Abstract
Rates of overweight and obesity are above 70% in typically developing adults in the United States, with higher rates observed in individuals diagnosed with developmental disability (DD). Lottery reinforcement systems have been validated as effective exercise interventions for individuals with DD. Although high-intensity interval training (HIIT) has demonstrated health benefits, it has not been studied using individuals within this population. The purpose of this study was to implement a lottery reinforcement system to systematically increase heart rate (HR) during 30-min HIIT sessions with 3 adults with DD. Results demonstrated increases in HR from below to within the prescribed range in all 3 participants. For 1 participant, weight decreased by 10.8 pounds during the 9-week program. Implications include that lottery systems increase exercise intensity with adults with DD, that HR during exercise can be reliably controlled using a lottery system, and that similar programs may result in health benefits.
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References
Allen, L. D., & Iwata, B. A. (1980). Reinforcing exercise maintenance: Using existing high-rate activities. Behavior Modification, 4(3), 337–354. https://doi.org/10.1177/014544558043004.
American Heart Association. (2015). Know your target heart rates for exercise, losing weight and health. Retrieved from https://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates
Barlow, P., Reeves, A., McKee, M., Galea, G., & Stuckler, D. (2016). Unhealthy diets, obesity and time discounting: A systematic literature review and network analysis. Obesity Reviews, 17(9), 810–819. https://doi.org/10.1111/obr.12431.
Bennett, F., Eisenman, P., French, R., Henderson, H., & Shultz, B. (1989). The effect of a token economy on the exercise behavior of individuals with Down syndrome. Adapted Physical Activity Quarterly, 6(3), 230–246. https://doi.org/10.1123/apaq.6.3.230.
Centers for Disease Control and Prevention. (2019). Disability and obesity. Retrieved from https://www.cdc.gov/ncbddd/disabilityandhealth/obesity.html
Cervantes, C. M., & Porretta, D. L. (2010). Physical activity measurement among individuals with disabilities: A literature review. Adapted Physical Activity Quarterly, 27(3), 173–190. https://doi.org/10.1123/apaq.27.3.173.
Critchfield, T. S., & Kollins, S. H. (2001). Temporal discounting: Basic research and the analysis of socially important behavior. Journal of Applied Behavior Analysis, 34(1), 101–122. https://doi.org/10.1901/jaba.2001.34-101.
De Luca, R. V., & Holborn, S. W. (1985). Effects of a fixed-interval schedule of token reinforcement on exercise with obese and non-obese boys. The Psychological Record, 35(4), 525–533.
De Luca, R. V., & Holborn, S. W. (1990). Effects of fixed-interval and fixed-ratio schedules of token reinforcement on exercise with obese and nonobese boys. The Psychological Record, 40(1), 67–82 Retrieved from https://link.springer.com/journal/40732.
De Luca, R. V., & Holborn, S. W. (1992). Effects of a variable-ratio reinforcement schedule with changing criteria on exercise in obese and nonobese boys. Journal of Applied Behavior Analysis, 25(3), 671–679. https://doi.org/10.1901/jaba.1992.25-671.
Dixon, M. R., Horner, M. J., & Guercio, J. (2003a). Self-control and the preference for delayed reinforcement: An example in brain injury. Journal of Applied Behavior Analysis, 36(3), 371–374. https://doi.org/10.1901/jaba.2003.36-371.
Dixon, M. R., Rehfeldt, R. A., & Randich, L. (2003b). Enhancing tolerance to delayed reinforcers: The role of intervening activities. Journal of Applied Behavior Analysis, 36(2), 263–266. https://doi.org/10.1901/jaba.2003.36-263.
Eckard, M. L., Kuwabara, H. C., & Van Camp, C. M. (2019). Using heart rate as a physical activity metric. Journal of Applied Behavior Analysis. https://doi.org/10.1002/jaba.581.
Epstein, L. H., Wing, R. R., Thompson, J. K., & Griffin, W. (1980). Attendance and fitness in aerobics exercise: The effects of contract and lottery procedures. Behavior Modification, 4(4), 465–479. https://doi.org/10.1177/014544558044003.
Ferster, C. B., & Skinner, B. F. (1957). Schedules of reinforcement. New York, NY: Appleton-Century-Crofts. https://doi.org/10.1037/10627-000.
Gibala, M. J., & McGee, S. L. (2008). Metabolic adaptations to short-term high-intensity interval training: A little pain for a lot of gain? Exercise and Sport Sciences Reviews, 36(2), 58. https://doi.org/10.1097/JES.0b013e318168ec1f.
Hardy, O., Worley, G., Lee, M. M., Chaing, S., Mackey, J., Crissman, B., & Kishnani, P. S. (2004). Hypothyroidism in Down syndrome: Screening guidelines and testing methodology. American Journal of Medical Genetics, 124A(4), 436–437. https://doi.org/10.1002/ajmg.a.20356.
