Exercise and Repetitive Behaviours

Have you ever seen someone with autism rocking back and forward, flapping their hand, or repeatedly touching objects? These behaviours are often harmless and can be a person’s way of seeking or controlling sensory stimulation. But sometimes this can really interrupt the day to day tasks that a person needs to do. E.g. Josh rocks back and forth in his sheltered workshop continually which affects his focus on work. 

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Lots of different ways are used to help people to manage these repetitive behaviours. One of the ways is exercise! Exercise has already been shown to help people to sleep better, relieve stress, and improve concentration. But now research is showing that exercise could even help with these repetitive behaviours!

The research people looked at…

The level of repetitive behaviours before and after activities like jogging, horseback riding and martial arts. Researchers found a significant decrease of these behaviours after exercise. Some of these effects were seen straight after the exercise, and some were only seen after a number of weeks doing the program.


How much, how long, how far?

So far in the studies:

How often: 1-5x/week
How long? 15-90 minutes
Program length? 5 weeks - 6 months

You can see that the exercise amount really varies!

So what can you do? 

Because every person with autism is unique and different, it’s difficult to find one prescription that will work for everyone. Exercise needs to be tailored to the person’s physical and intellectual ability, fitness, interests and lifestyle. What the research does indicate is that exercise is likely to help reduce these repetitive behaviors.

 
Exercise needs to be tailored to the person’s physical and intellectual ability, fitness, interests and lifestyle.
 

If the person with autism is not currently active

Start small! Start with walking 10 minutes a few times each week. From there, you can gradually increase it to most days of the week and increase the time you spend walking. From there, you can progress to jogging. 

Remember, for a person with autism, changing routines can be quite challenging, so it’s helpful to communicate the changes to them and make the changes gradually. 

If you don’t like walking, you could join Riding for the Disabled (RDA) for the benefits of horse riding or find a martial arts class near you.


If the person with autism is already active

Great! The next step could be to look at any improvements in repetitive behaviour after the exercise?  Do you notice more behaviours when they haven’t exercised in a while? Monitoring this can really help you to see what types or lengths of exercise work!

If you’re a monitoring kind of person, you can look at these questions:

  • how long was the exercise?

  • how hard was the exercise?

  • what type of exercise was it?

  • what kind of behaviour effect did it have?

  • how long did these behaviour effects last for? 

By answering these questions, you’ll be able to start designing your own autism-specific exercise program!


Happy exercising!









Bremer, E., Crozier, M. and Lloyd, M. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism, 20(8), pp.899-915.

Autism Spectrum Australia (2017) Sensory Processing Factsheet







Exercise and the NDIS

So you’re a participant in the National Disability Insurance Scheme (NDIS). You want to get fitter and exercise more. But where do you start? And how do you even get there?

My experience

I'm an NDIS registered Exercise Physiologist (EP) who has:

  • supported people who are on their first NDIS plan
  • written support letters to help NDIS participants get the funding they deserve
  • had lots of experience explaining to participants how they might use their NDIS funding (not my actual job!) just because they are often totally confused

So without further ado, here are a key pieces of information:

1. NDIS funding needs to be disability related:

NDIS should provide ‘reasonable and necessary’ supports for areas of their life affected by their disability. For example:

  • ✓ a person with traumatic brain injury which has affected their mobility should be eligible for NDIS funding to improve their mobility
  • ✓ a person with schizophrenia who experiences significant anti-psychotic related weight gain may be eligible for NDIS funding to improve their health
  • ✕ an overweight child with a moderate intellectual disability only is unlikely to be eligible for NDIS funding for attendance in the local sports team. Why? It is a reasonable expectation for parents to pay for sports participation where the child does not require specialised disability related support.

2. NDIS funding needs to be goal focussed

Every NDIS participant has the opportunity to select several goals to focus on for their NDIS plan. This might be to "find a job" or "join community sports". A person is more likely to get funding for health and wellbeing activities if their goal is to improve their health and wellbeing. 

3. Funding for Exercise Physiology needs to be under “Improved Health and Wellbeing”

This is a confusing one for a lot of people! In your NDIS plan, supports are categorised into big groups such as “Core Supports” and “Capacity Building Supports.” Under “Capacity Building,” there are sub-categories such as “Improved Daily Living”, “Improved Health and Wellbeing” and more. Most therapy supports such as speech pathology, occupational therapy and physiotherapy fall under Improved Daily Living. If you want exercise physiology, the funding needs to be under “Improved Health and Wellbeing.” I have lost count of the number of times I have spoken to people wanting to use their NDIS plan for exercise physiology and had to explain that they do not have funding under the correct category.

 

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I have funding under “Improved Health and Wellbeing”, how do I use it?

The great thing about the NDIS is you have the freedom to choose just that. In the category of “Improved Health and Wellbeing” you can access several different services: 

  1. Exercise Physiology (EP) 1:1 sessions
  2. Exercise Physiology (EP) group sessions
  3. Personal Training (PT) sessions
  4. Dietitian consultation sessions
  5. Dietitian groups sessions

You can mix and match which services you want, according to the goals you want to reach. Some examples I have had with my own clients:

    • EP/PT Have an Exercise physiologist write up your rehabilitation program and the gym personal trainer helps you to do it on a regular basis. The program is then reviewed every few months by the EP
    • EP/Support Worker Have an Exercise physiologist write up your exercise program and provide training to you or your regular care staff in how to support you in it. The program is then reviewed every few months by the EP
    • EP/Dietitian This person split their funding to use majority for his exercise physiology sessions and several hours with the dietitian as their goal was to maintain a healthy weight. This client’s weight had increased after using medication related to his disability. 

