Eric Chessen: Autism Fitness for Adults

There was a time when “Why is exercise important for individuals with autism?” was an actual question that I had to answer.

Yes, I mean that.

There was such a disconnect in understanding what fitness had in the way of benefit for this population that it was a discussion non-starter. Today, there’s more of a cultural appreciation of exercise as being crucial for all populations and the focus of accessibility becomes the more relevant discussion.

While discussion is great, it also includes the most common, well-meaning, error. When others share or cite Autism Fitness, it’s always: “ . . . great programs for children with autism!” Meanwhile, the athlete in the video or example in question is clearly a young adult.

Fitness is a lifelong process with skills that coincide with daily activities. That’s true for everyone.

The sentiment that vigorous physical activity should only be youth-based is rightfully dying. However, when we consider the autism and developmentally disabled populations, the majority of therapeutic and activity-based programs are for the 12-and-under crowd. Contrary to whatever it needs to be contrary to, individuals with autism do get older. They also continue to have autism.

In addition to the challenges that coincide with an autism diagnosis (and they vary in severity but highlights are deficits in social skills, functional communication, self-regulation, anxiety, cognitive delays and gross motor deficits), the medical complications that arise among sedentary populations (Type II diabetes, cardiovascular disease, mobility issues/compensatory movement patterns/low back pain) are not exclusive to neurotypical/normally developing populations. We have severe consequences pending for current and future generations of individuals with autism if fitness programming is relegated to younger individuals.

What needs to be established first is a standard of practice for assessing and developing fitness programs for the autism population. In Autism Fitness programming, we’ve doing this with the PAC Profile™ approach, that enables protocols to be decided and implemented based on Physical, Adaptive and Cognitive baselines as they relate to a variety of exercises. Given a population that has a high rate of gross motor deficits (as diagnosed by low tone, weak trunk and/or gait pattern abnormalities.)

Because these issues are typically diagnosed early, children with ASD may receive physical therapy, to which there is an age-specific cutoff due to insurance policies (usually around 12 years of age).

Then what? The supposition that once we turn 12 we never have to worry about movement again is asinine, but that’s exactly what the outcome is for those with autism. No more PT (regardless of how effective the program was/wasn’t) and very little in the way of continuing physical development.

If we consider fitness as a life skill first, the concepts and practices validated within general strength and conditioning should hold true for the ASD population. Squat, hinge, push, pull, crawl and locomote with progressions introduced when adaptation occurs. Increase reps, increase weight, increase motor planning variables.

The adaptive/behavioral and cognitive challenges in autism may appear to prohibit participation in strength and conditioning activities. This is the reason an interdisciplinary approach is required to increase motivation, decrease anxiety and off-task behavior and create contingencies that lead to reinforcement. This process is not age-specific, nor are the exercises selected.

I’m often greeted with the following email:

“Hi Eric, I have a 16-year-old son with autism who is not very active. What exercises should we do?”

The amount of information that is needed to supply anything approaching a helpful answer isn’t quite available in that email. Interestingly, the most frequently offered detail is age . . . which is mostly irrelevant. Unless we’re discussing the five-and-younger crowd, for whom motor planning is a priority, we are always looking to increase strength, stability, strength endurance and motor planning across the fundamental movement patterns. Programming for a sixteen or thirty-six year old may look identical, save for specific progressions and regressions of squats, presses, band rows and heavy carries.

In Autism Fitness programming, we start all athletes with the PAC Profile™ Assessment to determine baseline physical, adaptive and cognitive functioning as they related to specific exercises. Divided into categories of warm-up/mobility and strength/focus, assessment gives us a working knowledge of appropriate progression and regressions to implement.

For a large segment of the adult autism population, the strength and stability deficits inherent to the diagnosis paired with sedentary lifestyle lead to significant issues with general strength in essential movements. When programming squats, presses, pulls, hinges and loaded carries, regressions are the norm.

With squats, our go-to regression is a reduced range of motion using a Dynamax ball elevated by cardio step risers. This enables the athlete to break parallel safely and, eventually, efficiently as they begin to develop strength and stability through the movement.

For presses, shoulder and trunk stability, in addition to thoracic mobility, are often compromised. This compromise is evident when heels elevate during the press and/or the arms begin falling forward of the head.  We used physical prompting, most often guiding the athlete into position via the elbows, to support performance. We can gradually reduce the prompt (aka fading) as capacity increases.

Similar to presses, during band pull-downs and standing row variations (all done with resistance bands), rooting, trunk stability and strength in the upper back are priority issues. On band pull-downs, we can control the amount of resistance, as can also be done with standing band rows by increasing or decreasing distance.

Hinges are tricky due to the abstract nature of explaining “neutral spine,” which as many of you know can be a challenge with the general/neurotypical population. We initiate hinge movements by teaching a scoop throw with a light medicine ball. This often requires a physical prompt with the coach guiding the athlete into “hips loaded” position.

Heavy carries have wonderful generalization to activities of daily living. For both farmers walks and chest carries, we provide enough weight to be challenging without compromising posture or gait. With farmers walks, swinging of the objects requires either a physical prompt (from the elbows or shoulders to support stability), or lowering the weight. For safety, we always use Sandbells or sandbags.

Below is a chart featuring each strength exercise from regression to our most-used progressions.

The young autism population will age, and there exists a responsibility towards their general health, skill development and independence. The astounding benefits of strength training can be applied to those with ASD when their particular levels of function (physical, adaptive and cognitive) are accounted for. As fitness professionals, we are able to take the best of what we know and apply it with remarkable outcomes. Providing appropriate programs for the ASD population opens the gateway to a higher quality of life in adulthood.

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