This study investigated the effects of participating in an educational exercise program on physical fitness and gross motor function (GMF) in adults with varying degrees of autistic spectrum disorder (ASD). The subjects consisted of 35 voluntary male participants between 20 and 29 years of age who were allocated to one of two groups: mild ASD (n=17) group and severe ASD (n=18) group. All selected tests for physical fitness, including body composition and GMF, have been used in previous studies. The results were as follows: first, with the exception of the basal metabolic rate, there were significant differences in the interaction of all other body composition variables. Second, there were significant differences in the interaction of almost all physical fitness variables, except for muscle strength. Finally, although there were significant differences in the interaction of all variables, except the locomotion skill for hopping, there were significant differences in the interaction of all variables of object control skill. Specifically, although the Δ% in the sum of locomotion skill in mild ASD group increased ~19.81%, that of severe ASD group decreased ~4.78%. The Δ% in the sum of object control skill in mild ASD group improved ~29.96%, while that of severe ASD group reduced ~15.2%. In conclusion, it is thought that these results are due to the better understanding of educational exercise and better performance of educational exercise in adults with mild ASD compared to adults with severe ASD.
The World Health Organization refers to the concept of disability as a loss of body structure or function, abnormality or impairment that implies restrictions on the activities of individuals in daily life (
An active educational exercise program can improve the health of children with disabilities and promote psychological stability. Many researchers have reported that participating in physical activity during educational exercise programs can provide psychophysiological benefits for children or adults with ASD (
In Korea, educational exercise programs for children with ASD are available at certain institutions, but it is unknown whether there are differentiated programs according to the level of disability. Also, most educational exercise programs, as well as exercise programs for people with disabilities, are primarily focused only on children. This has led to a lack of research pertaining to adults with ASD. In particular, if educational exercise programs in Korea are differentiated according to disability levels, more meaningful changes may result. Therefore, in order to solve the problem, this study analyzed the educational exercise program performed by adults with ASD and identified the differences in physical fitness and gross motor function (GMF) according to their severity of ASD.
Male adults between 20 to 29 years of age voluntarily participated in this study. Inclusion criteria consisted of having ASD and not having exercised regularly for over 6 months. Based on this criteria, 40 participants were screened and determined to be eligible for the study. However, five participants declined to participate. Finally, 35 participants took part in the study. The participants were divided into mild ASD group (n=17) and severe ASD group (n=18) depending on the symptom severity. Those with physical impairment or visual or hearing impairment were excluded. Furthermore, participants who were unable to be assessed or required to quit the study were excluded. Those who received any kind of medical treatment that is known to have an effect on physical condition or had any kind of major surgery for the past year prior to the beginning of this study were excluded. Additional reasons for exclusion included having a history of cerebrovascular or coronary arterial disease, uncontrolled hypertension, or impairment of a major organ. Comprehensive physical characteristics are shown in
This was a double-blind, controlled trial that was carried out in a research center from February 17, 2020 to May 8, 2020. The participants and their parents were encouraged and motivated to complete all of the tests. Advertisements were used to recruit the participants and an informed consent form was signed prior to enrollment. The parents of the participants also agreed to their family participating in this study by signing an informed consent form. This study was completed in compliance with the 2013 version of The Declaration of Helsinki and approved (2-7001793- AB-N-012019113HR) by the Institutional Review Board.
