when kids show the biggest decline in active time.

According to a national survey of autism treatment effectiveness — which rated more than 300 medications, nutritional supplements, diets and therapies — more than 700 autism families rated exercise as the number one treatment overall.

In honor of Autism Acceptance Month, Geslak and ACSM teamed up to share three simple, evidence-based physical activity strategies for those with autism:

1.    Use visuals. They say a picture is worth a thousand words. This is especially true for individuals with autism because communication can be one of the biggest challenges. Using visual supports like pictures can establish structure and routine, helping those with autism make the exercise connection.

2.    Make exercise part of their routine. Those on the autism spectrum benefit from following a structured schedule. An exercise program should be thoughtfully integrated into the daily or weekly routine. Even one exercise session per week can be beneficial.

3.    Remember, persistence over perfection. Don’t worry if the exercise doesn’t resemble what you’ve seen on TV or how you demonstrated it. You simply need to get your child or students moving. Engage them in a few exercises and gradually increase the amount of time or repetitions.

“Teaching exercise to those with autism has a profound impact on the individual, their parents and the therapists or educators working with them,” said Geslak in a press release. “ACSM and I are committed to training more professionals to successfully teach exercise to this deserving population so they can transform lives in their communities.”

Geslak’s firsthand experience teaching exercise at a school for children with autism sparked a passion and led to the development of custom fitness program that has since been incorporate in 12 universities’ curriculum. His passion, along with ACSM’s expertise on exercise guidelines, also led to the launch of the fitness industry’s first educational certificate in 2018. To date, more than 500 professionals have participated in the Autism Exercise Specialist Certificate program. A recent study indicates the program is making a difference and equipping professionals with needed skills and knowledge. 

“Analysis of participants’ engagement in the online portion of the Autism Exercise Specialist Certificate program indicates increased confidence in using evidence-based practices,” said Scott McNamara, Ph.D., an assistant professor at the University of Northern Iowa. “This shows the program is filling a knowledge gap for practitioners, which ultimately translates to increased access to quality physical activity programming for those living with autism.”

Autism and Exercise: Special Benefits

September 5, 2018

Guest post by Sean Healy, author of a new meta-analysis of research on the benefits of exercise for youth who have autism. Dr. Healy is an assistant professor in the Department of Behavioral Health and Nutrition, at the University of Delaware. He conducts research on physical activity adapted to the needs of special groups.

The phrase “exercise is medicine” is a common refrain among fitness experts and health practitioners. A wealth of research gives credence to this truism. And now – thanks to a growing number of studies involving youth with autism – we can confidently say that physical activity provides them with a wide range of benefits.

Jasper, a surfer in our “Surfing on the Spectrum” summer camp, takes a wave. I recently published the results of my team’s meta-analysis of 29 studies looking at the benefits of exercise among more than a thousand young people on the autism spectrum. In a meta-analysis, we combine the findings of multiple studies to gain a deeper and more reliable picture of a potential effect of an intervention.

Overall, we found that physical activity programs for youth with autism produced moderate to large benefits in a variety of important areas. These include improving motor skills, skill-related fitness, social functioning and muscular strength and endurance. I describe these in more detail below.Exercise and autism: The wide-ranging benefits

Social skillsOur meta-analysis showed that youth who participated in physical activity programs designed for individuals with autism showed significant gains in their social and communication skills. The activities included horseback riding, various types of group play, running/jogging programs and exergaming (e.g. Nintendo Wii and other electronic games that involve physical activity).

Researchers have considered why physical activity improves social skills. When designed appropriately, physical activity programs can provide a fun, safe setting for interacting with other children. In other words, they can offer excellent opportunities for practicing social skills. In addition, activities involving animals (e.g. horseback riding) provide children with a fun way to interact nonverbally as well as verbally.

Fitness

It’s very encouraging that our analysis confirmed that youth on the spectrum significantly improved their muscular strength and endurance by participating in programs such as exergaming, aquatic exercise and horseback riding. This is particularly important as we knew from previous studies that people with autism tend to have poorer muscular strength and endurance than is typical for their age. Strength and endurance are important for not only physical health, but also for taking advantage of social opportunities that involve physical activity including recreational sports and non-structured games.

Skill-related fitness

Many individuals with autism have lower fitness skills compared to other people. These skills include balance, body coordination, visual-motor control and other mobility skills. Here again, we were encouraged to find that many types of physical activities improve skill-related fitness for youth with autism. These activities included computer-based exergaming, jumping on a trampoline (with supervision and safety barriers), motor skill training (e.g. table tennis) and horseback riding.

Motor skills

Many kinds of physical activities – and the social opportunities they afford – require what we call “fundamental motor skills.” These basic skills include running, throwing, catching and so on. Again, our analysis showed that exercise programs significantly improved these skills among youth with autism.

Looking forward

We would like to see more research on the benefits of exercise for people on the autism spectrum and on the type and duration of activity that provides the greatest benefits. We also want to improve how we tailor and personalize physical activity programs to each participant needs and goals.

Most importantly, perhaps, we need to understand how to promote lifetime physical activity for people who have autism.

Meanwhile, we hope that our encouraging findings will inspire fitness practitioners, physical-education teachers and parents to engage children, teens and adults with autism in a wide range of activities. The benefits appear to be tremendous.

Autism-friendly strategies for encouraging physical activity

Research and our clinical experience have helped us understand and address many autism-related barriers to enjoyable participation in physical activity.

