the efficacy of a 9-month treadmill walking program on the exercise capacity and weight reduction...

Abstract This study evaluated the efficacy of a

9-month treadmill walking (TW) program on exercise

capacity and body mass index (BMI) for adolescents

with severe autism. Ten youth residing in a residential/

school treatment facility were assigned to either a

supplemental treadmill walking (TW) or control group.

Both groups continued to participate in their regular

physical education curriculum. Monthly records were

maintained for the following: (a) TW progression in

frequency, duration, speed and elevation; (b) caloric

expenditure; and (c) BMI. The TW program resulted

in significant increases in mean monthly TW frequency,

speed, elevation, and calories expended coupled with a

reduction in BMI.

Keywords Autism Æ Adolescents Æ Exercise Capacity ÆBody Mass Index

The health benefits (e.g., reducing the risk for heart dis-

ease and type 2 diabetes) of regular exercise/physical

activity are well established (Blair et al., 1989; Booth,

Gordon, Carlson, & Hamilton, 2000; Pate, Pratt, & Blair,

1995). It has been documented that children, adolescents,

and adults with developmental disabilities (e.g., mild to

moderate mental retardation) demonstrate physical fit-

ness levels that are not only inferior to their non-disabled

peers but reflect a population exhibiting a sedentary

lifestyle (Fernhall & Pitetti, 2001; Pitetti & Campbell,

1991; Pitetti, Rimmer, & Fernhall, 1993; Pitetti, Jong-

mans, & Fernhall, 1999; Pitetti, Yarmer, Fernhall, 2001).

This is also true of youth with severe developmental

disabilities, including youth with autism, living in a resi-

dential/school treatment facility (Pitetti et al., 1999).

Thus, it is suggested that a sedentary lifestyle contributes

to an increased risk of early morbidity and mortality in

persons with developmental disabilities. This belief is

strengthened by data showing that adults with develop-

mental disabilities may be at risk for preventable mo-

bidity and motality because of insufficient health-

promoting behaviors, including physical inactivity

(Chanias, Reid, & Hoover, 1998; Hayden, 1998; Suther-

land, Couch, & Iacono, 2002). Accordingly, it appears

that physical activity is an important contributor to

health in populations with developmental disabilities.

It has been shown that participation in exercise pro-

grams can improve the physical fitness and health pro-

files of persons with mild to moderate mental retardation

(Andrew, Reid, Beck, & McDonald, 1979; Beasley, 1982;

Bundschuh & Cureton, 1982; Fernhall, 1993; Frey,

McCubbin, Hannington-Downs, Kasser, & Skags, 1999;

Nordgren, 1971; Pitetti & Tan, 1991; Pitetti et al., 1993;

Rimmer, Heller, Wang, & Valerio, 2004; Schurrer,

Weltman, & Brannel, 1985) and persons with severe

K. H. Pitetti (&)Department of Physical Therapy, College of HealthProfessions, Wichita State University, Wichita, KS 67260-0043, USAe-mail: [email protected]

A. D. RendoffDepartment of Physician Assistant, College of HealthProfessions, Wichita State University, Wichita, KS 67260-0043, USA

T. GroverHeartspring, Wichita, KS, USA

M. W. BeetsOregon State University, Corvallis, OR, USA

J Autism Dev Disord (2007) 37:997–1006

DOI 10.1007/s10803-006-0238-3

123

ORIGINAL PAPER

The Efficacy of a 9-Month Treadmill Walking Programon the Exercise Capacity and Weight Reduction for Adolescentswith Severe Autism

Kenneth H. Pitetti Æ Andrew D. Rendoff ÆTravis Grover Æ Michael W. Beets

Published online: 6 December 2006� Springer Science+Business Media, LLC 2006

mental retardation without autism (Tomporowski & El-

lis, 1985; Tomporowski & Jameson, 1985). While exer-

cise studies have been performed with youth diagnosed

with severe developmental disabilities including autism

(Bachman & Fugua, 1983; Bachman & Sluyter, 1988;

Baumeister & MacLean, 1984; Elliot, Dobbin, Rose, &

Soper, 1994; Kern, Koegel, Dyer, Blew, & Fenton, 1982;

Kern, Koegel, & Dunlap, 1984; McGimsey & Favell,

1988; Rosenthal-Malek & Mitchell, 1997), the main

interest was the reduction of maladaptive behaviors and

not specifically the ability to increase exercise capacity

or the reduction of body weight.