The bioelectrical impedance analysis method was used to measure the height and weight of the participants with an IOI353 Model (Jawon Medical, Seoul, Korea), which is a composition analyzer and segmental impedance device that has stainless steel interfaces for the electrodes. The participants stood upright by placing their feet on the foot electrodes without gripping the handles. Analysis of height and weight was measured before dinner and after voiding (
Before the test, an expert described the procedures and had the subjects do warm-ups. A 15-m shuttle run test was used to measure cardiopulmonary endurance. This test is a commonly used aerobic fitness test, which is also known as a beep or bleep test (
To measure flexibility, a sit and reach flexion test was administered. The equipment used included a test platform with a perpendicularly attached ruler (TKK1859, Takei Inc., Tokyo, Japan). In a seated position, the participants placed their heels against the test platform with their both feet approximately 5 cm apart. After taking a deep breath, the participants reached forward as they exhaled and extended their fingertips to the furthest possible point without bouncing their waists. They kept their knees fully extended and their head between their arms. The greatest distance after two attempts was recorded (
Grip strengths of both hands were measured to assess muscle strength. It was measured with a hand dynamometer (preferably the Jamar Hand Dynamometer #5030J1, Sammons Preston Rolyan, Bolingbrook, IL, USA) in a seated position. Participants sat in a seat with an armrest and had their shoulders positioned at 0° flexion, elbows at 90° flexion, and wrists in the vertical position between supination and pronation. Participants held the hand dynamometer with the middle phalanges resting in the middle. The hand dynamometer was squeezed 3 times with maximum force with 1 minute of recovery between attempts. This had to be done for both hands in case handedness was not self-evident (
To assess muscle power, a standing long jump was used. In a standing long jump, the participant begins at the starting line. Using their entire bodies, they jump as far as possible and the distance between the starting line and the landing point is measured. The test instructors performed long jump exercises and demonstrated how to jump in place. For this task, both groups of participants initially lacked comprehension. Later, some participants jumped beyond the target footstep, while others did not. Regardless, the distance was recorded. After landing, measurement errors can be caused from falling back or running forward. In preparation for this, the two measurements were quickly recorded quickly by two assistants. The maximum distance was recorded between a total of two measurements.
This study used the GMF scale-II (
Participants took part in a supervised educational exercise program twice a week (Tuesdays and Fridays) for 12 weeks as shown in
Microsoft Excel (Microsoft, Redmond, WA, USA) was used to input the results, and the technical statistics (mean±standard deviation) was calculated using IBM SPSS Statistics ver. 22.0 (IBM Co., Armonk, NY, USA). The Shapiro–Wilk test was used to check the distribution of data. Prior to analysis, we observed the difference between groups through Mann–Whitney
A total of 35 male adults voluntarily participated in this study (
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Most of the educational exercise programs related to ASD have only focused on children. The adult population, as well as the severity of ASD, were not taken into consideration by such intervention programs. Therefore, this study aimed to investigate physical fitness and GMF in adult participants with mild or severe ASD who took part in a 12-week educational exercise program. Upon completion of the experiment, this study found significant differences in the interaction of body composition and physical fitness variables, except muscle strength, when comparing between mild and severe ASD groups. This study also found that there were significant differences in the locomotion skill and object control skill of GMF between groups. These results suggest that individuals with more severe levels of ASD may have more difficulty in adapting to and understanding the educational exercise program while those with milder levels of ASD may have an easier time adapting to and understanding the program.
Many researchers have reported that adults with ASD are characterized by decreased physical, cognitive, and adaptive skills when compared to those without ASD. Moreover, they are often stereotyped with having challenging behaviors (
However, there was no significant difference in muscle strength between the two groups. This may be due to the fact that the educational exercise program mainly focused on developing endurance. The effect of fatigue is a factor that may influence such a result. A study by
To date, exercise programs for individuals with ASD have only been implemented in an educational environment, and not according to gender, age, or severity of disability. However, this study showed that adults with ASD who participated in the educational exercise program had differing results based on the severity of their disability. It would beneficial for future studies to investigate the effects of exercise on other types of disorders. Also, there is a need to research the mechanisms on how exercise positively influences behaviors. Gaining an understanding of this mechanism may lead to improvements in applying exercise to treat various levels of ASD and help practitioners develop more effective programs for people with ASD.
This study found that educational exercise programs have a positive effect on adults with ASD. However, it affects adults with ASD according to the severity of their disability. In other words, this study revealed that adults with ASD who participated in the educational exercise program showed differences in physical fitness and GMF according to the severity of their ASD. In conclusion, these results are thought to be due to the better understanding and performance of educational exercise in adults with mild ASD compared to severe ASD.
No potential conflict of interest relevant to this article was reported.
Differences of the Δ% of the sum of locomotion and object control skills of gross motor function in mild autism spectrum disorder group (mASD) and severe autism spectrum disorder group (sASD) between baseline and 12 weeks. ns, nonsignificant.