Hartmann, D. P., & Hall, R. V. (1976). The changing criterion design. Journal of Applied Behavior Analysis, 9(4), 527–532. https://doi.org/10.1901/jaba.1976.9-527.
Hausman, N. L., & Kahng, S. (2015). Treatment of pediatric obesity: An opportunity for behavior analysts. In H. S. Roane, J. L. Ringdahl, & T. S. Falcomata (Eds.), Clinical and organizational applications of applied behavior analysis (pp. 303–319). Cambridge, MA: Academic Press.https://doi.org/10.1016/B978-0-12-420249-8.00013-7.
Herrnstein, R. J. (1961). Relative and absolute strength of response as a function of frequency of reinforcement. Journal of the Experimental Analysis of Behavior, 4(3), 267–272. https://doi.org/10.1901/jeab.1961.4-267.
Jensen, M. T., Suadicani, P., Hein, H. O., & Gyntelberg, F. (2013). Elevated resting heart rate, physical fitness and all-cause mortality: A 16-year follow-up in the Copenhagen Male Study. Heart (British Cardiac Society), 99(12), 882–887. https://doi.org/10.1136/heartjnl-2012-303375.
Kazdin, A. E. (1982). Single-case research designs: Methods for clinical and applied settings. New York, NY: Oxford University Press.
Kim, D. D., & Basu, A. (2016). Estimating the medical care costs of obesity in the United States: Systematic review, meta-analysis, and empirical analysis. Value in Health, 19(5), 602–613. https://doi.org/10.1016/j.jval.2016.02.008.
Krentz, H., Miltenberger, R., & Valbuena, D. (2016). Using token reinforcement to increase walking for adults with intellectual disabilities. Journal of Applied Behavior Analysis, 49(4), 745–750. https://doi.org/10.1002/jaba.326.
Laursen, P. B., & Jenkins, D. G. (2002). The scientific basis for high-intensity interval training: Optimising training programmes and maximising performance in highly trained endurance athletes. Sports Medicine (Auckland, New Zealand), 32(1), 53–73. https://doi.org/10.2165/00007256-200232010-00003.
Li, A., Curiel, H., Ragotzy, S., & Poling, A. (2018). Using a lottery to promote physical activity by young adults with developmental disabilities. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-018-00292-8.
Magge, S. N., O’Neill, K. L., Shults, J., Stallings, V. A., & Stettler, N. (2008). Leptin levels among prepubertal children with Down syndrome compared with their siblings. The Journal of Pediatrics, 152(3), 321–326. https://doi.org/10.1016/j.jpeds.2007.08.008.
Mayo Clinic Staff. (2019). Exercise intensity: How to measure it. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887
Melville, C. A., Cooper, S.-A., Morrison, J., Allan, L., Smiley, E., & Williamson, A. (2008). The prevalence and determinants of obesity in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 21(5), 425–437. https://doi.org/10.1111/j.1468-3148.2007.00412.x.
Michael, J. (1982). Distinguishing between discriminative and motivational functions of stimuli. Journal of the Experimental Analysis of Behavior, 37(1), 149–155. https://doi.org/10.1901/jeab.1982.37-149.
Michael, J. (1993). Establishing operations. The Behavior Analyst, 16(2), 191–206. https://doi.org/10.1007/bf03392623.
Patja, K., Iivanainen, M., Vesala, H., Oksanen, H., & Ruoppila, I. (2000). Life expectancy of people with intellectual disability: A 35-year follow-up study. Journal of Intellectual Disability Research, 44(Part 5), 591–599. https://doi.org/10.1046/j.1365-2788.2000.00280.x.
Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes, and they will come: Contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68(2), 250–257. https://doi.org/10.1037//0022-006x.68.2.250.
Petry, N. M., Tedford, J., Austin, M., Nich, C., Carroll, K. M., & Rounsaville, B. J. (2004). Prize reinforcement contingency management for treating cocaine users: How low can we go, and with whom? Addiction (Abingdon, UK), 99(3), 349–360. https://doi.org/10.1111/j.1360-0443.2003.00642.x.
Ramos, J. S., Dalleck, L. C., Tjonna, A. E., Beetham, K. S., & Coombes, J. S. (2015). The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: A systematic review and meta-analysis. Sports Medicine, 45(5), 679–692.https://doi.org/10.1007/s40279-015-0321-z.
Roy, B. A. (2015). Monitoring your exercise intensity. ACSM’s Health & Fitness Journal, 19(4), 3. https://doi.org/10.1249/FIT.0000000000000128.
Schweitzer, J. B., & Sulzer-Azaroff, B. (1988). Self-control: Teaching tolerance for delay in impulsive children. Journal of the Experimental Analysis of Behavior, 50(2), 173–186. https://doi.org/10.1901/jeab.1988.50-173.