In a recent study, Lotan and colleagues (Lotan, Isa-

kov, & Merrick, 2004) performed a 2-month treadmill

walking program with 4 children (8.5–11 years) with

Rett syndrome to determine the affect treadmill walk-

ing program on aerobic fitness. Although children with

Rett syndrome share behavior characteristics similar to

autism (Diagnostic and Statistical Manual of Mental

Disorders, 2000), they also demonstrate ataxic motor

anomalies (i.e., gait patterns are unsteady and initiating

motor movements can be difficult). Lotan et al. (2004)

reported improvements in physical fitness by changes in

resting and treadmill exercise heart rates. In addition,

the efficacy of the treadmill walking program to in-

crease weekly activity levels was determine by the

amount of calories (kilo-calories) expended throughout

the study. However, the specific methodology used by

Lotan et al. (2004) to determine resting and treadmill

heart rates was not reported and the validity of the

method used to determine caloric expenditure for each

treadmill training session is problematic in that it did

not follow established guidelines (American College of

Sports Medicine, 2005).

Therefore, the purpose of this study was to determine

the efficacy of incorporating a 9-month treadmill walking

program into the weekly academic curriculum of youth

with severe developmental disabilities including autism.

For this study, efficacy was defined as a significant pro-

gression in treadmill walking frequency, speed, elevation

(i.e., exercise capacity), and monthly calories expended

coupled with a reduction in body mass index.

Methods

Participants

Ten adolescents/young adults (6 male and 4 female)

participating in this study were clients of a Midwestern

residential/school treatment facility for people with

severe developmental disabilities. Written informed

consent was obtained from parents/guardians of the

participants and the study protocol was approved by the

residential/school treatment facility ethical committee

and the University Institutional Review Board. Partic-

ipants were selected from 42 clients residing in this

facility and assigned to either treadmill walking group

(TWG) or the control group (CG). The sampling design

was purposive (Henry, 1990; Sherrill & O’Conner,

1999) and followed a previously established selection

criteria (Pitetti et al., 1999): (a) a physician and a psy-

chologist, both experienced in autism, confirmed that

diagnosis met the DSM-IV-Text Revised (American

Psychiatric Association, 2000); (b) manifested moder-

ate to profound mental retardation as assessed by

standardized tests of intelligence, including the Leiter

International Performance Scale (Leiter, 1969), the

Slosson Intelligence Test (Slosson, 1963), and/or

Wechsler Adult Intelligence Scale (Wechsler, 1981); (c)

all had histories of lengthy and restrictive placement

resulting from their severe maladaptive behaviors; (d)

had no medical contraindications (i.e., cardiovascular/

respiratory anomalies) or significant primary sensory or

motor impairments that restricted them from treadmill

walking; and (e) identified by staff as able to follow

instructions to perform treadmill walking . Descriptive

statistics on the participants are found in Table 1 and

diagnosis and medications are found in Table 2.

Procedures

Control Group

For the control group (CG), their Student Support

Plan (SSP), as designed and implemented by the resi-

dential treatment facility staff members, allowed for

30 min of ‘‘leisure activity’’, 3-times per week, at the

Table 1 Descriptive statistics of exercise and control groups

Subject Gender Age(years)

Weight(kg)

Height(cm)

Body mass(kg m–2)

Exercise group1 Male 18 96.2 179.7 30.02 Male 18 92.9 180.3 28.63 Male 18 129.2 168.3 45.64 Female 15 80.7 176.5 25.95 Female 14 91.4 160.0 35.7

Mean ± SD 16.6 ± 1.9 98.0 ± 18.3 173.0 ± 7.8 33.2 ± 7.8Control group6 Male 18 72.6 168.9 25.47 Male 16 80.3 178.4 25.28 Female 19 107.9 166.4 39.09 Female 17 63.1 163.2 23.710 Male 17 142.9 186.1 41.3

17.4 ± 1.1* 93.4 ± 32.4 172.6 ± 8.4 30.9 ± 8.5

* Significantly (P < .05) older

998 J Autism Dev Disord (2007) 37:997–1006

123

Table 2 Clinical diagnosisand medications of exerciseand control groups

Participant Diagnoses Medications

Exercise group1 Autism Risperdal 1 mg tab (1 tab BID)

Severe mental retardation Docusate Sodium (200 mg SID)Obesity Certavite (1 tab SID)

Diphenhydramine (25 mg BID)Benzac gel 10% (Apply to skin BID)

2 Autism Clonidine 0.1 mg tab (1/2 tab am, 2 tabs pm)Severe mental retardation Risperdal 1 mg tab (1 tab am, 2 tabs pm)Visual impairedBehavior disorder

3 Autism Protonix (40 mg SID)Hypertension Diovan (160 mg SID)Fibromyalgia Zyrtec (10 mg SID)Chronic constipation Neurontin (300 mg SID)HypercalcemiaMild mental retardation

4 Autism Nordette (1 tab SID for menses)Chronic constipation Metamucil Apple Wafer (1 wafer 5·/wk)Severe mental retardation Acetominophen (650 mg every 4 h

as needed for pain/fever)Aleve (220 mg BID as needed

for dysmenorrhea)5 Autism Ziprasidone (40 mg SID @8 pm)

