# Exercise as it relates to Disease/Increasing physical activity and reducing sedentary time in children with developmental disabilities

This page is critiquing the article:Breaking tradition: Increasing physical activity and reducing sedentary time of children with developmental disabilities

## What is the background to this research?

Developmental disabilities interfere with neurological functions affecting attention, memory, language, problem solving and social interaction. Developmental Disabilities are becoming more common affecting 1 in 6 children and thus decreasing their physical activity time. Having a development impairment can interfere with appropriate behaviour however, when Autistic children completed 15 minutes of vigorous exercise their behaviour improved immediately.
According to the US 2018 Physical Activity Guidelines all youth should be participating in 60 minutes of moderate-to-vigorous physical activity everyday of the week. Multiple data statistics in numerous countries have found children are not meeting the guidelines, especially children with developmental disabilities with up to 81-88% not meeting guidelines. People with developmental disabilities face barriers when it comes to activities such as physical limitations, negative social attitudes, accompanied with a lack of training for adults in how to accommodate everyone.There is a gap in research exploring strategies to increase physical activity and reduce sedentary time in children with developmental disabilities, this study investigates these strategies.

## Where is the research from?

Keith Brazendale, Allison Brazendale, Jeanette M Garcia, Nicholas Leahy, Abigail A McDonald, Manya Kenney, Glenn Weaver and Michael W Beets conducted the study in the southeast region of the United States at a summer camp for children with developmental disabilities. The study was conducted in 2015 however the report was received in 2019. Allison Brazendale, Psy.D is the founder of Camp M.A.T.E.S and a clinical psychologist specialising in children developmental disorders she is married to Keith Brazendale, Ph.D who is an Exercise Scientist and co-founder of Camp M.A.T.E.S..

## What kind of research was this?

The research conducted was a single group quasi-experimental study with children 4 to 21 years old. This puts the study under moderate quality for recommending treatment due to it not being randomised. A repeated measures counterbalance design was carried out to ensure the results have a smaller margin of error and improved efficiency. To be eligible for the study children had to meet the criteria to ensure the camp was able to accommodate to everyone's needs. Therefore, children who needed a one on one therapist were excluded.

## What did the research involve?

The aim of camp MATES is to improve social skills, promote physical activity and educate about nutrition, reading and life lessons. The research was 2 days a week for 8 weeks, throughout the day 6 periods of activities where scheduled 2 of these being physical activity based. The activities where either soccer, relay races, kickball or free play with one being run as a traditional sport and the other was modified to the LET US Play principles and included a social narrative explanation video. The LET-US Play games modified the sports to include team running activities, shorter game time, decreasing numbers on teams and encouragement from adults to boost activity time in comparison to traditional games. Before each LET-US Play activity children watched a cartoon of how to play the game and appropriate behaviour expected compared to the traditional sport where the instructor verbally explains the rules and how to behave.
Accelerometers were given to the children to measure the physical activity levels which have high validity reliability of greater than 90% when walking or jogging therefore the results are accurate enough for this study.
52 participants between the ages of 4 and 21 took part in the study, 84% where male and 81% non-Hispanic white this can skew the findings of the data due to not having an even ratio of genders or cultures. The predominately male based study could have issues as it doesn't recognise gender as a limitation. Girls tend to have lower levels of motivation towards sports and are typically less involved in sports during physical activity classes. Investigating the statistics between the genders may show varied results for females as they typically need more motivation to participate.

## What were the basic results?

The LET US Play sessions for soccer, relay races and kickball increased the time spent at a moderate to vigorous exercise level and decreased sedentary time. Although the free play in the traditional setting was more exercise inducing than the modified version. Therefore, using a social narrative and physical activity promotion strategies can increase physical activity in children with developmental disorders during sports but not free play.
The percent of time spent at different activity levels
| | MVPA: TS | MVPA: LUP | Sedentary: TS | Sedentary: LUP |
| Free Play | 36.2±20.5 | 28.3±16.4 | 23.4±19.7 | 31.1±16.4 |
| Kickball | 13.0±9.3 | 18.0±17.9 | 52.3±19.8 | 43.4±15.9 |
| Relays | 19.0±9.3 | 24.0±9.9 | 51.0±19.3 | 44.7±21.6 |
| Soccer | 17.5±15.3 | 23.4±15.6 | 42.6±24.6 | 34.2±17.0 |
* MVPA= Moderate to Vigorous physical activity
* TS= Traditional Sessions
* LUP= LET-US Play sessions
Strengths
* Innovative approach for promoting Physical Activity
* Counterbalance design
* Accelerometers for objective measures
The article acknowledges the weaknesses and does not over emphasise the results. The following are the weaknesses seen:
Weaknesses
* Staff had to monitor children were not taking off accelerometers
* Attendance varied across activities
* Only 4 physical activities observed and may not generalise to others
* Small sample size with mainly male participants