Understanding aversions. Recently I encouraged a boy with autism to play alongside his peers during recess. He replied, “I don’t think you could design a worse place for me to be!” I got it. I was asking him to enter a setting that was social, active, loud and unpredictable – all qualities he disliked.

Several issues make physical activity less appealing for many people with autism. These include poor social and motor skills, a preference for screen-based activities, and a lack of exercise partners and autism-friendly opportunities for physical activity in our communities.

The good news: We have strategies to help. Here are some practical tips for encouraging regular physical activity:

1. Start small

The Centers for Disease Control and Prevention (CDC) recommends that children get at least an hour of physical activity daily. That’s good to know, but I suggest starting with a more modest goal and building from there.

We’ve found that shorter periods of physical activity, spaced throughout the day, tend to be easier to maintain. Remember: The goal is to make physical activity a regular and enjoyable part of daily life. So, be patient and think long term.

Here are some ways to add physical activity into a daily routine:

• Walking to school (or work) – or at least some of the way.
• Walking the dog (if you have one).
• Turn TV advertisements into exercise breaks. I recommend a few minutes of a rigorous activity such as jumping jacks. Join your child in the fun.
• Make a family trip to the playground a regular, after-dinner activity. If you can walk there, even better.

I recommend gradually expanding the amount of time spent in these and other activities – with the aim of ultimately achieving the recommended daily hour of physical activity.

2. Build motor skills

Keep in mind that your child will need to build some fundamental motor skills to successfully participate in physical activities and sports. You can make this skill-building enjoyable by playing games that encourage your child to:

• Move in different ways (e.g. run, jump, hop, and skip)
• Play with different types of equipment such as balls, bats and racquets (e.g. throw, catch, kick and strike).

Practicing these skills at home can foster your child’s success in physical education class, while increasing the likelihood that he or she will enjoy other socially engaging physical activities such as playground games and recreational sports.

3. Sample different types of physical activity

Our analysis identified a wide range of activities that can deliver benefits. From table-tennis to swimming, from riding bikes to riding horses, there’s an abundance of physical activities that you or your child can try. I suggest sampling from the menu.

Ideally, include one or more activities that encourage:

• Fitness. An activity that involves moderate to vigorous activity – activity that gets a person breathing heavily.
• Social interaction. An activity that involves one or more other people, such as tennis or catch.
• Independence. An activity that can be done alone, such as a home fitness or yoga routine – perhaps with the help of a video.

4. Be a role model and enlist friends and family

As a parent, you are the most important role model for your child. I encourage you to model an active lifestyle for your child. Show them the enjoyment and value you gain from being active.

Next, consider the many people who interact with your child on a daily or weekly basis and how might you enlist them to encourage your child’s physical activity.

Teachers, especially physical education teachers, can be a great influence. Share your aspirations and strategies for your child. If your child has an Individualized Education Plan (IEP), be sure to include physical education goals in your IEP discussions. If possible, invite the PE teacher to attend the IEP meeting.

Also consider contacting the people who run recreational sports programs in your community. Some may worry that they lack the skills to engage and include someone with autism in their programs. You may be able to give them the confidence they need by sharing your strategies for communicating, motivating, and instructing your child.

5. Tips for making physical activities autism friendly

Here are three practical strategies commonly used in activity programs designed for youth who have autism:

• Someone who understands. Ideally, we want people with autism – especially children and teens – to have access to physical activity programs led by facilitators who understand how to communicate and motivate participants in autism-friendly ways. This doesn’t have to be a professional in the field of autism. It can even be a “peer tutor” – another child who understands how to communicate with your child and can provide some one-on-one support.
• Routine. Most of us need routine, and this appears to be especially true for many people on the spectrum. I suggest building a regular and predictable structure into the physical activity program. Create a visual schedule to help reinforce the routine. (See the Autism Speaks Visual Supports Tool Kit link above for instructions on making a visual schedule.)
• Get visual. Many people with autism are visual learners. Visual supports such as task cards, physical demonstrations and video modelling often prove very helpful.

Challenging Autism with Exercise

An Opportunity Worth Stretching For

Geslak, David S. B.S., ACSM EP-C, CSCS

ACSM's Health & Fitness Journal: March/April 2017 - Volume 21 - Issue 2 - p 19-24

Abstract

By reading this article, the health and fitness professional will

·      Gain a better understanding of autism — Those with autism learn differently. You will learn a successful and proven approach in teaching exercise using visuals, creating structured routines, and establishing the right goals for those with autism.

·      See an opportunity to help — School systems that are challenged with limited resources are leaving those with autism both wandering and wondering in physical education classes. Parents of children with autism who are already overwhelmed with therapies, education, and difficult family dynamics need your help to introduce the proven benefits of exercise. This is important, not only because of the health benefits exercise brings, but in the autism population, exercise also helps to reduce maladaptive behaviors and improves focus and academics.

Exercise is healthy for everyone, but it can have a major positive impact on the quality of life for those on the autism spectrum. Exercise doesn’t just help the child or adult with autism, it also has a profound impact on his or her family. There is a tremendous opportunity for those who want to combine their love of exercise and desire to do something exceptionally rewarding and meaningful.Autism spectrum disorders (ASDs) are the fastest growing developmental disability in the world, and according to the U.S. Centers for Disease Control and Prevention, 1 in 68 children are diagnosed (⁵). ASD is approximately 4.5 times more common in boys (1 in 42) than in girls (1 in 189) (⁵). Currently, there is no cure for autism, although with early intervention, a child’s prognosis can improve greatly (^7,11).

