playful strategies to promote physical activity · 1. distinguish between the terms: physical...
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Playful Strategies to Promote Physical Activityin Children and Adolescents with Special Needs
By Katie Glaser-LeClere, MSPT, PCS
•Allied Health Education and the presenter of this webinar do not have any financial or other associations with the manufacturers of any products or suppliers of commercial services that may be discussed or displayed in this presentation.
•There was no commercial support for this presentation.
•The views expressed in this presentation are the views and opinions of the presenter.
•Participants must use discretion when using the information contained in this presentation.
Provider Disclaimer
BS in Health Studies from Boston University, 1995
MSPT from Boston University in 1997
Maryland Physical Therapy license since 1997
School-Based PT from 1998-2003
Private Practice Owner since 2003
Presenter Bio
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Board-Certified Pediatric Specialist since 2004
Home and Community Setting
Public and Private School Setting
Outpatient Setting
Presenter Bio
Prevention and Wellness Services
Kids on the Block Educational Troupe Puppeteer
Athletics and Fitness Association of America
Primary Group Exercise Instructor
Accessibility and Inclusion Consulting
Presenter Bio
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1. Distinguish between the terms: Physical Activity, Exercise, Fitness, Participation and select the most appropriate measurement tool for the purpose intended.
Course Objectives
2. Describe common barriers and facilitators
that impact exercise, activity, fitness, and
participation in children and adolescents
with disabilities.
Course Objectives
3. Identify age-appropriate resources and
strategies to support children and adolescents
with disabilities and reduce the barriers to exercise, activity, fitness, and participation.
Course Objectives
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World Health Organization (WHO)
The International Classification of Functioning, Disability, and Health (ICF)
The Centers for Disease Control and Prevention
The Maternal and Child Health Bureau
Data Resource Center for Child & Adolescent Health
Introduction
Health Condition (disease, disorder, injury)
Body Function and Structure Impairments
Activity Limitations
Participation Restrictions
Environmental Factors
Risk reduction / Prevention
Health/Wellness/Fitness
Terminology
Physical Activity-(CDC)
Any bodily movement
produced by skeletal
muscle that increases
energy expenditure
above a basal level.
Generally refers to the
subset of physical
activity that enhances health.
Terminology
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Physical Activity-(Ross, et al)
Engagement in a
physically demanding
movement, sport,
game, or recreational
play that results in
energy expenditure
and perceptions of communal involvement.
Terminology
Exercise-
a subset of physical activity that is planned, structured, and
repetitive, and has a
final or intermediate
objective of the
improvement or
maintenance of
physical fitness.
Terminology
Fitness-
A set of attributes that are either health related or skill related (sports or occupational performance). The degree to which people have these attributes can be measured with specific tests.
Terminology
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Health-Related Fitness components:
Cardiorespiratory Endurance
Muscular Endurance
Muscular Strength
Body Composition
Flexibility
Terminology
Fitness (continued)
Skill-related components:
Agility
Balance
Power
Speed
Coordination
Reaction Time
Terminology
Participation-
A person’s involvement in a life situation; represents the societal perspective of functioning;
the connections between
the behavior of individual
people and the structures
of the society in which they live.
Terminology
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Impairment (WHO): A problem in body function or structure
Activity Limitation (WHO): Difficulty in executing a task or action
Participation Restriction (WHO): Problem in life situation involvement
Terminology
Disability (WHO):
An umbrella term including impairments, activity limitations, and participation restrictions
Terminology
SPECIAL HEALTH CARE NEEDS (MCHB) :
Those who have, or are
at increased risk for, a chronic
physical, developmental,
behavioral, or emotional condition
and who also require health and
related services of a type or
amount beyond that required by children generally.
Terminology
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Center for Disease Control Recommendation for
all individuals ages 6-17:
60min/day Physical Activity
Must be age appropriate, enjoyable, and offer variety
3 days per week muscle strengthening
3 days per week bone strengthening
Guidelines
7 days per week, moderate or vigorous aerobic activity (3 days per week vigorous)
Moderate intensity=increase in HR and RR,
5-6/10 rating of perceived exertion
Vigorous intensity=greatly increases HR and RR,
7-8/10
Guidelines
Physical Activity Guidelines for Adults with Disabilities (500 MET minutes):
150 min/week moderate intensity aerobic
(walking) OR
75 min/week vigorous intensity aerobic
(running)
Minimum of 10 minute intervals throughout the week
Guidelines
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Muscle strengthening activities
2 or more days/week
Moderate or high intensity
Involving all major muscle groups
Guidelines
If unable to meet the guidelines, adults with disabilities should avoid inactivity and incorporate as much physical activity as possible.
