Inattentiveness, procrastination, fidgetiness, and disorganized work habits are just a few of the symptoms of ADHD. For a child with ADHD, such behaviors impair functioning at school, home, and their ability to maintain relationships with peers. The cause of ADHD is largely unknown and likely to be a multi-factorial interplay between genetic and environmental influences. Current strategies for management include medications and intensive behavioral therapy which are not optimal for long term management of the disorder.

Can physical activity help symptoms of ADHD? There is burgeoning research in this area that suggests this may be the case. A recent review paper published by Jeffery M. Halperin and colleagues from Queens College of the City University of New York, in Neuroscience and Behavioral Reviews, January 2011, suggests ADHD in children should be viewed within the context of a “developmental trajectory” rather than a fixed medical condition. As such, ADHD can be modified by environmental influences, including exercise. Individuals with ADHD are never cured, but they can compensate. Environmental influences, including exercise, may affect the degree of later brain development and hence determine the extent to which an individual can compensate.

Functional magnetic resonance imaging (fMRI) scans of the brains of children show that exercise increases activity in the frontal lobes, which are responsible for executive function (see USA Today article). The executive functions consist of processes responsible for planning, rule acquisition, initiating appropriate actions/inhibiting inappropriate actions, and selecting relevant sensory information. ADHD is a disorder of executive function. In an NIH funded study performed by Catherine Davis and colleagues at the Medical College of Georgia, on 94 sedentary children randomized to a high dose exercise intervention group, found improvement in planning scores (i.e., executive function) in the high dose group compared to controls. 

Studies are underway to determine the optimal frequency and amount of physical activity appropriate for children with ADHD. There is some consensus however, that certain types of physical activities may be more beneficial in children with ADHD (see article). Activities that require memorization and sequencing of behaviors help focus attention and repeat learned movement patterns, e.g., yoga, martial arts, dance/ballet, gymnastics, swimming and team sports. One study of the brains of judo players (adults) by Jacini and colleagues found significantly higher volume of gray matter in the frontal, parietal, occipital, temporal, and cerebellar regions of the brains of judo players versus controls. Interestingly, neuroimaging studies have shown reduced volume of the frontal, posterior, and cerebellar areas of brains of children with ADHD.

There is also evidence that physical activity outdoors may be more beneficial for children with ADHD. Dr. Frances Kuo from the University of Illinois found that green outdoor settings (green backyard, park, or neighborhood space) appeared to reduce the symptoms of ADHD in children compared to the same activities performed in indoor settings AND built outdoor settings (concrete areas, not much green).  Lastly, in July 2010, Yale Researcher, Dr. David Katz published preliminary results of the ABC Fitness Program (Activity Bursts in the Classroom) which focuses on physical activity during the school day.  The study compared an intervention group (schools that incorporated bursts of physical activity throughout the day) versus a control group. Preliminary results indicated that medication use for ADHD decreased in the intervention group. Green settings for playgrounds at schools, physical activity in the morning before class (tai chi on the lawn anyone?), and incorporating physical activity during the day in the classroom, may be just the prescription needed to help children overcome the hurdles of ADHD.

Thanks to Farzana L. Walcott, MD, MPH, for submission of this post.

There is a critical need to increase participation in physical activity for everyone, this we already know.  Unfortunately, many physical activity programs are not designed in a way that includes people with disabilities.  Recognizing the need for inclusive programming and the common barriers to physical activity for people with disabilities (cost, transportation, don’t know where/how to exercise, inaccessible facilities, lack of knowledgeable staff) the staff at the National Center on Physical Activity and Disability (NCPAD) knew it was time to put their heads together to come up with something creative, something that hadn’t been tried before. 

It quickly became clear that the internet is a growing platform for delivering health promotion programs that can tackle many of the barriers faced by people with disabilities and reach large numbers of people.  The existing web-based programs, though, didn’t seem to be providing modifications to allow people with a variety of different abilities to be able to participate.  This was NCPAD’s niche!  After much discussion and research, the 14-Week Program to a Healthier You was born; an inclusive web-based program that uses three stages of progression to promote physical activity (that can be done anywhere, without specialized equipment) and healthy eating for people of all abilities.