Although many groups, organizations, and researchers are focused on finding the underlying causes as well as a cure, parents who have a child with autism are much more focused on “what can help my child, now?”“The increased prevalence of ASD has intensified the demand for effective educational and therapeutic services, and intervention science is now providing evidence about which practices are effective” (³). There are numerous treatments and therapies for autism, but they do not have sufficient empirical support to be considered evidence based. Exercise is an evidence-based practice (³), but unfortunately, it is often overlooked as a therapy. Perhaps because exercise is not perceived as a quick fix or as a magic pill. Even with all the dedicated and tireless research efforts that have shown exercise has a positive impact on autism, most parents, educators, and even autism professionals are unaware of its benefits.

Even with all the dedicated and tireless research efforts that have shown exercise has a positive impact on autism, most parents, educators, and even autism professionals are unaware of its benefits.

In addition to the overall health-related benefits of physical activity, decrease in repetitive behaviors is the most common behavioral improvement after physical activity for children with autism, and more pronounced effects were evident after vigorous bouts of physical activity, according to an article published in BioMed Central (BMC) Research Notes (¹⁰). In addition, vigorous physical activities, in conjunction with appropriate behavior management practices (⁸), can be helpful in reducing inappropriate behaviors in children with autism. Once the autism and fitness communities are aware of its benefits, exercise could very likely become an important part of each individual’s daily treatment plan.

Those interested in teaching exercise to individuals with autism will need to be taught specific skills and be equipped with the right resources to successfully create an effective exercise plan. As ACSM professionals, we are in a position to lead and improve the lives of more than 1 million diagnosed with autism and their families. Let’s give hope an action plan.

THE CHARACTERISTICS OF AUTISM

People who have limited exposure to the autism community may think autism is represented by Raymond, who was played by Dustin Hoffman in the movie, Rain Man. Raymond was considered as an autistic savant — a condition in which a person with a mental disability demonstrates certain abilities far superior to what would be considered as normal. Although some individuals on the autism spectrum have savant abilities, most of them do not have these extraordinary skills. It is important to mention that autism is a spectrum disorder. These individuals vary greatly among one another with regard to their communication, social and cognitive abilities, and their sensory and behavioral challenges. As such, it is important to acquire an understanding of their many differences to develop an appropriate skill set for working with these individuals.

In the mid-1940s, autism was first identified as a unique disorder, and soon after, most professionals began to blame the parents, especially the mother, for emotionally neglecting their children. Since then, our understanding of autism has greatly evolved as well as the opportunities to improve their condition. Today, parents are the driving force to help their children get better.

Autism is a developmental disorder that is associated with significant social, communication, and behavioral challenges. At one time, several similar disabilities were considered as separate disorders including autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified. Autism was redefined a few years ago, and these conditions now belong to the diagnostic category called ASD (²).

Autism characteristics are not physically noticeable like those of Down syndrome. Most individuals with autism look like typical individuals of their respective age. However, those with autism may at times behave differently and sometimes inappropriately. They might repeat actions over and over again (e.g., hand flapping, rocking, and staring at spinning objects). They might repeat or echo words or phrases heard earlier. They also may become aggressive toward others or engage in self-injurious behaviors such as biting, hitting, and pinching themselves. The reasons for these behaviors are not understood fully, but many believe that they are related to their communication and sensory challenges.

Sensory overload and sensory integration are terms commonly used among parents and professionals in the autism field. Many of these children and adults have compromised sensory systems (tactile, taste, vision, smell, hearing, and vestibular), where one or more of their senses are underreactive or overreactive to stimulation. To reduce an overresponsive sensory system, these individuals may wear headphones to muffle or block out loud noises (auditory), chew on an object to reduce sensitivity in their mouth (taste), shield their eyes from bright or blinking lights (vision), avoid being touched by others (tactile), and/or engage in repetitive behaviors such as bouncing or spinning in circles (vestibular). If left untreated, such sensory issues can lead to behavioral challenges, which often are a reaction to discomfort and pain and can disrupt their attention and responsiveness to people in their surroundings.

Learning can look very different for these individuals. Most often, they require different, often simplified, strategies to help them process information such as understanding requests and following directions. Supports that are commonly used, which are all evidence based, include visual supports, video modeling, and technology-aided instruction (iPad^®/computer) (³). Two types of supports used to teach exercise include ExerciseBuddy^® (an iPad^® app) and the hard copy, Visual Exercise System^®.

Those with autism prefer to follow daily routines, and when disrupted or asked to make a change, they may engage in disruptive behaviors. Consider a morning routine; you may begin the day by waking up to the sound of an alarm clock, getting out of bed, and then turning on the shower. As the shower warms up, you walk to the kitchen, start brewing coffee, and then take a shower. If this also was the routine of someone with autism, and the coffee pot was already turned on when they got to the kitchen, this 

change

 in their routine could cause anxiety and lead to behaviors such as hitting, biting, or having a tantrum. Most people handle unexpected events in life by 

going with the flow

. But for those with autism, such events can cause confusion and uncertainty in terms of their understanding of the world around them.AUTISM AND OBESITY

Those diagnosed with autism are at risk of obesity and other chronic disease risks. A population-based study indicated that U.S. adolescents with learning and behavioral developmental disabilities are 60% more likely to become obese. The study found that 31.8% of adolescents with autism were obese. One factor that may contribute to their obesity is their very selective food preferences (^14,15,18). For example, some children with autism tend to eat only highly caloric foods such as those with high sugar content (^13,20). In addition, studies indicate that many individuals with autism receive various psychotropic medications, and adverse effects often include weight gain and increased appetites (^6,19).