Shiraev, T., & Barclay, G. (2012). Evidence based exercise—Clinical benefits of high intensity interval training. Australian Family Physician, 41(12), 960–962 Retrieved from https://www.racgp.org.au/afp.
Sweeney, A. M., & Culcea, I. (2017). Does a future-oriented temporal perspective relate to body mass index, eating, and exercise? A meta-analysis. Appetite, 112, 272–285. https://doi.org/10.1016/j.appet.2017.02.006.
Tapper, K. (2005). Motivating operations in appetite research. Appetite, 45(2), 95–107. https://doi.org/10.1016/j.appet.2005.05.002.
Thyer, B. A., Irvine, S., & Santa, C. A. (1984). Contingency management of exercise by chronic schizophrenics. Perceptual and Motor Skills, 58(2), 419–425. https://doi.org/10.2466/pms.1984.58.2.419.
Todd, T., & Reid, G. (2006). Increasing physical activity in individuals with autism. Focus on Autism and Other Developmental Disabilities, 21(3), 167–176. https://doi.org/10.1177/10883576060210030501.
Trapp, E. G., Chisholm, D. J., Freund, J., & Boutcher, S. H. (2008). The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. International Journal of Obesity, 32(4), 684–691. https://doi.org/10.1038/sj.ijo.0803781.
Viana, R. B., Naves, J. P. A., Coswig, V. S., de Lira, C. A. B., Steele, J., Fisher, J. P., & Gentil, P. (2019). Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT). British Journal of Sports Medicine, 53(10), 655–664. https://doi.org/10.1136/bjsports-2018-099928.
Volpp, K. G., John, L. K., Troxel, A. B., Norton, L., Fassbender, J., & Loewenstein, G. (2008). Financial incentive-based approaches for weight loss: A randomized trial. JAMA: Journal of the American Medical Association, 300(22), 2631–2637. https://doi.org/10.1001/jama.2008.804.
Washington, W. D., Banna, K. M., & Gibson, A. L. (2014). Preliminary efficacy of prize-based contingency management to increase activity levels in healthy adults. Journal of Applied Behavior Analysis, 47(2), 231–245. https://doi.org/10.1002/jaba.119.
Watson, P. J., & Workman, E. A. (1981). The non-concurrent multiple baseline across-individuals design: An extension of the traditional multiple baseline design. Journal of Behavior Therapy and Experimental Psychiatry, 12(3), 257–259. https://doi.org/10.1016/0005-7916(81)90055-0.
Weltman, A., Weltman, J., Rutt, R., Seip, R., Levine, S., Snead, D., et al. (1989). Percentages of maximal heart rate, heart rate reserve, and V̇O2peak for determining endurance training intensity in sedentary women. International Journal of Sports Medicine, 10(3), 212–216. https://doi.org/10.1055/s-2007-1024903.
World Health Organization. (2010). Global recommendations on physical activity for health. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK305057/
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The authors would like to thank Heather Lewis for her thoughtful comments on an earlier version of this manuscript.
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Research Highlights
• Of adults over the age of 20 in the United States, 71.6% are overweight or obese, with individuals diagnosed with developmental disability (DD) at increased risk.
• Lottery reinforcement systems have been effective in promoting physical fitness in typically developing populations and participants with DD.
• High-intensity interval training (HIIT) is an exercise procedure with strong empirical support, but it has not been studied with individuals with DD.
• A lottery system was implemented with 3 adults with DD to systematically shape heart rate during exercise from below to within the prescribed range for HIIT.
• Participants increased their heart rate during HIIT by 37%, 38%, and 52% during a 9-week implementation of the lottery reinforcement system.
• Weight was tracked throughout the experiment in 1 participant, resulting in a 10.8-pound reduction
Appendices
Appendices
Baseline Script
“I would like you to use the treadmill for 10 minutes at whatever speed you choose. I will be watching and occasionally writing things down. If you use the treadmill for the entire 10-minute period, you will receive a token, which can be used to purchase one of the lottery tickets in our prize box. Please begin whenever you are ready.”
Treatment Script
“Today, your target heart rate is [target]. For the first 6 minutes, you can walk at whatever speed you choose. I will then ask you to raise your heart rate to [target]. You will have 2 minutes to get your heart rate to [target]. Once you reach your target, you must keep your heart rate at [target] for the next 2 minutes in order to earn a token. This token can be used to purchase one of the lottery tickets from our prize box. Please begin whenever you are ready.”
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May, B.K., Treadwell, R.E. Increasing Exercise Intensity: Teaching High-Intensity Interval Training to Individuals with Developmental Disabilities Using a Lottery Reinforcement System. Behav Analysis Practice 13, 826–837 (2020). https://doi.org/10.1007/s40617-020-00428-9
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DOI: https://doi.org/10.1007/s40617-020-00428-9