Can I have an Exercise Physiology come in to see me every week?

It's great that you're really keen on us EPs! Unfortunately, it's unlikely for the NDIS to fund weekly EP sessions. This is because we're meant to be a capacity building service - a time-limited, goal directed service. We provide an assessment, exercise program, staff training and reviews. But generally, the ongoing exercise will need to be sustained by yourself and any regular staff workers. And you usually need to exercise more than once per week anyway!

If you have any questions at all, don't hesitate to contact us.

Healthy active kids!

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You might have heard it on the radio or TV - childhood obesity is very quickly becoming one of the leading health concerns in NSW. Children who are above their healthy weight range are much more likely to be above their healthy weight range as adults.

Many of us know that being above our healthy weight range can impact on other areas of health:

  • More risk of heart disease 
  • More likely to develop insulin resistance or type 2 diabetes
  • More likely to develop some cancers
  • Issues with mobility, arthritis and joints 

One of the current NSW Health priorities is to reduce the rates of childhood overweight and obesity by 5% over 10 years. So what's out there to help this to happen? 

1. Active Kids $100 Rebate - The NSW government is launching the Active Kids Rebate rebate in January 2018! This is a $100 voucher for every school aged child to support their enrolment in a community sports or fitness program. $100 per child, per year, for the next four years. For more information: https://sport.nsw.gov.au/sectordevelopment/activekids

2. Go4Fun - A fun 10 week group program, Go4Fun provides education to children and parents about healthy eating and exercise.  To be eligible, children need to be 7-13 and be above their healthy weight range. For more information: https://go4fun.com.au/what#go-4-fun

3. Exercise Right for Kids Does your child have specific health conditions? This site has information and resources written by university trained exercise professionals about safe and effective exercise for kids. It is powered by Exercise Sport Science Australia's (ESSA), the accreditation body for Exercise Physiologists in Australia. See http://exerciseright.com.au/kids/

4. Healthy Kids for Professionals - This great website was launched just recently. It has lots of great resources for health professionals to identify when a child is above their healthy weight range and some basic advice that can be provided to families. Parents might find some of these resources helpful too!  Go to: https://pro.healthykids.nsw.gov.au

  • I particularly like the “8 for a healthy weight” resource which has been popping up around Children’s Hospital Westmead. This has been translated into Arabic, Vietnamese, Chinese and Hindi. (see here) 
    • The other resource I like is the children’s growth chart which helps families to see where their child sits in comparison to their healthy weight range. Green = safe zone, Yellow = caution, Red = danger zone. 

Parents and kids, keep an eye out for these initiatives and take advantage of them! They are provided for you and your family so that you can a happy and healthy lifestyle. 

 

3 Tips on Exercise and Autism

1. Go Sensory

You probably know this already, but almost all people with autism have specific sensory preferences or aversions. This might be an aversion to bright light or loud noises. Or it might be a love for certain textures or movements - rocking forwards and backwards is a common one. 

If you’re supporting someone with autism to exercise, it’s a great idea to have a bit of a sensory profile - what sensations do they like? what makes them want to crawl up and hide away?

Many people with autism love water, so swimming and hydrotherapy would be perfect for such people! If you work with a person’s sensory preferences, you’ll find that exercise will be easier and more enjoyable. 

 

2. Use Visuals

Many people with autism have impaired communication skills. I’ve worked with lots of people with a dual diagnosis of intellectual disability and autism. For these people, your complex, wordy, verbal instructions often go straight over their head! It’s a lot to process. Using visual images is a great way to cut through all of this. I also use a lot of demonstration and physical gestures to complement what I say. 

Real life example: I once worked with a young man with intellectual disability and autism. He was so good with visuals, that when I tried to teach him to do a side plank (see picture), he copied every body positioning to a tee - even the hand on the hip. 

3. Be Concrete

People with autism tend to struggle with understanding abstract ideas. A instruction like “stay at the wall” whilst in an aquaerobics class may be confusing, while saying “touch the wall until I say you can go” is much clearer. Using clear external cues can be better for helping someone with autism to exercise. 

For example, if you are teaching a squat, instead of saying “stick your bottom out more”, you can use a rubber ball and say “your bottom has to touch the ball”. 

Real life example: I created a visual exercise program for a boy with autism. In the first column was the exercise picture. In each of the next two columns, there was a picture of a flag. When he finished each set of the exercise, he moved the picture to the flag to indicate “finish”. After a while, he got fitter and so I encouraged his mum to do 3 sets of each exercise, instead of 2. It didn’t work though! For him, the picture clearly said '2 sets'. He couldn’t understand that he could just do an extra set - even if it didn’t match his visual program! The solution wasn't difficult - a new visual program with three flag columns!

 

 
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    Image from WorkOutLabs.com
 
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