## What conclusions can we take from this research?

Having a set social narrative explanation video and physical activity promotion strategies to encourage participation, can increase activity levels and reduce sedentary time in children with developmental disorders. Engaging children with developmental disorders in activities can be challenging, a modified approach to explaining the activity is excellent to engage them. Strategies such as smaller teams so the children don't have time to get distracted can boost participation along with having a trusted adult play alongside them. These findings can help further increase activity in children with disabilities creating a greater quality of life for them. Further research should be conducted separating the social narrative and LET-US Play strategies to observe if one strategy has a greater effect. Conducting additional research to find if an indoor or outdoor play space has an impact on activity levels would be encouraged. Taking into consideration the male dominated results of this study, having separate results for females and males or ensuring the genders are relatively even could be beneficial. Following increased exercise interventions other studies have found a decrease in aggression and an increase in good behaviour, thus it is important studies continue so an improved physical activity plan can be put in place for children with developmental disabilities..

## Practical advice

Starting a lesson with a social narrative video can overcome challenges such as inappropriate behaviours and problems understanding, which are normally seen by children with development disabilities. Actively encouraging children to join in activities and modifying traditional sports to include team-based activities, smaller groups and more water breaks in-between game time can increase physical activity participation. Informing coaches and practitioners in ways to increase activity in children especially with developmental disabilities can ultimately improve the overall activity levels and quality of life of these children.

## Further information/resources

There are further articles for curious minds about physical activity and developmental disabilities:
* Physical activity guideline compliance among children with various developmental disabilities
* Physical activity improving physical fitness in children with developmental disabilities
To read further about Disabilities and physical inactivity:
* Physical Activity in Individuals with Disabilities
* Intellectual and Developmental Disabilities
If you are in need of support for your child with a developmental disability:
* Raising Children
* Developmental Disabilities support

## References

* ↑ Brazendale K, Brazendal A, Garcia J M, Leahy N, McDonald A A, Kenney M, Weaver G, Beets M W. Breaking tradition: Increasing physical activity and reducing sedentary time of children with developmental disabilities.Elsevier.2020 .Vol 13(2)
* ↑ Sulkes S. Definition of Developmental Disorders. MSD manual.May 2020 [Cited 10th Sep 2020]Available from:https://www.msdmanuals.com/en-jp/home/children-s-health-issues/learning-and-developmental-disorders/definition-of-developmental-disorders
* ↑ Boyle C A. Boulet S.Schieve L A. Cohen R A. Blumberg S J. Yeargin-Allsopp M. Visser A. Kogan M D. Tends in the prevalence of the Developmental Disabilities in US Children. 2011. Vol 127(6). Pg1034-1042
* ↑ Kern L. Koegel RL. Dunlap G. The influence of vigorous versus mild exercise on autistic stereotyped behaviours. J Autism Dev Disord. 1984. Vol 14. Pg 57-67
* 1 2 Case L, Ross S, Yun J. Physical activity guideline compliance among a national sample of children with various developmental disabilities. Elsevier Inc. 2020. Vol 13(2)
* ↑ Brazendale A.CampMATES[Internet]U.S.2018 [Cited 2020 Sep 11]. Available form:http://campmates.weebly.com/meet-the-leadership.html
* ↑ Petrisor BA, Bhandari M. The hierarchy of evidence:Levels and grades of recommendation, Indian J Orthop. 2007. Vol 41(1).Pg 11-15
* ↑ Logan HL. Glueck DH. Muller KE. Selecting a sample size for studies with repeated measures. BMC Medical Research Methodology. 2013. Vol13
* ↑ Lugade V. Fortune E. Morrow M. Kaufman K.Validity of using tri-axial accelerometers to measure human movement—Part I: Posture and movement detection. Medical Engineering & Physics. 2014. Vol 36(2). Pg 169-176.
* ↑ Martinovic D. Ilic J. Visnjic D. Gender differences in sports involvement and motivation for engagement in physical education in Primary school. Problems in Education. 2011. Vol 31. Pg 94-100
* ↑ Lang R. Koegel LK. Ashbaugh K. Regester A. Ence W. Smith W. Physical exercise and individuals with autism spectrum disorders:A systematic review. Elsevier. 2010, Vol 4(4). Pg 565-576.