Whether in the gym, residential, or outdoor setting, engagement in routine exercise can help individuals on the autism spectrum to dramatically improve their physical, mental, emotional, and social wellbeing. As time spent in the fitness setting creates opportunities to develop communication skills, facilitate sensory processing, and enhance social awareness, exercise task demands gradually transform into fun, motivating elements of a sustainable, healthy lifestyle for the individual.
Yet, despite the many ways in which the exercise experience can positively impact global health and wellbeing, there are several physical, psychological, and environmental considerations that can significantly hinder the exercise experience for individuals with autism spectrum disorder (ASD). Given low tone substrate, sensory hyperstimulation, impulse control, behavioral rigidity, sleep issues, and medication interactions as common concerns faced by individuals on the spectrum, the following points should be taken into consideration prior to the transition into the fitness domain to ensure a safe and successful exercise experience.
Low Tone Substrate
Given limitations in core strength and spinal stability experienced by many individuals on the spectrum, special attention should be given to the potential for hypotonia—or, low muscle tone substrate. To prevent muscular imbalances and injury during strength training, individuals with ASD who are new to the exercise experience should avoid the use of unstable forms of resistance (e.g., free weights) and, instead, use stable forms of resistance (e.g., resistance machines) for the first three to six months of program participation.
If the individual routinely adheres to her/his exercise program, such routines will allow for slow, gradual neuromuscular adaptations to the resistance stimulus, which promote functional strength, sensory integration, and safety awareness. After six months has elapsed, parents, caregivers, and members of the individual’s treatment team can make a clinical determination as to whether the individual is prepared to incorporate free weights and other, less stable resistance forces into their training program. Regardless of the individual’s physical condition, he/she should be encouraged to continually self-monitor her/his biomechanical form (e.g., posture) and function (e.g., slow, controlled movement) in order to optimize safety and enjoyment.
Given challenges associated with managing unexpected sensory experiences4, the exercise environment can contain an array of sensory aversions for individuals with ASD. In the gym setting, the contact of steel plates, dropped weights, and the simultaneous whirring of fitness machines can produce highly aversive, if not excruciating, sensory experiences for individuals with auditory hyperacuities5. In addition, many gyms use fluorescent lighting, which has been shown to emit pulsing vibrations that can cause photosensitivity, sensory discomfort, and behavioral challenges in many individuals on the spectrum.
For individuals who are prone to subclinical or acute seizures, breaks that allow for psychological de-escalation should be offered as frequently as necessary. To minimize sensory defensiveness and establish realistic expectations of the exercise experience, parents and caregivers should make every effort to prepare individuals for exposure to the exercise setting through social stories in a preferred format (e.g., PowerPoint, video, audio story) that support the individual’s unique learning style7. In instances in which it is impossible to adequately prepare the individual for the occurrence of undesirable sensory events (e.g., contractors performing unscheduled maintenance in the gym), the individual should be given the option to stay or leave the facility. In such cases, alternative exercise settings, such as outdoor spaces that lack aversive stimuli, may prove to support a more enjoyable exercise experience.
Given behavioral control as a challenge for many individuals with ASD, sensory challenges, social interactions, and other distractive stimuli in the gym setting can inhibit the level of impulse control required to delay gratification and ensure the individual’s safety9. To help the individual to decrease impulsive tendencies, parents, caregivers, and gym staff members are encouraged to establish clear expectations about appropriate conduct in the gym setting, reward positive behavior that occurred within the exercise session, and encourage the individual to independently engage in strategies that support self-regulation. As the individual becomes increasingly familiar with the exercise environment, distractions and impulsive urges may continue to arise; however, such challenges can be used as teachable moments that help to foster autonomy, competence, effortful control, and positive participation within the exercise experience.
For many individuals on the spectrum, routine can be a double-edged sword. In one sense, fixed behavioral patterns can create a predictable structure, which can promote familiarity and reduce stress. Yet, given a tendency toward sameness in many individuals with ASD, fixed routines may not only induce boredom, disinterest, and lack of enjoyment in specific exercise task demands, but can promote restricted patterns of interest and behavioral inflexibility.
