April 2016 Issue

Focus on Fitness: Exercise as Autism Therapy
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 18 No. 4 P. 48

April is National Autism Awareness Month. I'll be reviewing some recently published evidence supporting the benefits of some types of exercise for children and adolescents with autism spectrum disorder (ASD). I'll also discuss some recent fitness trends for those with ASD, including dedicated gyms and specialized trainer certifications.

The National Institute of Mental Health defines ASD as a group of neurobiological and developmental disabilities characterized by social, communication, and behavioral symptoms, including the following:
• persistent deficits in communication and social interactions across multiple contexts;
• restricted, repetitive patterns of behavior, interests, or activities;
• repetitive or ritualistic movements, postures, or sounds (referred to as stereotypy, eg, body rocking);
• presentation of symptoms in the early developmental period (ie, the first two years of life); and
• clinically significant impairment in social, occupational, or other important areas of functioning.1

The word "spectrum" refers to the wide range of symptoms, functional skills, and levels of impairment that can occur in ASD; some children may have only mild expression of the above symptoms, while others may be severely disabled.

According to the Centers for Disease Control and Prevention, ASD occurs in one in 68 births in the United States. From 2000 to 2010, the prevalence of ASD in American children increased by almost 120%, making it the fastest growing developmental disability. ASD is approximately five times more common among boys than girls.2

Prevalence of Obesity
American youth with ASD have a greater risk of overweight and obesity than other children, and this risk continues into adulthood. American teens with autism are more than twice as likely to be obese as those who don't have a developmental disorder. A large study demonstrated that adolescents with a developmental disorder and obesity had the highest prevalence of common respiratory, gastrointestinal, dermatological, and neurological symptoms.3

The reason overweight and obesity are more prevalent among children and adolescents with ASD is because they face many barriers to regular exercise. Some of these barriers—accessibility of children's fitness programs/facilities, cost, and time—are no different from other children. But symptoms of ASD add to those barriers. Motor issues, like low muscle strength, poor balance, and gait irregularities, can make participation in simple exercise activities, such as walking or bouncing on a trampoline, very challenging. Social anxiety and difficulty with social communication and interaction can prevent playing sports or participation in games with other children.

The benefits of regular appropriate exercise for youth with ASD go beyond weight loss and improved physical health. Recent studies have shown that some types of exercise also can improve ASD symptoms and behaviors. A January 2016 systematic review of 13 published studies on exercise interventions in children aged 16 or younger with ASD evaluated behavioral outcomes associated with different types of activities. The researchers found that jogging, horseback riding, martial arts, swimming, yoga, and dance improved some ASD behavioral symptoms, such as stereotypy, social-emotional functioning, attention, and cognition. Horseback riding and martial arts had the greatest effect. The researchers caution that different exercise activities may have different effects for each individual, depending on the type and severity of symptoms. For instance, martial arts training may appeal to children with ASD who thrive on structure, while jogging and swimming may not provide enough structure. However, jogging and swimming, which are more solitary, may appeal to children for whom social interaction is challenging.4

Finding appropriate activities and settings for regular exercise for children and adolescents with ASD may be challenging, especially if symptoms necessitate one-on-one supervision and instruction. However, fitness opportunities for this special population are steadily increasing.

Fitness Facilities Available
In May 2014, the first-ever dedicated fitness center specializing in training clients with ASD opened its doors in Florida. The ASD Fitness Center was constructed as a completely sensory-friendly environment, with lighting, flooring, and color scheme designed to be calming and inviting to those who might be overstimulated by the bright colors that are typical in many youth fitness center settings. The 5,000-square-foot fitness center offers one-on-one personal training, as well as adaptive karate, yoga, cardio, and hip hop dance classes for children, adolescents, and young adults with ASD. The center also offers personalized individual fitness programs and optional goal-setting for nutrition and functional skills. All trainers and class instructors have a background in special education. A separate workout is available for parents and guardians while ASD clients are exercising. Additional information is available at their website, www.asdfitnesscenter.com.

Some children with ASD may prefer settings with more varied activities that still offer exercise opportunities. A franchise, We Rock the Spectrum (www.wrtsfranchise.com), has more than 30 facilities across the United States and offers a variety of activities for children with ASD. Dubbed a "sensory gym," We Rock the Spectrum centers feature occupational therapy-based equipment to work on different areas of the body and different skills. The facilities offer yoga and dance classes, and some of the sensory equipment, such as trampolines, monkey bars, and ziplines, can provide physical conditioning for ASD children. Arts and crafts activities also are offered.

ASD Fitness and We Rock the Spectrum are only two of the many fitness options available for children and adolescents with ASD. Recently, predesigned fitness programs and ASD fitness consultants also have emerged in the field of ASD fitness to assist with program implementation in schools, community centers, and at home.

Opportunities for Certifications
Specialized fitness trainings and instructor certifications for special needs clients are also now available. The American College of Sports Medicine (ACSM), in collaboration with the National Center on Health, Physical Activity and Disability, offers the Certified Inclusive Fitness Trainer (CIFT) certification. This program trains fitness professionals to assess, develop, and implement individualized exercise programming for healthy or medically cleared individuals with physical, sensory, or cognitive disabilities. CIFTs learn safe, adapted exercise techniques, current Americans with Disabilities Act policies relevant to recreational facilities, and standards for facility design. According to the ACSM, CIFTs typically work in public health and community settings, but opportunities in dedicated ASD gyms are now becoming more common. Additional information can be found at certification.acsm.org/specialty-certifications.

Eric Chessen is considered the leading expert in ASD fitness. His website, Autism Fitness (autismfitness.com), provides numerous resources for fitness professionals and parents interested in exercise for children with ASD. He also offers in-person and online/Skype training for fitness professionals in ASD fitness program design and delivery.

As the prevalence of ASD continues to rise, expect more research to be published that helps to refine exercise recommendations for youth with ASD. And, expect fitness facilities and programs dedicated to serving clients with ASD to also increase in number.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania area.

1. Autism spectrum disorder. National Institute of Mental Health website. http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

2. Autism spectrum disorder (ASD). Centers for Disease Control and Prevention website. http://www.cdc.gov/ncbddd/autism/data.html. Updated August 12, 2015.

3. Phillips KL, Schieve LA, Visser S, et al. Prevalence and impact of unhealthy weight in a national sample of US adolescents with autism and other learning and behavioral disabilities. Matern Child Health J. 2014;18(8):1964-1975.

4. Bremer E, Crozier M, Lloyd M. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder [published online January 28, 2016]. Autism. pii: 1362361315616002.