For many parents, obesity is a low priority. Instead, they are focused on getting their children to talk, engage with others, express their feelings, and stay on task during school and other activities. Parents and professionals need to be made aware that exercise can help manage behaviors, reduce health risks, and even improve academics.

In a study published in Psychology in the Schools, the authors examined the impact of antecedent physical activity on academic engagement time among third-grade boys with autism. The authors concluded “participation in a physical activity intervention contributed to overall increased academic engagement for high-functioning students diagnosed with an ASD” (¹²). Furthermore, a meta-analysis of 16 studies suggested that on average, exercise interventions led to a 37% improvement in symptoms of autism, specifically behavioral and academic improvement (¹⁷).

Parents, professionals, and even physical education teachers struggle with ways to teach exercise in this population. There are several resources that provide advice on what type and duration of exercises are best. However, they often give conflicting information. Thus, it is no surprise that both parents and professionals are intimidated by where and how to start an effective exercise program.

DELIVERING EXERCISE REQUIRES A VISUAL PROGRAM

Just as you would conduct an evaluation and develop an action plan for people who are injured, obese, or in their senior years, the same is true for those with autism. Instead of simply asking them to walk or run on the treadmill, you may first need to show them a picture of the treadmill (a visual support) rather than simply telling them what to do. Next to the picture, you also would want to show them the amount of time you want them to be on the treadmill.

When you set the amount of time to walk or run on a treadmill, you should not expect them to be on it for the entire time. Remember, this is a new experience for their sensory system and for their minds. Exercising is a lot to process. If you set expectations that he or she will exercise for 60 consecutive minutes, you are setting yourself and everyone else up for failure. You need to remind the families that you are building a relationship based on success and trust. You want to make exercise a part of their lifestyle, and this takes time. Most parents will understand and appreciate this approach.

You can simply begin to introduce exercise by showing a large (8.5 inches × 11 inches) picture of the exercise you want them to perform. And do this in combination with modeling the exercise to them, to which most of you are accustomed. As they progress and their relationship with exercises builds, you can gradually add more exercises. As this happens, think of visually structuring their routine much like a daily to-do list. Write the name of the exercise and the amount (time/reps) you want them to perform. To the left of the written name of each exercise, you should have the picture of the exercise. In the case that you may be working with someone who has a higher cognitive ability, you may not have to use pictures. However, still having a written daily exercise routine provides expectations (beginning, middle, and end) of the exercise session and also allows for better goal setting while adhering to the principles of a qualified exercise professional.

Although the treadmill was used as an example, this is not a miracle exercise nor the only way they can exercise. For children with autism, watching spinning objects may fascinate them. So, it may be more exciting to watch the tread spin in circles rather than actually stepping on it. The bottom line: 

you simply need to get their bodies moving.

 Working with this population will enable you to view exercise from a new perspective, and I promise, it’s definitely worth the effort. You will become a better trainer for any person you work with.A common saying in the autism community is, “If you’ve met one person with autism, you’ve met one person with autism.” Every person with autism is different. Before the first session, ask the parents what motivates or helps their child stay on task. They can be the best help on how to best engage their son or daughter.

THE FIVE COMPONENTS OF PHYSICAL FITNESS — REVISITED

For the past 50 years, the physical educational starting point has consisted of The Five Components of Physical Fitness (Body Composition, Flexibility, Muscular Strength, Muscular Endurance, and Cardiovascular Fitness). With the rise in obesity and emerging discussions of physical literacy for our youth, these components do not seem to be effective with the autism population nor their typical developing peers.

The current five components do not fulfill the unique needs of individuals with ASD. Exercise Connection (EC) has developed “The Five Components of Physical Fitness for Children with Autism Spectrum Disorders©” to help parents and professionals understand where to focus their efforts. The EC Five Components for those with ASD include:

1.   Body image

2.   Posture

3.   Motor coordination

4.   Muscular fitness

5.   Cardiovascular fitness

These terms are commonly used in the autism community, and they do not contradict the recommendations put forth in the current five components.

BODY IMAGE

Body image aligns with a child’s fundamental motor skills. Too often, children and adults with ASD do not know their hand from their foot or their right side from their left side. If we are going to teach them how to exercise, it is critical they first know the parts of their body and what actions each part performs. The song “hands, shoulders, knees, and toes….” is a good starting point to teach them to label and move their body parts. In addition, a complete physical activity program should begin with a physical assessment and measurement of body composition, which is included in this component.

POSTURE AND MOTOR COORDINATION

Posture and motor coordination directly relate to an individual’s skill-related fitness components. Balance and coordination are common terms discussed among parents, occupational therapists, physical therapists, and special education professionals during a child’s IEP meeting. Thus, posture and motor coordination should be at the forefront of our children’s physical education. For example, in addition to balance skills such as standing on one foot, evaluation and exercises should focus on the symmetry between both sides of the body (e.g., “can the left arm throw like the right arm?”). Posture and motor coordination activities can have a significant impact on the child’s gross motor development, sensory systems, and cognitive development.