Adults with disabilities should consult a health care provider for individual guidance regarding appropriate physical activity.
Guidelines
. Absolute intensity is the amount of energy expended per minute of activity.
Relative intensity is the level of effort required to perform an activity.
Guidelines
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Physical Activity
Age Group Prevalence of Meeting PA Recommendations
6-11 years 42.5%
12-15 years 7.5%
16-19 years 5.1%
2005-06 NHANES
National Health and Nutrition Examination Survey
(Accelerometry data)
Statistics
Physical Activity
Age Group Prevalence of Meeting PA Recommendations
High School Aged Boys 57.8%
High School Aged Girls 39.1%
2015 YRBSS
Youth Risk Behavior Surveillance System
(Self-report Self-administered Questionnaire)
Statistics
VIGOROUS Physical Activity
Age Group Prevalence of Meeting PA Recommendations
0-17 with no special health care needs
21% failed to meet requirements
0-17 with Functional Limitations
34% failed to meet the requirements
2007 NSCH
National Survey of Children’s Health(Proxy-report Interview Administered Questionnaire)
Statistics
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Individuals with Special Health Care Needs
19.8% of children/adolescents age 0-17 nationwide
National Survey of Children's Health. NSCH 2011/12. Data query from the Child and Adolescent Health Measurement Initiative, DataResource Center for Child and Adolescent Health website. Retrieved from www.childhealthdata.org
Statistics
Physical Activity Disparities
between children with and without specific conditions,
ages 0-17:
Learning Disability: 33% less likely to meet PA guidelines
ADHD: 57% less likely to meet PA guidelines
LD/ADHD: 39% less likely to meet PA guidelines
2007 NSCH
National Survey of Children’s Health(Proxy-report Interview Administered Questionnaire)
Statistics
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1) Indirect calorimetry
2) Self-report measures
3) Proxy-report from parents, caregivers, and teachers
4) Vital Signs
5) Motion Sensors
6) Direct observation/Field tests
Measuring PA
Indirect Calorimetry quantifies energy expenditure based upon gas exchange measurements during rest and steady state exercise.
Basal Metabolism
Dietary Induced Thermogenesis
Physical Activity
Stress Factors associated with disease, injury and pharmacological intervention
Measuring PA
Doubly-labeled water
Direct measure of CO2 production using two stable isotopes of water
One isotope is eliminated as water loss, the other eliminated as water loss and CO2 loss
The difference between the elimination rates is directly proportional to CO2 production or energy expenditure
Measuring PA
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Doubly-labeled water Advantages
Noninvasive
Minimal compliance
Can assess up to
2 week time periods
Measuring PA
Doubly-labeled water Limitations
Expensive
Complex technical analysis
Isotope availability
Doesn’t specify energy expenditure specific to PA
Measuring PA
Respirometry Advantages
Noninvasive
Resting state and/or steady state
Can determine specific activity energy expenditure
Measuring PA
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Respirometry Limitations
Requires a mask to be
worn over the face or in
the mouth
Requires technological
equipment and training
Measuring PA
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Self-Report Measures
Advantages
Simple, inexpensive, useful for a large sample of individuals in a research context
Self-administered, interview-administered, diary
Limitations
Item interpretation, recall accuracy, overestimation of time and intensity
May not be valid or reliable for children under 10
Measuring PA
Proxy-report measures (parent/caregiver)
Advantages
Moderate correlation with activity monitor counts
Limitations
Limited association compared with direct observation
Inconsistent association with heart rate data
Measuring PA
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Children’s Activity, Participation and Enjoyment (CAPE) measure CAPE: 55-item questionnaire examining extracurricular activities
Self-administered AND
interviewer-assisted versions
Appropriate for ages 6-21
with and without disabilities
Preferences for Children's Activities (PAC) measure
55-item questionnaire examining activity preference
Measuring PA
Heart Rate Monitoring-Advantages
Objective indirect assessment of
frequency, intensity, and duration
Inexpensive, unobtrusive
Measuring PA
Heart Rate Monitoring-Disadvantages
Weak relationship with energy expenditure during high and low intensity levels
May be influenced by age, body size, environmental factors, emotional stress, and cardiorespiratory fitness
Delay in heart rate response to movement
Measuring PA
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Accelerometry-Advantages
Small, lightweight, wearable on waist or extremity
Records frequency and magnitude of acceleration in “epochs” to estimate PA intensity or energy expenditure
Strong positive correlation with indirect calorimetry
Variable association with direct observation
Measuring PA
Accelerometry-Limitations
Epoch length may not capture spontaneous bouts of intermittent activity
Lack of standardization of cut-points that define moderate/vigorous PA
Insensitive to certain activities like biking or swimming
Measuring PA
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Pedometry- Advantages
Cost-effective, well tolerated
Moderate to strong validation against direct observation (less at slower walking speeds), accelerometry, O2 uptake, and HR.
