1 2 3 4 5 6 Introduction Intervention Results Aim Methods Conclusions The efficacy of a 12 week exercise intervention in adolescents aged 11-16 with Autism Spectrum Disorder in Johannesburg, South Africa Natalia Neophytou, Kerith Aginsky & Natalie Benjamin Centre for Exercise Science and Sports Medicine | School of Therapeutic Sciences | Faculty of Health Sciences | University of the Witwatersrand 1 Introduction Intervention Aerobic Activity Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, which often results in an array of motor impairments.1 Individuals with ASD have also been reported to have significantly lower physical activity levels compared to typically developing individuals.2 Motor impairments and these lower physical activity levels often lead to reduced performance in activities of daily living (ADLs), and have led to various health problems including obesity, cardiovascular disease and insulin resistance syndrome.3 It may therefore be necessary to intervene in the population, to reduce sedentary-related health risks as well as attempt to improve motor impairments. Since exercise has been shown to be an effective therapeutic modality in reducing motor impairments and improving cardiovascular fitness, the efficacy of exercise interventions within this population needs to be established. Validation of a 12-week exercise intervention was conducted by an expert panel via an online form. The intervention included an aerobic warm up, upper, core and lower body exercises, balance exercises, agility drills, fine motor skill training and a brief aerobic cooldown (examples of exercises are shown in Figures 1-6). The intervention group participated in the exercise intervention bi-weekly for 12 weeks, while the control group received their usual standard care. 2 Strength Results A sample of 27 adolescents with ASD (mental age 5.6 ± 1.8 years; chronologic age 13.0 ± 1.8 ) participated in the study. The comparison between the overall test scores for posture, body composition, balance, coordination, agility and physical fitness for the control and intervention group are shown in Table 1 below. Overall compliance to the intervention was 97.24%. Aim 3 Balance To determine the efficacy of a 12 week exercise intervention by assessing the change in posture, body composition, balance, coordination, agility, gait and physical fitness pre- and post-exercise intervention in adolescents with autism aged 11 to 16 years. Table 1: Overall test scores for posture, body composition, balance, coordination, agility, gait and physical fitness in the control(n=11) vs the intervention group(16) pre and post intervention. TEST CONTROL GROUP (n=11) Mean ± SD INTERVENTION GROUP (n=16) Pre intervention Post intervention P value Overall Posture score 59.6 ± 18.8 60.90 ±18.76 0.7164 55.6 ± 14.5 68.4± 15.8 0.0004* BMI (kg/m2) 21.9 ± 5.2 22.1± 5.5 0.5403 25.8 ± 6.0 24.8 ± 5.3 0.0130* Static balance 6.8 ± 6.0 7.7± 8.9 0.1371 10.5 ± 9.2 17.0 ± 11.0 0.0028* Throwing D (no.) 5.1 ± 2.0 8.0 ± 1.8 0.0112* 5.2 ± 1.3 8.9 ± 1.5 0.0007 Agility (s) 34.1 ± 12.4 31.5 ± 8.6 0.1094 27.4± 12.2 23.0 ± 9.9 0.0061 Stride length D (m) 1.9 ± 0.4 1.6 ± 0.5 0.2544 1.8 ± 1.7 1.0000 Step length D (m) 1.0 ± 0.2 0.8 ± 0.2 0.9 ± 0.1 1.0 ± 0.3 0.1463 Heart Rate (bpm) 92.7 ± 21.6 92.4 ± 21.9 0.7973 78.0 ± 13.0 75.1 ± 9.9 0.0046* SBP (mmHg) 107.8 ± 14.6 105.0 ± 14.73 0.6823 116.9 ± 17.7 102.9 ± 16.5 0.0069* DBP(mmHg) 72.2 ± 13.4 69.8 ± 9.7 0.4571 74.3 ± 9.2 71.7 ± 10.4 0.2419 Hand Grip Strength D (kg) 13.94 ± 9.6 12.55± 7.6 0.3850 19.0 ± 11.8 20.0 ± 11.00 0.1006 Modified Curl up (no.) 11.6 ± 5.7 8.0±7.1 0.1718 10.1 ± 6.6 14.3 ± 4.5 0.0094* Methods 4 Study Design A randomised control trial was conducted to assess the efficacy of an exercise intervention programme. Ethical clearance was obtained from the University of the Witwatersrand’s Human Research Ethics Committee (M130755). Sample A sample of 27 adolescents with ASD (mental age 5.6 ± 1.8 years) were recruited in the study. The sample was divided into 2 groups (intervention (n=16) and control (n=11)) using randomisation software. All the participants’ posture, body composition, balance, coordination, agility, gait and physical fitness was tested pre and post intervention using the below tools. Measuring tools/ Instruments Posture was assessed using a posture grid, and scores out of 10 were given per body area, where good posture = 10, average posture = 5 and poor posture = 0. Body composition, and physical fitness were assessed using the Brockport Physical Fitness Test (BPFT),4 and balance and coordination were assessed using the Movement Assessment Battery for Children test (MABC-2).5 Gait was assessed using Dartfish two-dimensional video analysis, and agility was assessed using a standard agility T-test. Data analysis: Data analysis was performed using Stata version 13.1. Descriptive data were expressed as means and standard deviations. To compare variables during pre-and post- intervention within groups for continuous variables, the Wilcoxon signed-rank test was used. To compare variables during pre and post intervention within groups, for categorical variables, Mc Nemar’s test for symmetry was used. Fisher’s exact test was used for categorical variables. Significance was accepted at 95% (p< 0.05). Manual Dexterity 5 Ball skills D= Dominant; SBP= Systolic Blood Pressure; DBP=Diastolic Blood Pressure; no.=Number; *p <0.05 = significant Conclusions A 12 week exercise intervention significantly improved overall posture, cardiovascular fitness, BMI, coordination, balance and agility in individuals with ASD. Handgrip strength and manual dexterity also improved. This therefore suggests that exercise may be a viable therapeutic intervention in the ASD population. 6 Flexibility Recommendations Exercises for adolescents with ASD should be simple, modifiable as well as enjoyable. Exercise group classes should not exceed 5 individuals per trainer. A standardised motor skill testing battery specific for individuals with ASD needs to be developed. Read more here References: Berkeley S, ZittelI L, Pitney L, Nichols S. Locomotor and object control skills of children diagnosed with autism. Adapted Physical Activity Quarterly. 2001;18:405-16. Macdonald M, Esposito P, Ulrich D. The physical activity patterns of children with autism. BMC Research Notes. 2011;4:4-422. Chanias A, Ried G, Hoover M. Exercise effects on health related physical fitness of individuals with intellectual disability: a meta-analysis. Adapted Physical Activity Quarterly. 1998;15:119-40. Winnick J, Short F. The Brockport Physical Fitness Test Manual. New York: State University of New York, College at Brockport; 1998. Brown T, Lalor A. The Movement Assessment Battery for Children-second edition (MABC-2): A review and critique. Physical and Occupational Therapy in Pediatrics. 2009 29(1):86-103.