MUSCULAR FITNESS

This component remains a top priority to a child’s health-related physical fitness. Combining two of the current five components, muscular strength and muscular endurance, into one, lessens confusion. One definition of muscular fitness is the strength and endurance of the muscles. In this way, parents and educators can better understand that dumbbells, exercise bands, and/or bodyweight activities can be used to benefit our children. For those with autism, learning to use dumbbells, for example, also may provide an additional form of sensory integration.

CARDIOVASCULAR FITNESS

A cardiovascular routine may be one of the most challenging components to add to any child’s schedule. As mentioned, the repetitive movement of the treadmill can be a distraction, or he or she may not want to run. Using a recumbent bike or walking can be a great exercise to start with. As you know, there are ways to build the strength of the cardiovascular system without running on a treadmill, biking, or running. Setting up a circuit-training structure can gradually help increase the activity level of the child quickly through multiple exercises while developing his or her cardiovascular fitness.

EXERCISE AS A PREVENTATIVE STRATEGY

Parents of a child with autism will try almost anything to help their son or daughter improve. But when challenged with a disruptive behavior, they are naturally reactive, and do what they can to simply get through the moment. A better strategy is to be proactive and rely on exercise to avoid the behavior in the first place.

This is where exercise professionals can help both the child and overwhelmed parent. You may think exercise is a school’s responsibility, but because of their lack of understanding regarding autism and simply not valuing exercise, many schools have left students with autism wandering and wondering in physical education classes. We can do better; we need to do better.

Without investing a great deal of money, we can better serve these children and their families. By having trained professionals who can deliver exercise, and gyms that are more accepting, we can transform a community desperately looking for help.

I have trained both college and professional football players to achieve their weight room goals, and I have proudly watched them succeed on the field. Many trainers strive to work with these elite athletes, and I don’t take these experiences for granted. These were incredible opportunities that led me to mature as an exercise professional.

Years later, I applied the strategies that I learned as an assistant strength coach for the University of Iowa football team and taught a child with autism to skip for the first time in only 4 sessions. He and his parents had been trying to accomplish this goal for years. That day changed my life and career.

To know that because of your efforts, a child will be able to make his or her way in this difficult world with more strength, confidence, and physical abilities is just the beginning. What it does for these families may be more profound. As fitness professionals, we all aspire to change people’s lives, and there is a great opportunity to do so in the autism community. The smiles I get from both the individuals and parents are like winning the Super Bowl everyday. I hope you will join me.

BRIDGING THE GAP

By using the right approach with evidence-based strategies to teach exercise, it will become an integral part of the daily routine of those with autism. With this population, exercise not only establishes a lifelong healthy habit, but it also increases confidence, improves focus, and reduces symptoms associated with autism. The results speak for themselves, and they speak in a loud, clear voice; exercise creates life-changing opportunities for the children, adults, families, and their newfound coach.

HOW EXERCISE CAN HELP IMPROVE THE SYMPTOMS OF AUTISM

by Casey Ames April 15, 2020 6 Comments

We all know that exercise is important for good health. When you exercise regularly, you help your physical body- your muscles, heart, and lungs- stay healthy and strong.

You also benefit your mental health. Your brain releases endorphins, which help fight against stress and depression. You just overall tend to feel better when you are active!

It can be particularly important for children with autism to exercise, even helping to improve their autistic symptoms. And since children with autism tend to spend more time playing video games and watching tv than their peers, it’s important to make sure they are being active!

HOW PHYSICAL ACTIVITY CAN HELP IMPROVE AUTISTIC SYMPTOMS

A meta-analysis that looked at 16 different studies found that there were “robust benefits of physical exercise on the patients’ motor and social functioning.” To be more specific, they saw a 35% improvement in the ASD symptoms as a result of exercise.

They went on to say that it wasn’t because the physical activity tired the kids out, because their on-task behavior, academic responding, and appropriate motor behavior increased after the exercise.

Another study found that exercise provides a short-term reduction in stereotypical behaviors in children with ASD. This third study was more specific in its findings, in that after exercise, they saw a decrease in aggression, off-task behavior, and elopement. 

While there are many things you can do to help your child’s autistic symptoms, like improving their gut bacteria or avoiding MSG, it turns out exercise is a major win that takes relatively little work. 

So it appears that overall exercise is a great thing to have as part of your child’s daily routine. And since it helps with their ability to perform better in school, having them do quick exercises before class could be a big win!

WHAT ARE GOOD EXERCISES FOR AUTISM?

What is interesting, and something to take into consideration is that individual exercise programs seem to have a bigger impact than group exercise programs.

One study found that children’s social skills actually improved more in an individual program, which involves only the child and an adult leader, versus being part of a group. This doesn’t mean that group exercise isn’t useful. The study simply showed that individual programs proved more beneficial.

Another factor that studies have looked at is whether the exercise should be intense or mild. It turns out that mild exercise didn’t show much improvement at all on children’s autistic behaviors, but intense exercise had a really good effect.

The first study on mild versus vigorous exercise looked at the difference between 15 minutes of playing with a ball (mild) and 15 minutes of jogging (vigorous). It turns out that the mild exercise had no effect, while the vigorous exercise showed a reduction in stereotypical behaviors.

