Blog post written by: Donna B Bainbridge, PT, EdD, ATC; James Michael Gleason, PT, MS; and Victoria S T Tilley, PT, GCS

People with intellectual disability are at risk for poorer health and earlier death than the general population. People with intellectual disability may have more difficulty understanding advertisements and media messages intended to enhance or promote health, and they often depend on family or caregivers to provide support and guidance in daily decision making. Many people with intellectual disability are underemployed or unemployed with limited financial resources, especially discretionary income to allow them to participate in recreational and physical activity programs. Many coaches and volunteers who work with sports teams in local communities may be reluctant to include children, youth, and adults with disabilities, or do not have the knowledge to teach sports-related skills to those who have difficulty learning or need extra time to learn or practice basic skills. As a result, people with intellectual disability may not have access to the many programs available to the nondisabled population that are extremely important to staying active and avoiding many chronic health conditions such as cardiovascular disease, diabetes, overweight, and other health problems. 

In response to these needs, physical therapists (PTs) have become important contributors to the Special Olympics Healthy Athletes screening and other healthy lifestyle initiatives. In 2000, a fitness screening protocol called FUNFitness was developed by the American Physical Therapy Association (APTA) in collaboration with Special Olympics to evaluate flexibility, strength, balance, and aerobic fitness in Special Olympics athletes. FUNfitness volunteers have screened over 160,000 Special Olympics athletes, collected data on physical performance, and provided individual instruction and referrals to physicians and to physical therapists as needed as a result of these screenings. The screening tests reveal that most Special Olympics athletes with intellectual disabilities have limitations in flexibility and poor balance skills. Much also needs to be done to improve their athletic skills, promote better daily function and health, prevent falls, and enlist more health care providers to provide needed services. Special Olympics has trained thousands of PTs and PT students to conduct the screenings and provide meaningful information and advice to athletes. FUNfitness has developed close collaborative ties with APTA in the United States and has developed a network through the World Confederation for Physical Therapy to expand these discussions and efforts globally .

These screening efforts have become a routine part of Special Olympics activities in many states and in countries around the globe. In addition, FUNfitness has developed a range of fitness materials and protocols for Special Olympics coaches to use for promotion of fitness with their athletes. Currently, FUNfitness and Special Olympics programs are developing and pilot testing a variety of community-based year-round fitness programs for athletes, such as the Special Olympics Get Fit for Sport designed for the Presidential Active Lifestyle Award, or PALA+. These resources will be posted on the Get Fit for Sport Special Olympics webpage so that Special Olympics programs, families, and physical therapists can use them to encourage individual and group fitness activities.

People with intellectual disabilities need access to knowledgeable health and fitness resources and to practitioners who can provide information and programs that are barrier free, can be easily understood, and encourage participation in physical activity and fitness. PTs are ideally suited to help make this happen. We challenge PTs to become more involved in their communities and to include people with intellectual disability who are frequently underserved by health promotion efforts. 

What is your experience with working with people with intellectual disability? How can we promote improved fitness and physical activity for this population?

Cross-promoted from the NCHPAD News: Volume 12, Issue 1

Written by: Carol Kutik, Director of Fitness & Health Promotion at the Lakeshore Foundation

Never! Even if you have had an inactive lifestyle, research suggests that you are never too old to benefit from exercise. The National Institutes of Health (NIH) report that even moderate physical activity can improve the health of older adults who are frail, or who have diseases that accompany age. A substantial number of research studies confirming the many benefits of regular physical activity for older adults helped the U.S. government to report in its 2008 Physical Activity Guidelines for Americans that, compared to less active people, more active people have lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, metabolic syndrome, colon cancer, breast cancer, and depression. The Guidelines add that “regular physical activity is essential for healthy aging.” Note the word essential, as opposed to the word suggested.

