Monday, 18 November 2013

Sedentary behaviours and autism

Standing up is better for your health than sitting down according to the BBC website. As one of those people known to wear a pedometer pretty regularly and generally be quite 'obsessive' about my 10,000 steps per day (or should that be 6000 steps per day [1]), I wasn't surprised by some of the discussions on this topic and how quite a proportion of the population at large could really do with standing up and indeed, moving a little more each day.
 The Ministry... @ Wikipedia 

We are all seemingly bombarded these days with information mixed in with a healthy sprinkling of science suggesting that one needn't be pounding the streets for hours on end in order to get a little bit more healthy. It's all about making sure that we aren't too sedentary and perhaps enjoying a little more of the great outdoors even if at a leisurely pace.

With this in mind, I was very interested to read the paper by Avivia Must and colleagues [2] who upon comparing a small-ish group of children diagnosed with an autism spectrum condition (n=53) with typically developing peers (n=58), found that "children with autism spectrum disorder spent an hour more in sedentary behaviors on weekdays compared to typically developing children". Further Must et al also reported quite a bit of that increase in sedentary behaviour was apportioned to an increase in screen time (TV and computer) and "sedentary behaiour is linked to relative weight status" in the group of children with autism. Think screen time and autism and I think about the work of Micah Mazurek as exemplified by this paper [3] and more recently with the issue of sleep in mind [4].

Some more digging into the various research done on exercise and autism revealed some equally interesting findings. The same authorship group have looked at this issue before as per the article by Bandini and colleagues [5] who suggested based on the same spread of participants (autism, n=53, not-autism, n=58) "moderate and vigorous activity was similar in children with ASD (50.0 minutes/day and typically developing children 57.1 minutes/day)". That being said, the authors did report that children with autism participated in "fewer physical activities and for less time according to parental report" highlighting potential issues with the measurement schedule employed to examine activity levels.

These and other similar research on activity levels and autism perhaps represent the other side of the research coin in terms of the increasing interest in the use of technology to improve quality of life for those on the autism spectrum. The rise and rise of the use of tablet technology for example, whilst often a significant step forward for some on the autism spectrum, not necessarily being great news for levels of physical activity if replacing time that could be used on non-sedentary activities.

The question of whether physical activity might also have some added benefits outside of just physical health has also been looked at. Oriel and colleagues [6] reported that "aerobic exercise prior to classroom activities may improve academic responding in young children with autism spectrum disorder". I'm not for one minute suggesting that every classroom should be installing a treadmill so as to increase 'correct' responses to I assume, questions posed by the teacher. But as I've indicated on a previous post about stress (see here), physical exercise often goes so much further than just improving physical health and that applies to autism too [7]. Other research reviews whilst highlighting a lack of good quality evidence in this area, have nonetheless suggested that exercise participation might have a least some short-term bearing on the presentation of facets of autism also [8].

With all the mind, the question of what kind of activities might increase activity levels in cases of autism in childhood has similarly been examined in autism research circles.

Walking is often a good place to start when it comes to increasing activity levels. The paper by Pitetti and colleagues [9] reported that even for those at the more severe end of the autism spectrum, the implementation of a walking program may well have some important benefits. Correspondingly, I've heard a few people talk about young people and adults with autism (again towards the more severe end of the autism spectrum) who very much enjoy long (sometimes very long) walks in all weathers. One wonders whether they might know more than us about what makes them feel good?

Swimming is another option to consider as per the paper by Fragala-Pinkham and colleagues [10]. Granted their results weren't astounding in terms of fitness outcomes for some participants (although contrasted with previous work of theirs [11]) but one might suggest that anything which increases activity is worthwhile. That and the often life-saving skills that are gained by learning to swim. Indeed, Pan [12] reported on some other potentially important changes noted following implementation of a water exercise swimming program with a small group of children with autism.

And then there are other exercise options to consider. Horseback riding (see here) assuming no fear of such animals and something which has cropped up before on this blog, the various martial arts (see this post) might also be good ways of increasing activity levels and decreasing sedentary behaviours. I suppose it's all about finding something that the individual enjoys.

Recognising that a sedentary lifestyle is not really ideal for anyone, there are perhaps some important lessons to be learned about increasing activity levels among children and adults with autism. Physical activity is an important part of physical health, and as we've seen in relation to schizophrenia, there is an emerging gap appearing in terms of health inequality which includes the issue of physical activity levels. That physical activity levels may also have important knock-on effects for things like bone health (see this post) and possibly exposure to sunshine and that all-important vitamin D (see this post) are also important considerations too.

To close, a song about walking by two brothers who are talking about walking an awfully long way. Oh and for those who were also wondering about the word 'haver', some background can be found here.

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[1] Tudor-Locke C. & Bassett DR Jnr. How many steps/day are enough? Sports Med. 2004: 34: 1-8.

[2] Must A. et al. Comparison of sedentary behaviors between children with autism spectrum disorders and typically developing children. Autism. 2013 Oct 10.

[3] Mazurek MO. & Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord. 2013 Jun;43(6):1258-71.

[4] Engelhardt CR. et al. Media Use and Sleep Among Boys With Autism Spectrum Disorder, ADHD, or Typical Development. Pediatrics. November 2013.

[5] Bandini LG. et al. Comparison of physical activity between children with autism spectrum disorders and typically developing children. Autism. 2013 Jan;17(1):44-54.

[6] Oriel KN. et al. The effects of aerobic exercise on academic engagement in young children with autism spectrum disorder. Pediatr Phys Ther. 2011 Summer;23(2):187-93.

[7] García-Villamisar DA. & Dattilo J. Effects of a leisure programme on quality of life and stress of individuals with ASD. J Intellect Disabil Res. 2010 Jul;54(7):611-9.

[8] Petrus C. et al. Effects of exercise interventions on stereotypic behaviours in children with autism spectrum disorder. Physiother Can. 2008 Spring;60(2):134-45.

[9] Pitetti KH. et al. The efficacy of a 9-month treadmill walking program on the exercise capacity and weight reduction for adolescents with severe autism. J Autism Dev Disord. 2007 Jul;37(6):997-1006.

[10] Fragala-Pinkham MA. et al. Group swimming and aquatic exercise programme for children with autism spectrum disorders: a pilot study. Dev Neurorehabil. 2011;14(4):230-41.

[11] Fragala-Pinkham M. et al. Group aquatic aerobic exercise for children with disabilities. Dev Med Child Neurol. 2008 Nov;50(11):822-7.

[12] Pan CY. Effects of water exercise swimming program on aquatic skills and social behaviors in children with autism spectrum disorders. Autism. 2010 Jan;14(1):9-28.

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ResearchBlogging.org Must A, Phillips SM, Curtin C, Anderson SE, Maslin M, Lividini K, & Bandini LG (2013). Comparison of sedentary behaviors between children with autism spectrum disorders and typically developing children. Autism : the international journal of research and practice PMID: 24113339