Another study looked at jogging versus mild exercise and found that physical self-stimulation and “out of seat” behavior only improved after jogging. The improved behavior lasted for 40 minutes! That’s a solid amount of time of improved behavior for only a short time spent jogging.

If usual exercises like jogging and sports aren't your child's favorite thing to do, fortunately, "exergaming", which is exercise via video games, has been shown to "improved sensory and cognitive attention in Autistic children" according to a new study. 

AUTISM FITNESS PROGRAMS

So it turns out that jogging could be one of the best and easiest options for your child. Of course, if your child doesn’t like to jog, you should let him try other things. After all, the best exercise is the exercise that your child loves and will stick with. It could be chasing a soccer ball, jumping jacks, or even jumping on a trampoline.

If you’re looking for something more structured for your child, I would recommend checking out Autism Fitness by Eric Chessen. It has some great resources, including videos and eBooks that you can pick up.

CONCLUSION

If your child has autism, exercise is proven to be beneficial.

Make sure you get your child off the couch and involved in some type of high-intensity exercise. If you are consistent, you should see big improvements in behavior.

If you have any questions, feel free to ask in the comments! We are happy to help provide any more information.

THE CHALLENGE OF PHYSICAL FITNESS FOR PEOPLE WITH AUTISM

Marina Sarris  Interactive Autism Network November 17, 2014

You've probably seen the headlines: studies say that children and adults with autism are at risk for an inactive lifestyle and obesity. While the reasons are subject to debate, it's clear that people with ASD often face unique challenges to physical fitness.

The core features of autism – social, communication and behavior problems – can make joining a game of kickball at recess or playing tag with neighborhood kids a struggle. What may be less well known, however, is that many people with autism spectrum disorder (ASD) also face problems with motor (muscle) skills, including balance and coordination.^1-4

In fact, motor problems often start in infancy.⁵ Youngsters may be late to sit, crawl or walk, or have unusual ways of accomplishing those milestones. "It is very common for children with ASD to have some motor delays that are recognized by the parents before the delays in social and communication skills are apparent," said IAN Director Paul H. Lipkin M.D., a developmental pediatrician whose research and practice has focused on the identification and treatment of young children with developmental disabilities.

Children with below-average motor skills may struggle with everyday activities such as using a spoon, toothbrush or crayon; riding a bike; or fastening their clothes. Imagine the frustration of a speech-delayed child who can't zip his jacket and can't ask for help in doing it.

A recent study used a test of motor skills to compare children with autism to both typically-developing children and to children with attention deficit hyperactivity disorder.⁶ Children with autism scored the poorest in balance and in catching a ball. They put less emphasis on what they saw when trying to catch a ball, and more emphasis on input from their own muscles, said one of the researchers, Ericka L. Wodka, a neuropsychologist at the Center for Autism and Related Disorders at Kennedy Krieger Institute.

 Dr. Ericka Wodka

That tendency to discount visual feedback from the outside world when catching a ball may be linked to difficulties in learning social skills in autism, according to that study. Children often learn social skills by watching other people's movements, such as gestures. But children who place less emphasis on what they see may struggle with learning gestures and interpreting the actions of others, Dr. Wodka explained.

Motor skills also involve planning – knowing what you want your body to do and coordinating your movements to do it. Before you pick up a ball, you plan to bend down, grab the ball between your hands, bring it to your chest and straighten your body. And of course, you must maintain your balance while you do that. Some researchers have gone as far as to suggest that motor planning problems, or dyspraxia, may be a "core deficit" of autism or a sign of the nervous system abnormalities behind autism.⁷

Doctors do not consider motor problems to be a symptom of autism, and some people with autism are, in fact, good athletes. However, motor deficits are common, especially an "odd gait," clumsiness and walking on tiptoes, according to the manual psychiatrists use to diagnose autism.⁸

PHYSICAL FITNESS AND OBESITY IN AUTISM

Physical fitness is tied to another health concern in autism. Beginning in the toddler years, American youngsters with ASD have a higher risk of being overweight or obese than other children.⁹ This pattern continues into adulthood. U.S. teenagers with autism are more than twice as likely to be obese as adolescents who don't have a developmental disability.¹⁰ Adults with autism have higher rates of obesity, as well as health conditions that can be caused or aggravated by obesity, such as diabetes, high cholesterol and high blood pressure.¹¹

Theories abound as to why obesity is more common in autism. Some people with autism take medications, particularly certain antipsychotics, that may cause weight gain. Many have extremely picky eating habits, insisting on eating only a few foods that may be high in calories.¹² Children and youth with autism tend to be less physically active than kids who do not have developmental disabilities.^13-14 According to the Centers for Disease Control and Prevention, regular physical activity is important for maintaining a healthy weight.

BARRIERS TO SPORTS FOR PEOPLE WITH AUTISM

In addition to below-average motor skills, many people with autism may have other problems that keep them from getting enough exercise, joining a soccer league or playing pick-up basketball in the neighborhood. Safety can be one such barrier. According to research by the Interactive Autism Network, nearly half of children with autism spectrum disorders wander or run away, and half of those go missing.¹⁵ Parents and caregivers may keep a child who wanders indoors more often to protect him or her.

Some families, in fact, go to tremendous lengths to keep their children with autism both physically active and safe.

Kimberly Kuiken's house near Myrtle Beach, South Carolina, has a six-foot fence around the yard. When her son with autism was young, he liked to run away, and she hoped the fence would keep him safe. One day she looked away for a moment and when she looked back, Jack had climbed halfway up the fence. He liked to jump from high places, she said, because he craved the sensory pressure of his feet hitting the ground.