Reliable at R/L hip and umbilicus
Limitations-
Counts ambulatory movements only
Measuring PA
Direct Observation-Advantages
Objective measure including context, social factors Provides info about type and intensity
Can be used in a variety of settings
May be computer analyzed
Limitations
Time-intensive for the purposes of observer training and data coding
Measuring PA
Direct Observation
Children’s Activity Rating Scale (CARS)Validated against respirometry
Rates PA intensity level from sedentary to vigorous on a scale of 1 to 5
Evaluates young individuals, age 2 up to age 6
Frequently used to validate and calibrate the ActiGraph accelerometer
Measuring PA
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Direct Observation
SOPLAY (System for Observing Play and Leisure Activity in Youth)
Appropriate for measuring PA in groups of children; ie; school environment
Uses momentary time-sampling techniques
Number, gender, activity level, type of activity including equipment
Coded Sedentary, Walking, or Very Active
Measuring PA
Child and Adolescent Scale of Participation
*Proxy report measuring perceived impact of problems experienced with physical, social and attitudinal environment features of the child’s home, school and community*Developed for monitoring needs and outcomes of children and adolescents with traumatic or acquired brain injuries
*Useful for individual intervention planning, program evaluation, and population-based research
*Moderate correlation with PEDI functional activity scores
Measuring Participation
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Participation and Environment Measure for Children and Youth
*Measures participation in home, school, and community settings
* Examines participation frequency, extent of involvement, and desire for change
*Used for children and adolescents between 5-17 years old with or without disabilities
* Reliable and validated for population-level studies
Measuring Participation
The Compendium of Energy Expenditures for Youth
Lists the MET expenditure for 26 pages worth of activities, from texting while lying down to windsurfing.
Differentiates between light, moderate, and hard effort for most activities
Not intended for use with children and adolescents who have disabilities that would significantly alter their movement patterns, mechanical efficiency and energy cost of activity.
Measurement
25% of U.S. children and youth, ages 6-15 met the guidelines for 60 minutes of MVPA per day
U.S. Report Card
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53.5% of U.S. children and youth, ages 6-11 met the guidelines for <2 hours screen time per day
U.S. Report Card
12.7% of U.S. children and youth, ages 5-14 who walked or biked to school
U.S. Report Card
58.4% of U.S. high school students participated in 1 school or community organized sport team
U.S. Report Card
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MVPA during spontaneous unorganized free play activities was 55% higher than in structured activities
U.S. Report Card
Insufficient National Data to grade health-related fitness components including cardiorespiratory, metabolic, morphological, motor, and muscular fitness.
U.S. Report Card
Family and peer support is another aspect considered in the National report card; again, there was not enough nationally representative data to grade this item.
U.S. Report Card
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Schools received a grade of C- based upon 51.8% of U.S. high school students attending at least one PE class per week.
U.S. Report Card
Community and Built Environment received a grade of B-, with 84.6% of children and youth living in a neighborhood with at least 1 park or playground.
U.S. Report Card
There is insufficient data to grade the effect of government strategies and investments on increasing physical activity levels. Some initiatives have included:
2008 PA Guidelines for Americans
2012 PA Guidelines Midcourse Report
Community Transformation Grant Program (No longer funded)
Federal Safe Routes to School Program (No longer funded)
Let’s Move (Discontinued)NHANES National Youth Fitness Survey
President’s Council on Fitness, Sports, and Nutrition
U.S. Report Card
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Demographic barriers to Active Transport:
Girls
Younger children
Children with higher socioeconomic status
Children in households with increased car ownership
are less likely to walk or bicycle to and from school
Barriers to PA
Active Transport
Barriers to PA
Intrapersonal Interpersonal Institutional Environmental
parental fears for safety
time management
motivation
schedule conflicts
social norms
low peer/parent support
parental time constraints
related to work
convenience of driving or
bus riding
greater support for
sedentary transport
safe equipment storage
(bike racks, etc)
logistical coordination of
car/bus/walkers
early school start times
lack of crossing guards
school material burden
travel distance
road infrastructure
hilly terrain
traffic dangers
crime danger
inclement weather
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Demographic Barriers to Structured and Unstructured PA
Age and socioeconomic status:
adolescents have more homework and part-time job requirements;
youth were impacted by cost, distance, safety, and condition of facilities
Barriers to PA
Structured and Unstructured PA
Barriers to PA
Intrapersonal Interpersonal Institutional Environmental