Although establishing a fixed routine may benefit learning and awareness in the initial stages of program participation for the individual, changing the order of exercises or changing the day of the week for targeting a specific muscle group can stave off boredom and promote continual interest in exercise20. By offering a variety of exercise programming options that periodically change over time, individuals with ASD can increase cognitive flexibility and decrease behavioral rigidity, as they expand their range of preferred activities and become more willing to undertake exciting, new exercise challenges.
Poor sleep quality has been linked to significant challenges in emotion regulation21. For individuals with ASD, dysregulated sleep patterns could further compromise existing sensory processing and integration issues and lead to an undesirable exercise experience. When fatigue is apparent in the individual, the intensity (e.g., rate, resistance) of her/his exercise efforts should always mirror her/his current capacity to adhere to exercise task demands. In such instances, exercise should fall at the less challenging end of the individual’s current ability range and include extended rest periods in between exercises to ensure adequate recovery time.
For example, the individual might be considered successful if he/she were to complete even the fewest number of repetitions in a set, such as completing five repetitions in a 5-10 repetition set of chest presses. Likewise, reducing the speed or intensity on a treadmill, elliptical, or bike during instances of fatigue would ensure that the individual experiences comfort and capability, not frustration and despair. By focusing on performance quality, not quantity, the exercise experience can be shaped to support the levels of confidence, competence, and comfort that promote feelings of success—regardless of the individual’s current status.
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Given the extent to which a single bout of exercise can induce pleasure, inspire motivation, and stimulate a sense of reward, research continues to highlight the positive impact of routine exercise as a non-pharmacological alternative to managing anxiety and other psychiatric conditions22. However, consideration should be given to the interaction between real medications and the rate and intensity of the exercise event for individuals with ASD. Although individuals may feel empowered by the freedom of choosing their exercise intensity level23, high-intensity forms of cardio (see anaerobic exercise) could lead to shortness of breath, hypertension, and challenges in returning the heart rate response to its resting baseline level24.
During an engagement in both cardio or resistance exercise, deconditioned individuals can experience high levels of cardiorespiratory and cardiovascular stress, which can lead to light-headedness, dizziness, and rapid-onset fatigue3. If the individual is prescribed psychotropic medications for mood regulation (e.g., depression, anxiety) or behavior management (e.g., aggression, self-injury), parents and caregivers are strongly encouraged to consult with the individual’s prescribing physician prior to participation in exercise to determine whether specific guidelines for exercise frequency, intensity, tempo, or duration are contraindicated.
Prior to engagement, specific biological, psychological, and contextual factors must be taken into consideration to ensure that individuals with ASD can enjoy the wide-ranging benefits of the exercise experience. However, within the many challenges that present during the exercise encounter, golden opportunities exist for individuals with ASD to ‘exercise’ adaptive life skills. While an individual with low tone substrate observes biomechanical form, he/she has an opportunity to develop strong self-awareness skills. Likewise, in instances of fatigue or sensory hyperstimulation, opportunities emerge for the individual to pro-socially communicate her/his needs.
When environmental distractions in the fitness setting cause impulsivity, the individual has an opportunity to access and apply her/his strategies for self-management. When boredom and disinterest begin to set in, the individual has the opportunity to collaborate with a fitness professional to design an exciting new program that challenges—and ultimately enhances—her/his current abilities. As the individual engages in dialogue about her/his fitness encounter, he/she decreases isolation, enhances accountability, and has opportunities to share her/his newfound expertise with friends who are new to the fitness experience. For parents and caregivers, creating an exercise experience that focuses on the individual’s unique communication, socialization, and sensory processing needs is the key to reframing exercise, not as a “chore,” but as a core value that supports a sustainable lifestyle.
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This article is second in a series of three. The first piece can be found in Issue 77.
This article was featured in Issue 79 – Managing Everyday Life