"For years we had to keep him inside because he was such a danger to go outside. I had a lot of guilt because I couldn't chase him all the time," said Mrs. Kuiken, who participated in the Simons Simplex Collection (SSC) autism research project.

She enrolled Jack in soccer, but his desire to wander would interfere. "In wide open spaces, he was compelled to run to the limits. He wouldn't stay on field; he would go to the fence," Ms. Kuiken said. Jack was fascinated by water, so the family built a swimming pool in the yard for him. He taught himself to hold his breath underwater, and he learned to swim and surf.

ARE CERTAIN SOCIAL SKILLS NECESSARY FOR SPORTS?

Safety isn't the only barrier to sports and recreation; sometimes understanding the rules and social conventions of games can keep a child with autism from participating.

Kim Martin had tried soccer and swimming programs with son Finn, now 8. Finn had crawled and walked late, and even now his physical coordination is not quite as developed as other boys his age, she said. But his physical skills were not the problem in playing sports, said Ms. Martin, a participant in the SSC project.

"If the only issue we had was motor skills, we'd be fine. He has sensory issues that sometimes preclude him from using his motor skills because it's too loud or too bright. If he's standing there with his hands over his ears, how is he going to function in a game? We also have social and emotional challenges that other people don't understand."

Many children on the spectrum find certain sports to be emotionally and socially taxing because they involve following complex rules, waiting your turn to play or get the ball, and interacting with many children all at once.

Ms. Martin found a running group tailored to children on the spectrum near her home in Atlanta, Georgia. No complicated rules to follow, and no waiting: it seemed to be a good fit. But there was one problem. Finn hit other runners in the program, which upset their parents and made Ms. Martin feel terrible. Finn had benefitted from occupational therapy and therapeutic horseback riding to address sensory challenges common to autism, but this problem was different.

She told him he couldn't go back to the group until he stopped hitting. Instead, he would run with her and follow certain rules, including no touching. While they were running together, however, "he started whacking me. I said, 'Finn, what are you doing?' And he said, 'Mom, high five!'

"This light dawned on me. He wasn't misbehaving. He wasn't being aggressive." When he hit his fellow runners, he had been trying to give them a "high five" – only without understanding all the rules behind that one, seemingly simple gesture. He didn't realize that you first must raise your hand, say "high five," and wait for the other person to raise his hand and slap yours.

TEACHING PHYSICAL EDUCATION TO STUDENTS WITH AUTISM

Most children learn the ins and outs of sports, from high-fives to the offside rule of soccer, in physical education class. But these often noisy, crowded classes may make children with sensory and social problems miserable. And it can be hard to get individual instruction with 30 or more other children in the class.

Physical education teacher Brian Wagner understands more than most the problems students with autism face in the gym. Mr. Wagner teaches at Kennedy Krieger High School, a nonpublic school for students with developmental disabilities, and has a degree in special education.

Some of his students come from schools where they did not get the attention or accommodations he provides in his smaller class. It's not uncommon for him to hear that a new student "hates" P.E. (physical education) class, he said. At a previous school, that student may have struggled to learn skills or understand the rules of a game, while his classmates became impatient. "These students think, 'I can't do this so why am I even bothering to try?'" he said.

In his class, Mr. Wagner routinely breaks down complex motor skills into small tasks and teaches them step-by-step. He also adjusts the rules of a game as necessary to accommodate students who struggle with remembering them. In this way, he hopes to make physical activity enjoyable for students with special needs.

U.S. special education law requires that students with disabilities receive physical education and, if necessary, special or adapted P.E. in which an instructor modifies the teaching, equipment or environment to help the student.¹⁶ The special education team, of which parents are members, determines the need for special help in P.E. class. Parents can ask the team to consider such assistance.

To teach a child how to throw a ball, for instance, a teacher could put dots on the floor to show a child where to place his feet while throwing. The teacher could also say "step and throw" to remind him.⁴

Parents also can ask the child's special education team about occupational and physical therapy in school. Occupational therapists work on fine motor skills, those involving the small muscles used to grasp pencils or utensils. They also may help people adapt to sensory challenges that interfere with school or daily activities. Physical therapists address gross motor skills, which involve the large muscles used to walk, run and jump. (See below for Additional Resources).

To maintain fitness, Mr. Wagner recommends building movement into the student's day and finding activities that interest them. "The challenge is getting the kids hooked," he said.

Ms. Kuiken did just that. She got her son to exercise at home by tapping into his interest in computers. She gave him Wii interactive fitness video games, such as bowling and baseball. "That did get him some cardio exercise," she said. It was a better fit for him than competitive sports teams, she said. He also has participated in regional Special Olympics events.

Special Olympics provides sports programs for children and adults with intellectual disabilities in many countries. Its coaches are trained to work with people with autism, and understand their communication and sensory needs, said Lynn Aylward, senior manager of Global Health External Relations for the organization. "We consider ourselves a primary source of fitness opportunities."

NAUTISM FITNESS FOR ADULTS

 Eric Chessen

 There was a time when “Why is exercise important for individuals with autism?” was an actual question that I had to answer.

Yes, I mean that.

