Routine Exercise: Achieving Better Health with Autism
With each click, swipe, and scroll through our news feeds, new tips, trends, and techniques for achieving better health make it impossible to ignore what we already know to be true: Along with proper diet and adequate sleep, routine exercise is one of the keys to a maintaining a healthy lifestyle. However, due to the cognitive, emotional, and sensory challenges that inhibit their path, adopting a healthy lifestyle can be difficult for individuals on the autism spectrum.
Yet, although impaired executive functioning can inhibit self-control, individuals with autism spectrum disorder (ASD) can use exercise as a tool for self-calming, increasing focus and attention, and habituating healthy behaviors. As the discipline, commitment, and perseverance required for maintaining a healthy lifestyle foster personal empowerment, adopting exercise as an essential part of one’s daily routine could enhance motivation, inspire an appreciation for a challenge, and forge a pathway to self-regulation for individuals with ASD.
Self-regulation is a form of self-control that uses thinking and feeling to modulate behavior. When exercise modulates the rate and intensity of our cardiovascular response, neurochemical changes improve our mental clarity and enhance our emotional stability. As our psychological status gradually improves, so, too, does our ability to regulate our thoughts and feelings, allowing us to more effectively process information, complete task demands, and achieve desired outcomes.
Although exercise can cause varying degrees of stress to our physical systems, routine engagement in physical exercise can create opportunities for individuals on the spectrum to develop receptive and expressive communication abilities, enhance self and social awareness, and apply strategies for self-management. When ‘get up and get moving’ becomes an essential part of their adaptive daily living routine, individuals with ASD are more likely to use the structured framework of a routine exercise to become more empowered, accountable agents of their wellbeing.
We know that exercise is a critical variable in the equation for good health. But how much exercise is considered enough? The American College of Sports Medicine recommends a minimum of 150 minutes of moderate-intensity exercise on three days per week for general health and fitness. Given time constraints in our daily schedules, this recommendation can be arranged in a variety of ways; for example, participating in several brief routines that equal to 150 minutes, such as 30 minutes on five days per week or 50 minutes on three days per week, is considered acceptable for maintaining an adequate degree of health and fitness.
Less than 150 minutes of exercise per week can contain some health benefit, although to a lesser degree. An exercise program that includes cardiovascular (e.g., walking, running, swimming), strength (e.g., free weights, resistance machines), and flexibility (e.g., stretching, yoga) activities performed at intensities greater than those in daily living routines can have significant, positive health benefits, such as decreasing resting heart rate, reducing body fat and minimizing the risk of heart disease. As the individual observes gradual changes in body composition, he/she internalizes a greater sense of control over health outcomes—an empowering first step for individuals with ASD to begin to embrace exercise as an effective, “go-to” self-regulation tool.
As our exercise routines gradually condition our bodies over time, changes in our neurochemical response patterns lead us to become less ‘reactive’ and more ‘responsive’ to situational challenges, which can dramatically decrease stress levels and enhance mental organization and mood. As our bodies adapt to the demands of exercise, gradual increases in the frequency, intensity, and duration of our exercise session can boost mental clarity, emotional resiliency, and behavioral control. While internalizing exercise habits, it is especially important to consider the quality (e.g., safe, fun, successful) of the exercise session, as positive exercise experiences have been linked to stronger intentions to continue to exercise.
Although individuals on the spectrum tend to respond better to an individual (e.g., minimally distractive) programming than group (e.g., potentially distractive) programming, situational challenges that occur within the context of the fitness environment offer opportunities to improve attentional control and enhance scanning, tracking, and safety awareness abilities. Whether in the gym, residential, or outdoor settings, the exercise experience provides countless opportunities for individuals to develop the adaptive life skills and functional independence that support a successful integration into the community.
Cortisol, the human stress hormone, has been observed at considerably higher levels in children with ASD than in children without ASD. Excess cortisol in the bloodstream can negatively impact fat, protein, and sugar metabolism, leading to chronic conditions such as diabetes and heart disease. High levels of stress can cause cortisol imbalances, which have been linked to high blood pressure, immunosuppression, and chronic behavioral challenges.
