Functional Fitness For People With Autism and Developmental Disabilities.

I recently listened to a podcast regarding choosing the right functional fitness movements when training a person with Autism. In the world of Autism, like most other disabilities, the medical model focuses on therapeutic aides or recovery tools that are functional, and will optimally help the individual. The view is that there is a pathology that has to be corrected. However, the thing that got me really thinking about this topic was that the podcaster said that exercise programming for people with Autism has to be functional - meaning that the exercises chosen should correlate to some type of life benefit, kind of like a one-to-one objective benefit for that specific movement. Something about that didn't sit right with me, and it got me analyzing further into what functional fitness means to this population, and for everyone else as well. For those that don't know what functional fitness is, Crossfit is the leading example of what people think about when they think of functional fitness - typically, training programs that prioritize certain movements that have greater life impact over movements that have less overall impact. After I thought about it for a while, I had to disagree with the common thought out there by fitness professionals who work with people with special needs. To me, any type of fitness is truly functional by design for this group - and for everyone else for that matter.

On the surface, bicep curls would not be considered functional to Crossfit athletes. Seated leg extensions may be not considered as functional as goblet squats to Autism fitness coaches. At a very specific high level, or in very specific instances, certain exercises are more functional than others. For example, a professional body builder may train forearms, but that would be of little importance to a marathon runner or olympic swimmer. A basketball player may want to improve a vertical jump, and do variations of box squats, but wouldn't care as much about strengthening neck muscles as would a boxer or wrestler. Each specific sports niche has certain functional movements aimed at providing them optimal results in their specific elite field. But, I think what matters most is how you define functional movements or functional fitness, and consider what functionality is when it comes to overall health and activities of daily living for people with developmental disabilities, and the general population for that matter.

People with developmental disabilities are at increased risk of being inactive, overweight, experiencing difficulty with social situations, as well as typically have poor muscle tone, motor control, balance, dexterity, body awareness, and the list goes on and on. What we do know about exercise in general, is that it can increase functionality in all of these areas, as well as reduce long term health disease risks. Exercise can also increase bone density, improve mood and emotional regulation, and decrease negative behaviours in this population. So functionality, if defined as what will keep the person with Autism the healthiest the longest, to be able to age well in their senior years, to try to overcome neural issues and behavioural issues, to increase their capacity across activities of daily living, then any type of well balanced exercise program should meet this criteria. I think it's fundamentally more important to have these people get engaged with fitness and go to the gym, and to perform exercises they enjoy - more on this point later - than to design a program solely around perceived "functionality" of exercise movements. Granted, if you were to train a competitive athlete, or perhaps, your goal for the person with Autism was to be able to do long jump - then, you may consider functionally appropriate exercises to their sport. But, for the large majority of this population, getting them active, in the gym, eating well, and having them look forward to exercise is vastly more functional to them all around, than including or excluding specific movements based on perceived functionality by the coach or therapist. Behaviourally speaking, the side effects of getting this population engaged in physical fitness would be reduction in negative symptoms and behaviours, and increased positive symptoms and behaviours. Better overall physiological health, better motor control, improved concentration, improved mood and emotional regulation, increased ability for independence and increased social skills - these should be the true measures of functional fitness for this population, and indeed these are the benefits of a well rounded fitness program, regardless of the exercises picked or movement performed.

The other functional impact that fitness can have on this population - especially the younger or teen groups - is that it may enable them to physically catch up to their peers, or at the very least close the gap a little bit. This group tends to be delayed in various aspects of cognitive, social, as well as physical development when compared to same-aged peers. Neurotypical people their age are running, playing sports, climbing, jumping, horsing around with others, and the list of how they are more physically active and developed compared to their peers with Autism goes on. The fact that neurotypical peers are typically more physically developed than their peers with Autism cannot be explain solely on proprioception, neural, or muscle tone differences alone. It may be the difference lies in the fact that people with Autism are not encouraged to do activities at the same degree as their peers - and the gym can be an equalizer for them in this regard. The other major difference can be seen in the school systems definition of gym class for these two groups. During middle school and high school, neurotypical people engage in all kinds of sports and activities for physical education - track and field, gymnastics, swimming, weightlifting, team sports, calisthenics, etc. For people with developmental delays, middle school gym class consists of dancing, walking around a track, perhaps some yoga, playing with a parachute, maybe bouncing a ball, or doing group style aerobics like you would see Jane Fonda do on a video. In high school, this activity declines further - maybe a daily walk, or the odd team sports game once per semester, or maybe tossing around a bean bag. The point is that even in the education system there is a wide disparity in how this group is trained physically compared to their neurotypical peers - now there are numerous reasons behind this, notably appropriate funding, staff numbers, and training. But, this group starts to be physically de-conditioned after middle school - a time in life when their neurotypical peers are becoming more conditioned. And, with something you don't develop to its fullest, to have it start to degrade in the physical prime of life is a shame. The old saying if you don't use it, you lose it is true - and why should these kids lose what small advances they made in fitness, health, strength, coordination, and balance all before their 18th birthday? To me, this is largely preventable, but the onus is on the parents to engage their kids in physical fitness, and to not rely on the school system.