We had learned that, in general, the more a web-based program is tailored and interactive, the better the results.  Understanding that one of our greatest challenges was going to be providing resources and exercises that fit the needs of each participant regardless of individual fitness level, exercise experience, and type of impairment, we knew that the opportunity for individualized interaction was crucial. 

With these things in mind, the features of the program were developed. They include:

• Communication with NCPAD’s 14-Week Coaches via live chat, toll-free hotline, and/or e-mail
• SMS (text) option
• Commitment pledge
• Goal, physical activity, and dietary intake logs
• Weekly e-mails
• Weekly updates to the website, including:
  • Motivational note from the coaches
  • Resources on physical activity and nutrition
  • Strength, flexibility, and balance exercises (step-by-step instructions included written description, pictures, videos,  and modifications)
  • Aerobic exercise videos and suggestions (a sample video can be viewed at http://www.youtube.com/user/NCPAD#p/u/42/mz4
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  • Advice on frequency, intensity, and duration of physical activity
  • Video blog of one participant’s experience with the program
• Follow-up wellness coaching with one of the 14-Week Coaches after the 14 weeks had ended

The results, so far, have been fantastic!  Interest in the program far-surpassed what we ever dreamed possible, with 3,500 people registering in 2010.  Although we have yet to do a detailed evaluation of the program, preliminary review shows that people of all abilities increased their levels of physical activity, enjoyed the program, and would highly recommend it to others in their social circle!  We are excited to run the program next spring and work in new ideas to continue to assist individuals of all abilities in becoming more physically active!

How are you creatively promoting physical activity for people of all abilities?       

Physical activity has been shown to improve cardiovascular and muscular fitness, mental health, and the ability to perform activities of daily living.  And though I hope it’s of no surprise, this holds true for everyone.

For the most part, the guidelines for people with disabilities are not much different from the guidelines designated for “active” adults.  The main difference seems to be the incorporation of the phrase “who are able to” into the specific recommendations as well as the removal of the suggestion that individuals should continue to increase or progress activity to reap even further health benefits (i.e. “the more the better”).  There is also an additional recommendation for people with disabilities to consult a health-care provider about the amounts and types of physical activity that are appropriate for their abilities.

So let’s break this down: 

• Physical activity provides the same benefits to everyone. 
• Everyone should work toward performing the same amount and types of physical activity on a daily basis.
• BUT, if you have a disability, you should find out how to do so. 

Sounds simple.

But how do you find out how and where to exercise if (for example) you were born with spina bifida and the only person that you have ever seen for exercise (physical therapy) is at the rehabilitation hospital 2 hours away?  PLUS, you use crutches to ambulate to work so don’t have enough energy reserve to take additional walks around your neighborhood but there are no curb cuts for using your wheelchair on the sidewalks.  PLUS, your local gym doesn’t have any upper body machines or staff members who seem comfortable with your disability.  PLUS, you have trouble regulating your body temperature and are concerned that any exercise will exacerbate your spasticity or other neurological symptoms. 

That doesn’t make it sound so easy, does it?

People with disabilities may find more difficulty than most in meeting the recommended Physical Activity Guidelines based on the barriers they face when seeking out physical activity.  Barriers can be architectural (there is no curb cut), programmatic (chairs are not available in exercise classes), or attitudinal (assumptions based on a diagnosis or the use of an assistive device). 

Studies show that physical activity can be done safely when the program is matched to an individual’s abilities.  We all have different abilities, different strengths and weaknesses, different levels of activity, different needs, different interests, etc.  As fitness professionals, we have the opportunity of a lifetime to provide a much needed and appreciated service to millions of people (with and without disabilities) by becoming trained, knowledgeable and willing to adapt activities to address society’s differences, regardless of the existence of medical diagnoses.

So what do we do now?  Here are a few suggestions:

1. Look at what the person can do, not their limitations.
2. Seek training and educational opportunities. 
   1. For example, there is a new specialty certification from the American College of Sports Medicine and the National Center on Physical Activity and Disability called a Certified Inclusive Fitness Trainer
3. Expand your marketing.  The world of disability is a large one, 54 million, and it is also a well connected.  Often one member/client will mean many more to follow.

 For more information about physical activity for people with disabilities, go to www.ncpad.org.

What else can fitness professionals do?  What are you already doing?