Physical characteristics of the participants
Variable | Group | |||
---|---|---|---|---|
Mild ASD (n=17) | Severe ASD (n=18) | |||
Age (yr) | 22.82±2.70 | 22.83±2.81 | −0.151 | 0.883 |
Height (cm) | 174.01±7.16 | 173.39±8.56 | −0.017 | 0.987 |
Weight (kg) | 73.02±12.63 | 72.09±10.32 | −0.066 | 0.961 |
Values are presented as mean±standard deviation.
ASD, autism spectrum disorder.
Bleep test’s table for cardiopulmonary endurance fitness
Level | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Shuttles | 7 | 8 | 8 | 8 | 9 | 9 | 10 | 10 | 10 | 11 | 11 | 12 | 12 | 12 | 13 | 13 |
Time/shuttle (sec) | 6.83 | 6.36 | 6.11 | 5.75 | 5.43 | 5.13 | 4.97 | 4.78 | 4.59 | 4.39 | 4.16 | 3.92 | 3.85 | 3.76 | 3.59 | 3.47 |
Total distance (m) | 105 | 225 | 345 | 465 | 600 | 735 | 885 | 1,035 | 1,185 | 1,350 | 1,515 | 1,695 | 1,875 | 2,070 | 2,265 | 2,460 |
Total time (min:sec) | 0:48 | 1:39 | 2:28 | 3:14 | 4:02 | 4:49 | 5:38 | 6:26 | 7:11 | 8:00 | 8:56 | 9:33 | 10:19 | 11:08 | 11:55 | 12:40 |
Educational play program
Item | Play and activity programs | Time (min) | Week |
---|---|---|---|
Warm-ups | Stretching | 5 | 1–12 |
| |||
Game | Catching a tail | 15 | 1–4 |
Playing tug-of-war | 15 | 1–4 | |
| |||
Floorball | Play for passing and receiving a ball | 15 | 1–4 |
Passing a ball (slapper, air pass) | 15 | 1–4 | |
Mini-short game | 15 | 5–8 | |
| |||
Basketball | Dribble (a hand dribble then both hands dribble) | 15 | 5–8 |
Pass (chest, overhand, one-hand, bound) | 15 | 5–8 | |
Shot (middle, layup, pass and shoot) | 15 | 5–8 | |
| |||
Inline skating | Skating adaptation (wearing, falling and standing) | 10 | 5–8 |
Walking with an expert | 5 | 5–8 | |
Pushing (kneeling, left or right foot push) | 15 | 9–12 | |
Turn (return target, turn left/right/front/back) | 15 | 9–12 | |
| |||
Jumping paly | Sprint, jump over obstacles, running jump | 20 | 9–12 |
High jump, triple jump | 20 | 9–12 | |
| |||
Cool-down | Stretching | 10 | 1–12 |
Comparative results of body composition
Item | Time (T) | Group (G) | Repeated ANOVA ( | |||
---|---|---|---|---|---|---|
|
| |||||
Mild ASD (n=17) | Severe ASD (n=18) | G | T | G*T | ||
Body weight (kg) | Pre | 73.02±12.63 | 72.09±10.32 | 0.842 | 0.245 | 0.001 |
Post | 70.87±10.05 | 73.26±10.14 | ||||
| ||||||
BMI (kg/m2) | Pre | 24.18±4.32 | 24.14±4.18 | 0.707 | 0.253 | 0.001 |
Post | 23.47±3.50 | 24.53±4.14 | ||||
| ||||||
Muscle mass (kg) | Pre | 51.47±6.97 | 51.61±6.62 | 0.920 | 0.005 | 0.013 |
Post | 52.26±7.12 | 51.66±6.56 | ||||
| ||||||
Fat mass (kg) | Pre | 21.75±8.20 | 24.14±6.99 | 0.209 | 0.227 | 0.001 |
Post | 21.24±7.25 | 25.09±6.40 | ||||
| ||||||
BMR (kcal/day) | Pre | 1,596.82±120.19 | 1,561.67±162.84 | 0.278 | 0.523 | 0.070 |
Post | 1,608.00±131.06 | 1,538.72±150.06 |
Values are presented as mean±standard deviation.