Despite the known benefits of physical activity, the NIH reports that rates are low among older people. Only about 30 percent of adults between age 45 and 64, 25 percent between age 65 and 74 years, and 11 percent age 85 and older engage in regular physical activity. Physical activity rates for older adults with physical disabilities are even lower. According to a study by the Centers for Disease Control and Prevention regarding adults age 50 and over, approximately 70 percent of those with disabilities do not participate in recommended amounts of physical activity, as compared to 60 percent of those without disabilities.

As older individuals become less active, they begin to lose their ability to perform standard daily living activities and become discouraged and reluctant to exercise, fearful that it will be too strenuous and cause them harm. All too often, decreased levels of both physical function and independence are accepted as natural consequences of aging, leading older adults to believe that exercise is not “for them” and perpetuating the downward spiral. Research from the NIH shows that the opposite is true – that exercise is safe for people of all age groups, and that older adults hurt their health far more by not exercising than exercising.

The following types of exercise are recommended for seniors who want to stay healthy and independent:

• Strength exercises build muscles and increase metabolism (which helps with weight control). Strength exercises can be performed by using machines, free weights, working with resistance bands, using your own body weight (push-ups, pull-ups, sit-ups, etc.), heavy gardening, yoga and other methods.
• Endurance exercises improve the ability of your heart and lungs to work efficiently. Any activity that increases heart rate and breathing will help build endurance. Try walking, pushing, swimming, cycling or raking leaves!
• Stretching exercises keep joints and muscles limber, which can give you more freedom of movement. Special attention is important for joints that are particularly tight.
• Balance exercises can help avoid falling, as well as build strength and postural awareness.

The following steps will help guide you in your new exercise routine:

• First, make a commitment to yourself. Keep in mind that research tells us it takes most people 21 days to develop a new habit. Get out your calendar and plan those first 21 days – the rest will follow!
• Start out slowly, especially if you have been inactive for a long time, and set realistic short-term goals. Seek the advice of a fitness professional who is experienced in working with older adults. If you are computer savvy, use the internet to find exercises that you enjoy. Explore NCHPAD’s multitude of exercise programs. Check out EASY (www.easyforyou.info), a website developed to help older adults identify the physical activity programs most suited to their personal needs, preferences, and health conditions.
• Use your own body awareness as your guide. Pay attention to how you feel before, during, and after exercise, and adjust your pace as needed. Keep in mind that it will take you a while to know when it’s just right, but trust me, when you experience that awesome feeling you will be hooked!
• Reward yourself along the way as you reach small goals to keep the habit.

It is well known the regular physical activity among aging adults can maintain bone health and decrease the risk of fractures. A new study presented at the American Orthopaedic Society for Sports Medicine's Specialty Day suggests that physical activity and exercise early in life might be equally important.

Bjorn Rosengren, MD, PhD and other researchers performed a controlled exercise intervention among children aged 7-9 in Malmo, Sweden. The intervention group comprised of 362 girls and 446 boys who received 40 minutes of daily physical education at school. The control group consisted of 780 girls and 807 boys who received 60 minutes of physical education per week. The authors collected data on fractures among all participants and assessed skeletal maturity each year.

During the study, there were 72 fractures in the daily exercise group and 143 in the control group. The participants in the exercise group also exhibited higher spine bone mass density than those in the control group.

“Increased activity in the younger ages helped induce higher bone mass and improve skeletal size in girls without increasing the fracture risk. Our study highlights yet another reason why kids need to get regular daily exercise to improve their health both now and in the future,” concluded Rosengren.

This study offers several important messages. First, all of us need to exercise. Even as we get older, we need to take long walks or go for jogs several times a week. Or we can swim, bike, lift weights, or play sports. While bone loss can occur with age, regular exercise can slow its loss. People with healthy bones likely suffer fewer fractures.

A large amount of bone formation occurs in the first two decades of life. As the study demonstrates, activity at these ages can lead to stronger bones that persist later in life. Sports and exercise done as a kid can lead to better bone health as an adult.

Adults should be exercising regularly for themselves. We can also help our children by getting outside and playing with them. Encouraging them to safely play sports and do all types of physical activities is beneficial for the entire family! How do you encourage physical activity at all ages?