Likewise, perseverative thoughts and negative mood states can impair hunger and satiety signaling, increasing the impulses that cause overconsumption. However, routine exercise can stimulate the reward response, which can help individuals with ASD to increase emotional control, decrease stress, and replace anxiety, tension, and fatigue with calm, composure, and revitalized energy. Given the idea of exercise as a “drug”, health professionals continue to highlight physical activity as an effective adjunct therapy to pharmacological approaches in the treatment of depression, anxiety, and chronic stress.
The exercise setting contains many opportunities for individuals with ASD to upregulate (e.g., when under-responsive) or downregulate (e.g., when over-responsive) two sensorimotor domains—the proprioceptive and vestibular systems. Another system, the tactile system, is equally vital to sensory processing and integration for individuals on the spectrum; however, decreasing tactile defensiveness can be achieved through physical contact with exercise apparatus, such as when gripping free weight and cardio machine handles.
As the individual learns how to manually adjust the rate, intensity, and duration of the exercise stimulus, s/he can eventually predict, control, and adapt to the sensory input, which can help to reduce impulsivity, minimize stereotypy, enhance safety awareness, and promote adaptation to other, more challenging sensory experiences.
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Pushing and pulling against fixed (e.g., same weight at different points in the movement) and variable (e.g., different weight at different points in the movement) resistance forces can dynamically activate the proprioceptive system—or, the sensory receptors in the muscle and joint complexes. For individuals on the spectrum, delays in achieving specific developmental milestones can lead to impaired motor planning, movement execution, and sensory processing and integration, all of which can significantly inhibit proprioceptive feedback regulation.
However, by independently adjusting the volume, intensity, and duration of the exercise stimulus, individuals with ASD can improve motor function and self-regulate the flow of sensory information into the muscles and joints. Resistance activities that involve slow, dynamic movement through a full range of motion can provide opportunities for individuals to experience the passive and active proprioceptive effects that ultimately enhance strength, muscularity, flexibility, and functional joint stability.
Movement and balance stimulate the receptor mechanisms of the vestibular system—or, the sensory receptors located in the inner ear. As the individual strives to determine her/his location in space and the rate at which s/he is moving within that space, the extent to which s/he seeks vestibular feedback will depend on her/his tolerance for motion.
In the fitness setting, Stairmaster climbing, elliptical trainer gliding, treadmill walking and running, bike pedaling, rope jumping, and trampoline bouncing represent examples of opportunities for individuals to simultaneously engage in cardiovascular activity while achieving varying degrees of proprioceptive and vestibular input. As a safety precaution, individuals should be encouraged to learn how to independently grade the amount of input they receive by carefully adjusting the rate and/or intensity of the motion to meet their sensory needs.
In one dynamic exercise encounter, individuals with ASD can enhance metabolic function, promote executive function, decrease stress responsivity, facilitate sensory processing, and independently achieve a state of self-regulation. In instances in which the gym-based exercise experience fails to support the individual’s unique sensory needs, parents and caregivers are strongly encouraged to look beyond the gym setting and explore complementary and alternative exercise modalities, such as yoga, tai chi, Qigong, and green exercise interventions.
The slow, mindful movements associated with Eastern movement practices can help to downregulate nervous system hyperactivity and promote calm, balance, and coordination. By contrast, the cardiovascular impact of high-intensity exercise programs such as Zumba can dramatically enhance body composition, while upregulating an under-responsive sensorimotor system through movement and music. Ultimately, the idea that “each individual with autism is unique” suggests a need to adopt a person-centric view of the exercise encounter—that is, an experience that meets the individual’s cognitive, affective, and sensory needs and that promotes a more independent, self-regulated pathway to optimal health and wellbeing.
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This article was featured in Issue 77 – Achieving Better Health with ASD