ANOVA, analysis of variance; ASD, autism spectrum disorder; BMI, body mass index; BMR, basal metabolic rate.
Comparative results of physical fitness
Item | Time (T) | Group (G) | Repeated ANOVA ( | |||
---|---|---|---|---|---|---|
|
| |||||
Mild ASD (n=17) | Severe ASD (n=18) | G | T | G*T | ||
Cardiopulmonary endurance (sec) | Pre | 6.09±0.33 | 6.13±0.31 | 0.006 | 0.007 | 0.001 |
Post | 6.59±0.35 | 5.95±0.40 | ||||
| ||||||
Flexibility (cm) | Pre | −6.21±3.89 | −6.33±3.34 | 0.001 | 0.001 | 0.001 |
Post | −0.54±2.99 | −7.68±2.80 | ||||
| ||||||
Strength (kg) | Pre | 17.19±4.59 | 15.78±5.10 | 0.264 | 0.001 | 0.732 |
Post | 19.44±4.23 | 17.66±3.79 | ||||
| ||||||
Endurance (rep.) | Pre | 14.29±2.52 | 13.28±2.11 | 0.596 | 0.001 | 0.001 |
Post | 15.76±2.54 | 11.44±1.79 |
Values are presented as mean±standard deviation.
ANOVA, analysis of variance; ASD, autism spectrum disorder.
Comparative results of gross motor function
Item | Time (T) | Group (G) | Repeated ANOVA ( | |||
---|---|---|---|---|---|---|
|
| |||||
Mild ASD (n=17) | Severe ASD (n=18) | G | T | G*T | ||
Locomotion skill | ||||||
Running | Pre | 4.71±2.02 | 4.78±2.60 | 0.347 | 0.005 | 0.008 |
Post | 6.12±1.36 | 4.83±1.82 | ||||
Galloping | Pre | 6.35±1.27 | 6.50±1.38 | 0.001 | 0.358 | 0.001 |
Post | 7.12±0.86 | 5.33±0.91 | ||||
Hopping | Pre | 5.88±1.36 | 6.06±1.63 | 0.640 | 0.006 | 0.081 |
Post | 6.82±1.13 | 6.28±1.02 | ||||
Leaping | Pre | 5.47±0.72 | 5.83±0.79 | 0.123 | 0.011 | 0.001 |
Post | 6.65±1.32 | 5.44±0.62 | ||||
Horizontal jumping | Pre | 3.29±2.85 | 2.39±2.66 | 0.047 | 0.081 | 0.006 |
Post | 4.47±2.43 | 2.11±1.75 | ||||
Sliding | Pre | 7.06±1.09 | 7.06±1.00 | 0.111 | 0.808 | 0.006 |
Post | 7.53±1.23 | 6.50±0.92 | ||||
| ||||||
Object (ball) control skill | ||||||
Striking | Pre | 3.59±1.00 | 3.39±1.38 | 0.004 | 0.163 | 0.002 |
Post | 4.71±0.99 | 2.94±1.21 | ||||
Dribbling | Pre | 6.06±2.30 | 7.06±1.59 | 0.870 | 0.318 | 0.005 |
Post | 7.29±0.85 | 6.44±1.34 | ||||
Catching | Pre | 4.88±1.36 | 4.89±1.13 | 0.005 | 0.390 | 0.001 |
Post | 5.76±0.90 | 3.61±1.54 | ||||
Kicking | Pre | 5.12±1.54 | 5.61±1.42 | 0.111 | 0.903 | 0.001 |
Post | 6.24±1.20 | 4.44±1.04 | ||||
Overthrowing | Pre | 0.12±0.33 | 0.06±0.24 | 0.013 | 0.001 | 0.016 |
Post | 0.76±0.66 | 0.22±0.43 | ||||
Under rolling | Pre | 3.47±1.77 | 3.11±1.64 | 0.030 | 0.704 | 0.001 |
Post | 4.29±1.65 | 2.44±1.15 |
Values are presented as mean±standard deviation.
ANOVA, analysis of variance; ASD, autism spectrum disorder.