embarrassment
Fear of injury
Weight criticism
Lack of
interest/time/skill/
motivation/equipment
Other priorities
Sedentary or No Peers
Low peer/parent support
Family obligations
Low priority
Negative experiences
Coaching problems
Staff discouragement
Heavy workload
Competitiveness
Facility unavailability
Job responsibilities
Undesirable choices
Transportation
Expense/cost
Inaccessibility
Lack of opportunity
Physical safety
Inclement weather
School-Based Physical Activity
Barriers to PA
Intrapersonal/Interpersonal Institutional Policy
Negative perceptions of PE
Lack of activity choices in PE
Lack of instructor support
Lack of confidence in front of peers
Girls feel dominated and discouraged
by boys
Lack of interest/priority
Uniforms
Negative experiences
Inappropriate class size
Inadequate time for
changing/showering
Lack of funding/equipment/facility
space
Inconsistent national
standards for PE
Inconsistent recess
policies
Withholding recess
punitively
Facility availability for
after-school use
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Active Transport
New construction: site plans
conducive to walking
Existing sites: crossing guards,
walking school bus
Solutions
Structured and Unstructured PA-Community Level
Develop community-level coalitions and programs to promote PA
Youth service agencies offer a variety of PA programs with flexible scheduling, transportation, and financial assistance
Comprehensive PA programs that include individual and team sports, activity lessons, and exercise classes
Solutions
Structured and Unstructured PA-Home Level
Time limits on sedentary entertainment
Encourage outdoor play
Provide equipment
(balls, bikes, etc.)
Parental support
(transport, monetary, attendance)
Parental activity alongside the children
Solutions
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Structured and Unstructured PA-School Based
PE provided by certified/licensed teachers
150min/wk elementary
225min/wk middle/high
Incorporate PA throughout the school day, with special events and activity clubs
Solutions
Compounded in children who have special needs
Lack of knowledge and skill
Child’s preferencesFear/Frustration/Loss of confidence
Negative Attitudes toward disability
Inadequate facilities
Lack of transportation
Lack of programs
Lack of staff capacity
Cost
Barriers to PA
Specific to children who have special needs
Child’s desire to be fit and activeSkills practice
Involvement of peers
Opportunities sensitive to the issues of children with special needs
Skilled staff and information dissemination
1:1 instruction
Positive encouragement
Flexible payment schemes
Subsidized programs
Access to modified equipment
Inclusive policies
Facilitators to PA
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Individual level
Incorporate practical instructor training
Invite families to express their activity choices
Introduce flexible/subsidized payment options
Encourage participation from early childhood
Strategies
Social level
Lessen the burden on parents through financial/social support or incentives
Invite families to express their activity choices
Introduce flexible/subsidized payment options
Encourage participation from early childhood
Strategies
Policy level
Develop partnerships in sport and disability sectors, local government, and schools
Encourage positive societal attitudes to disability
-learn how to value people who have disabilities, not condescend
Strategies
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Access to modified equipment
Bad Choice.mov
Case Examples
1:1 instruction
Sandra’s Samba.mov
Case Examples
Inviting families to express their activity choices
The Climb.mov
Case Examples
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Child’s desire to be active
Video: Donnie’s Dubstep.mov
Case Examples
Mentoring-examples of 1:1 instruction
The Physical Activity Mentoring Program for Persons with Disabilities (https://www.uwlax.edu/physical-activity-mentoring)
Sponsored by the Center on Disability Health and Adapted Physical Activity at the University of Wisconsin-La Crosse.
Goals: increase physical activity, improve nutrition habits, and enhance community-based physical activity experiences
Resources
Mentoring-examples of peer involvement
Unified Sports (http://www.specialolympics.org/unified-sports.aspx)
A Special Olympics program that promotes social inclusion through sports.
Over 4500 teams nationwide in elementary, middle, and high schools
Unified PE
A Special Olympics program structured around the national physical education standards and grade-level outcomes
Designed as a high-school level course
Resources
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Access to modified equipment examples
Maryland Technology Assistance Program (http://mdod.maryland.gov/mdtap/Pages/MDTAP-Home.aspx)
V-LINC (http://www.v-linc.org/)
Professionals working with high school or college students to provide custom solutions to barriers using assistive technology and adaptive equipment
iCanShine.org (Bike, Swim, Dance)
National program using modified equipment to teach bike riding to people with special needs
Resources
Inclusive policy-examples
National Center on Health, Physical Activity and Disability (http://www.nchpad.org)
Special Education State Advisory Committee (http://marylandpublicschools.org/programs/Pages/Special-Education/sesac/index.aspx)
Special Education Citizens Advisory Committee
Resources
Q & A