Increasing physical activity in young adults with autism spectrum disorders

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Highlights

  • Regular physical exercise is valuable.

  • Most people with autism spectrum disorders do not exercise regularly.

  • Walking is a good form of exercise.

  • Goal setting and reinforcement increased walking in five young adults with ASD.

  • The treatment was effective and socially valid and appears to deserve further investigation.

Abstract

Although regular physical exercise is clearly beneficial, many people with autism spectrum disorders do not exercise regularly. The present study used a multiple-baseline-across-participants design with a reversal to demonstrate that a treatment package comprising goal-setting and reinforcement substantially increased walking by young adults with autism spectrum disorders while at school. During the initial baseline condition participants were given pedometers to wear. Once each participant's number of steps stabilized, she/he sets daily goals for minimum number of steps taken and received access to valued objects or activities (reinforcers) for meeting those goals. By the end of the first treatment condition each of five participants was successfully meeting his or her goal and walking at or above 10,000 steps each day. Walking decreased when a return to baseline was implemented, then increased when treatment was reinstated. Social validity assessment indicated that both the participants and their teacher found the intervention highly acceptable. These findings suggest that simple strategies based on goal setting and reinforcement merit further investigation as interventions for increasing exercise.

Introduction

As indicated in a recent review (Lang et al., 2010) and a recent meta-analysis (Sowa & Meulenbroek, 2012), inducing physical exercise in people with autism spectrum disorders (ASD) has been shown to produce a substantial range of behavioral improvements, as well as increased physical fitness. Lang et al. provide a clear and concise summary of the 18 studies they reviewed:

A variety of exercise activities were employed (e.g., jogging, weight training, bike riding). Following the exercise interventions decreases in stereotypy, aggression, off-task and elopement were reported. Fatigue was not likely the cause of decreases in maladaptive behavior because on-task behavior, academic responding, and appropriate motor behavior (e.g., playing catch) increased following physical exercise. (p. 565).

It is interesting that each of the 18 studies focused on the beneficial effects of exercise on subsequent behavior, rather than on engendering a consistent pattern of regular physical activity per se. It is widely recognized that most people do not engage in sufficient physical exercise to confer health and other benefits (US Department of Health and Human Services, 2008), and it is also known that exercise levels are characteristically lower in people with ASD than in people without ASD (Drahelm, Williams, & McCubbin, 2002). The purpose of the present study was to examine a simple procedure for inducing young adults with ASD to walk long and often enough to meet or exceed minimum guidelines for aerobic activity. Although walking was not used as a form of exercise in any of the studies examined by Lang et al. (2010) or Sowa and Meulenbroek (2012), walking is a simple, convenient, and inexpensive way to exercise (Trosts, Owen, Bauman, Sallis, & Brown, 2002). Nearly everyone knows how to walk, so no special training is needed for this form of exercise, and walking requires only minimal equipment, in the form of comfortable shoes and clothing, so it is inexpensive. Moreover, walking can be easily and accurately quantified (in terms of steps taken) through the use of automated pedometers (Crowley-Koch and Van Houten, 2013, Iwane et al., 2000), which is an advantage in both research and everyday settings.

Although to the best of our knowledge no study in which walking was substantially increased in people with ASD has appeared, previous research has used behavioral interventions to increase the number of steps taken by sedentary adults (Kurti & Dallery, 2013), overweight adults (VanWormer, 2004), healthy, nonobese adults (Normand, 2008), and typically developing obese preschool children (Hustyi, Normand, & Larson, 2011). The main components of these interventions were goal setting with feedback and reinforcement. For example, Hustyi et al. (2011) demonstrated modest increases in steps taken by obese preschool children during 20-min sessions using goal setting and reinforcement. Half way through each session, the experimenter provided feedback to the participant and, if the daily goal was met, at the end of the session the participant took an item from a prize box. Kurti and Dallery (2013) used an online goal setting and feedback program for sedentary adults with no diagnostic label. If participants met their daily goals, which increased every 5 days, they received monetary rewards. For 5 of 6 participants, the number of steps increased substantially during treatment, eventually meeting national recommendations. These studies suggest that goal setting and reinforcement may be a viable treatment option for increasing the number of steps taken by individuals with ASD to a specified level, such as 10,000 steps per day, a level likely to have health benefits (Iwane et al., 2000). The present study examined the effects of such a procedure.

Section snippets

Participants and setting

Four men (herein called Billy, Casey, Charlie, and Peter, not their real names) and one woman (herein, Rose) volunteered for the study. All participants were between 21 and 26 years, were healthy, and were able to walk without difficulty. At the end of the study four participants had body mass index indices as calculated by the school nurse that placed them in the “obese” range as defined by the Centers for Disease Control and Prevention (2014); the other student's body mass index placed him in

Daily steps

Fig. 1 displays the number of steps taken every day by all participants, the mean number of steps taken daily by each participant in each condition (horizontal lines through the data points), and the daily goals during treatment (represented by bars). There were substantial differences across participants in the number of steps taken per day during the initial baseline condition and there was considerable within-participant variability in this measure. During treatment, the number of steps

Discussion

In the present study a treatment package comprising goal setting and reinforcement increased the number of steps taken each day by each of five young adult participants with ASD. By the end of the initial intervention condition all of the participants were walking 10,000 or more steps per day, which is generally recognized as sufficient exercise to confer health benefits (e.g., Iwane et al., 2000). Several prior studies, reviewed elsewhere (Lang et al., 2010, Sowa and Meulenbroek, 2012), have

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The reported data were collected as part of the first author's doctoral dissertation.

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