There was such a disconnect in understanding what fitness had in the way of benefit for this population that it was a discussion non-starter. Today, there’s more of a cultural appreciation of exercise as being crucial for all populations and the focus of accessibility becomes the more relevant discussion.

While discussion is great, it also includes the most common, well-meaning, error. When others share or cite Autism Fitness, it’s always: “ . . . great programs for children with autism!” Meanwhile, the athlete in the video or example in question is clearly a young adult.

Fitness is a lifelong process with skills that coincide with daily activities. That’s true for everyone.

The sentiment that vigorous physical activity should only be youth-based is rightfully dying. However, when we consider the autism and developmentally disabled populations, the majority of therapeutic and activity-based programs are for the 12-and-under crowd. Contrary to whatever it needs to be contrary to, individuals with autism do get older. They also continue to have autism.

In addition to the challenges that coincide with an autism diagnosis (and they vary in severity but highlights are deficits in social skills, functional communication, self-regulation, anxiety, cognitive delays and gross motor deficits), the medical complications that arise among sedentary populations (Type II diabetes, cardiovascular disease, mobility issues/compensatory movement patterns/low back pain) are not exclusive to neurotypical/normally developing populations. We have severe consequences pending for current and future generations of individuals with autism if fitness programming is relegated to younger individuals.

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What needs to be established first is a standard of practice for assessing and developing fitness programs for the autism population. In Autism Fitness programming, we’ve doing this with the PAC Profile™ approach, that enables protocols to be decided and implemented based on Physical, Adaptive and Cognitive baselines as they relate to a variety of exercises. Given a population that has a high rate of gross motor deficits (as diagnosed by low tone, weak trunk and/or gait pattern abnormalities.)

Because these issues are typically diagnosed early, children with ASD may receive physical therapy, to which there is an age-specific cutoff due to insurance policies (usually around 12 years of age).

Then what? The supposition that once we turn 12 we never have to worry about movement again is asinine, but that’s exactly what the outcome is for those with autism. No more PT (regardless of how effective the program was/wasn’t) and very little in the way of continuing physical development.

If we consider fitness as a life skill first, the concepts and practices validated within general strength and conditioning should hold true for the ASD population. Squat, hinge, push, pull, crawl and locomote with progressions introduced when adaptation occurs. Increase reps, increase weight, increase motor planning variables.

The adaptive/behavioral and cognitive challenges in autism may appear to prohibit participation in strength and conditioning activities. This is the reason an interdisciplinary approach is required to increase motivation, decrease anxiety and off-task behavior and create contingencies that lead to reinforcement. This process is not age-specific, nor are the exercises selected.

 I’m often greeted with the following email:

“Hi Eric, I have a 16-year-old son with autism who is not very active. What exercises should we do?”

The amount of information that is needed to supply anything approaching a helpful answer isn’t quite available in that email. Interestingly, the most frequently offered detail is age . . . which is mostly irrelevant. Unless we’re discussing the five-and-younger crowd, for whom motor planning is a priority, we are always looking to increase strength, stability, strength endurance and motor planning across the fundamental movement patterns. Programming for a sixteen or thirty-six year old may look identical, save for specific progressions and regressions of squats, presses, band rows and heavy carries.

In Autism Fitness programming, we start all athletes with the PAC Profile™ Assessment to determine baseline physical, adaptive and cognitive functioning as they related to specific exercises. Divided into categories of warm-up/mobility and strength/focus, assessment gives us a working knowledge of appropriate progression and regressions to implement.

For a large segment of the adult autism population, the strength and stability deficits inherent to the diagnosis paired with sedentary lifestyle lead to significant issues with general strength in essential movements. When programming squats, presses, pulls, hinges and loaded carries, regressions are the norm.

With squats, our go-to regression is a reduced range of motion using a Dynamax ball elevated by cardio step risers. This enables the athlete to break parallel safely and, eventually, efficiently as they begin to develop strength and stability through the movement.

For presses, shoulder and trunk stability, in addition to thoracic mobility, are often compromised. This compromise is evident when heels elevate during the press and/or the arms begin falling forward of the head. We used physical prompting, most often guiding the athlete into position via the elbows, to support performance. We can gradually reduce the prompt (aka fading) as capacity increases.

Similar to presses, during band pull-downs and standing row variations (all done with resistance bands), rooting, trunk stability and strength in the upper back are priority issues. On band pull-downs, we can control the amount of resistance, as can also be done with standing band rows by increasing or decreasing distance.

Hinges are tricky due to the abstract nature of explaining “neutral spine,” which as many of you know can be a challenge with the general/neurotypical population. We initiate hinge movements by teaching a scoop throw with a light medicine ball. This often requires a physical prompt with the coach guiding the athlete into “hips loaded” position.

Heavy carries have wonderful generalization to activities of daily living. For both farmers walks and chest carries, we provide enough weight to be challenging without compromising posture or gait. With farmers walks, swinging of the objects requires either a physical prompt (from the elbows or shoulders to support stability), or lowering the weight. For safety, we always use Sandbells or sandbags.

Below is a chart featuring each strength exercise from regression to our most-used progressions.

The young autism population will age, and there exists a responsibility towards their general health, skill development and independence. The astounding benefits of strength training can be applied to those with ASD when their particular levels of function (physical, adaptive and cognitive) are accounted for. As fitness professionals, we are able to take the best of what we know and apply it with remarkable outcomes. Providing appropriate programs for the ASD population opens the gateway to a higher quality of life in adulthood.