If your child has a disability, you may wonder how much he or she should exercise, and what kinds of physical activity are appropriate.
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In the United States, more than one-third of children and youth are overweight or obese, which have been defined as abnormal or excessive fat accumulation that may impair physical and psychosocial health and can lead to medical conditions including hypertension, diabetes, fatty liver disease and depression.
It is well documented that physical inactivity leads to obesity and related chronic health conditions in children with and without disabilities. It is recommended that children 5 to 17 should engage in at least 60 minutes of moderate to vigorous intensity of physical activity daily, regardless of gender, race, ethnicity or income level.
But what does moderate to vigorous activity mean? Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. It includes playtime, games, sports, chores, recreation, physical education, and planned exercise in the context of family, school and community activities. Accumulation of the recommended 60 minutes can be spread throughout the day, such as 30 minutes of playtime and 30 minutes of household chores.
Vigorous activity intensity refers to activities that should be aerobic in nature — such as taking a dance class or playing a sport that increases the heart rate at a level greater than resting heart rate. Increasing the amount of physical activity helps prevent weight gain and provides other positive health outcomes, including improved physical and mental health.
And what about children with disabilities?
Evidence indicates that children with disabilities do not meet the recommended 60 minutes per day of moderate to vigorous activity and are 4.5 times less active than children without disabilities. Compared with their typically developing peers, children with disabilities tend to engage more in sedentary pursuits, and are at three to six times greater risk for obesity. Increasing physical activity in children with disabilities is therefore important for reducing the prevalence of obesity as well as a number of secondary conditions or impairments, and has become a global public health priority.
Schools are important settings where children can engage in health-promoting physical activity, and a recent report from the Institute of Medicine suggests that although schools should provide at least half of the 60 minutes of daily recommended activity, more research is needed to understand activities for children with diverse types of disabilities during school time. In 2015, a study using accelerometers during PE and recess reported that the children with intellectual disabilities did not meet recommended levels for activity in school settings. Various studies have reported that regardless of disability type, these children tend to spend a small amount of school time in moderate to vigorous activity and a great amount in sedentary pursuits.
Strong evidence is emerging that for children with developmental disabilities such as Down syndrome and cerebral palsy, aerobic and resistance training programs are effective in improving physical fitness and achieving weight reduction. Evidence on the effects of physical activity on obesity in children with Autism Spectrum Disorder (ASD) is less clear. However, evidence exists that promoting activity and addressing motor deficiencies in children with ASD may indirectly affect their core social communication impairments by providing greater opportunities for socialization with peers, better attentional focus, and improved general motor performance.
The following are examples of activities for children and adolescents with disabilities:
▪ Aerobic exercise programs. Jogging, walk/run interval training, cycling, swimming, treadmill training, and many commercial exergames (i.e. Wii Dance).
▪ Resistance exercise programs. In children younger than 10, calisthenics and activities such as jumping, climbing and throwing. In children over 10, a strengthening program for muscles of the upper and lower extremities and trunk using free weights, elastic bands and body weight resistance. Machines such as leg press, shoulder press, and chest press with light resistance can be used with caution and supervision.
▪ Flexibility and neuromuscular training programs. Muscle stretching exercises for major arm and leg muscles, therapeutic horseback riding, aquatic exercises, yoga, tai-chi, and other martial arts programs.
Healthcare workers across disciplines should help increase physical activity and provide exercise recommendations for children with disabilities. Motor and physical activity-related goals should be included and addressed, when possible, with the young people with disabilities and their caregivers. Frequency, intensity, time, and type of activity should be determined for each individual by a licensed health care provider, such as a physical or occupational therapist.
For more information you can contact one of the University of Miami Health System physical and occupational therapy clinic locations by visiting http://hrld.us/2DVM2eL.
Martha H. Bloyer, PT, DPT, PCS, is a board certified pediatric clinical specialist in the Department of Physical Therapy at the University of Miami Miller School of Medicine.