So getting back to my main point - ANY type of physical fitness regimen or exercise, is functional to this group. You shouldn't put so much effort on picking the correct exercise to do with this group in the gym, as you should put more effort on just getting them in a gym and exercising. Perhaps, a correct exercise for them to do is one they like to perform - this is a concept (often lost in the personal training world) taken from psychology: person centred therapy uses the proposition to start where the person is at, and Pivotal Response Therapy uses what interests the person to engage them in learning and branching out to different things. If you take an individual to the gym, and force them to do the leg press, especially if they absolutely hate the leg press, chances are small you will engage them and encourage them to come back to the gym at all. This is true of anybody, but especially a person with a developmental disability. Now, if you take a person to the gym and let them explore on their first time, and let them pick equipment to use (and show them how to use it properly), then you can increase the fun and enjoyment for them, and strongly increase the chance they will want to come back. From here, you can slowly branch out and have them try different things, or different movements, until you're able to build a repertoire of things for them to do that constitute an exercise program. Again, with the high likelihood that they will want to return to the gym, and keep working out in the future. The functionality of fitness is kept in the fact that the person IS exercising, thus improving their fitness level, musculature, bone density, coordination and balance, regulating mood, improving attention and concentration, and helping them both age with dignity and improve their ability to complete ADL's. THAT is functional fitness for this group. So what, if the first month the person is at the gym their routine is a hodge podge of unrelated activities? The fact that they're there at all, and enjoying the activity is what is functional. And, chances are the activities they are choosing to do at the gym are more beneficial and functional to them in the long run, rather than playing with a parachute or dancing around as they would be in PE class. Moral of the story is that any type of fitness is functional by true definition of the meaning of functional. Don't waste your time worrying about what equipment or exercise movement to do - just get them into the gym and let them try stuff they enjoy.

Now, the other aspect of functionality of fitness that is often overlooked is the social aspect. This group can often lack social connections, or lack the ability to form meaningful social relationships. Gyms are social environments, even if your'e like me and work out alone with your headphones on - chances are you will say hi and talk to at least one person each time you go to the gym, or you will start to form friendships with regular gym goers over time. The fact that working out at a gym gives this group a chance to form more social connections, and to practice social skills with neurotypical peers is huge. It gives them a chance to practice their social functional fitness, outside of their small circle of teachers, caregivers, therapists, and developmentally delayed peers. Honestly, this is a huge part of the feedback loop that will make them want to go back to the gym as well. There's a difference between going to an empty gym and working one on one with the same trainer/therapist each week, then going to a full gym, seeing new people each day, and interacting with everyone there. This also increases their inclusivity in the community.

One more note about functionality, and it may seem paradoxical. Think of neurotypical peers, and think of what they are doing and how they control their emotions - how they regulate themselves (although even neurotypical teenage peers have difficulty in this area, as do some adults). How do they get their stress and anxiety out? What do they do when they are pissed off? Now think of that, and think of what we teach to kids and teens (even adults) with developmental delays - we read them social stories, we say things like "keep your hands to yourself", or we say things like you need to "calm down" or "go to the green zone" - we treat them like they were in kindergarten. This is probably confusing and insulting to them if they are stressed, worried, or upset about something - think of how you would feel if someone did that to you. Now, the paradoxical effect may be to let them get their frustration and anger out in a physically appropriate way with exercise - I would be willing to bet that if given the chance to physically get their emotions out in a controlled and safe environment, they would calm down and they would get the added benefit of exercise as well. We even teach this to adults - if you're upset, go for a walk to blow off steam. I say give these kids something they can throw, hit, kick, or let them run around if they want. Let them vent their emotions and energy, but in a productive way. Instead of correcting the emotional issue with a story, or treating them like they were 5 years old, let them physically expel their energy and frustration - as this not only calms the mind, but it is good for the body as well. When they are at a state to cognitively process their emotions, after they've calmed down - then is the time for emotional regulation skills and social stories. This is an aspect of making fitness functional for them.

In summary, any type of fitness or exercise movement is functional to a degree. What is not functional is not engaging in physical activity at all, or not engaging the muscle or cardiovascular systems effectively. Hence, functional fitness is just really fitness. Spend more time focusing on getting exercise, making it enjoyable, and less on which specific workout to do. Your body moving in general is functional. Being sedentary is not. The profound lifelong effects for meaningful physical activity for this population should not be overlooked. It's unfortunate that on any given day across the country, more people with special needs are not in a gym, given the physical, mental, emotional, and social advantages this could offer them.

But why should you listen to me about his topic? I'm a Registered Social Worker, Certified Personal Trainer, I have worked with people with special needs, and I am a father of a 14 year old with Autism who works out with me regularly.

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Thank You,

Peter J Bucciachio