Severe mental retardation Topiramate (50 mg BID)Reactive attachment Disorder Ziprasidone (20 mg BID @8 am and 2 pm)Oppositional defiant disorderPost-traumatic stress disorder

Control group6 Autism Ambien (2.5 mg SID)

Severe mental retardation Propanolol 80 mg tablets(1 tab am, ½ tab pm)

Mood disorder Seroquel 200 mg (1 tab QID)IED Topamax 100 mg tab ( 1 tab BID)

Trileptal 600 mg tab (1 tab 3x/day)7 Autism Depakote 250 tab(3 tabs BID)

Visual impairment Docusate Sodium 100 mgcaps (1 cap 3x/week)

Seizures Geodon 60 mg (1 cap BID)Mental retardation Lamictal 25 mg (2 tab BID)Attention deficit hyperactivity Loratadine 10 mg (1 tab SID)Disorder Ativan 2 mg/ml (2 mg rectally

as needed for seizures)8 Autism Clonazepam 1 mg tab

(1/2 tab am, 1 tab pm)Asperger’s syndrome Fiber-latex (1 tab every other morning)Attention deficit hyperactivity Lamictal 100 mg tabs (1 tab BID)Disorder Seroquel 100 mg tabs (2 tabs BID)PDDAnxiety disorder

9 Autism Allegra 60 mg tabs (1 tab SID)Seizure disorder Carnitor 330 mg tabs (1 tab BID)Disruptive behavior disorder Certagen Multivitamin (1 tab SID)Severe mental retardation Citrucel (1 tablespoon 5x per week)Scoliosis Depakote 250 mg tabs (1 tab SID)

Depakote ER 500 mg tabs (2 tabs BID)Geodon 40 mg cap (1 cap SID)Lamictal 100 mg tabs (1 tab BID)Necon 1/50 tabs (1 tab SID)Ativan 2 mg/ml (1 ml as needed for seizures)

10 Autism Glycolax Powder (1 tablespoon SID in 8oz juice)Mental retardation Seroquel 100 mg tabs (1 tab SID)Obesity Seroquel 25 mg tabs (2 tabs SID)

J Autism Dev Disord (2007) 37:997–1006 999

123

campus gymnasium. These activities took place under

the guidance of a staff member with a master’s degree

in adapted physical activity. Classes permitted partici-

pants to engage in the following activities; basketball

(shooting, dribbling, passing), jumping rope, roller

skating, Scooter-Board activities, object control skills

(i.e., throwing and catching the ball), striking a ball

(i.e., tennis or nerf) with a tennis racket or plastic bat,

and cycling skills (e.g., two or three wheeled adult

bicycle).

Treadmill Walking Group

The treadmill walking group’s (TWG) weekly activity

differed from the CG in the following manner, (a) the

majority of time within the regular activity classes (i.e.,

15–30 min, Monday–Wednesday–Friday) consisted of

treadmill walking, (b) during the weekdays when reg-

ular activity classes activity classes were not planned

(i.e., Tuesday and Thursday), they were taken to the

gymnasium and given the opportunity to walk on the

treadmill (i.e., taken to the gymnasium), and (c) they

were given the opportunity to walk on the treadmill at

their residence in the evening (i.e., 3:15 pm–8 pm).

Treadmill Protocol

Prior to initiating the study, all 10 participants had

been trained to walk unassisted (i.e., not holding on to

railing) on the treadmill during their regular class time

(e.g., 1–3 times per week, duration of 5–10 min) and,

therefore, were acclimated to the use of the treadmill.

For the TWG, the treadmill protocol consisted of (a)

an initial frequency of 2 times per week, with a pro-

gression of 1 day every 2 weeks to a peak frequency of

5 times per week, (b) an initial duration of 8 min per

session, with a progression of 1–2 min every 2–3 weeks

to a peak duration of 20 min per session, (c) an initial

treadmill speed (individualized based on ability) ran-

ged from 2.4 mph to 3.5 mph, with a progression

of .1 mph to .3 mph every 2–3 weeks to a peak speed

ranging from 3.7 mph to 4.1 mph, and (d) an initial

grade of 0%, with progressive increases of .5%. Due to

the fact that the participants in this study were partic-

ularly schedule oriented (i.e., abrupt changes potenti-

ated negative behaviors), frequency and duration was

slowly increased by an average of 1 day every

3–5 weeks and 1 min every 2–3 weeks, respectively.

Increases in speed and grade were also behavior

dependent. During residential (3:15–8 pm) or weekend

hours, participants were allowed to walk on the

treadmill at intensities, durations, and speeds consis-

tent with the treadmill protocol, under the direction of

their residential staff. All treadmill information (i.e.,

frequency, speed, grade, duration) was recorded by

residential staff members into daily logbooks for each

of the participants. This information was used to track

the progression of the participants over the duration of

the program (Table 3).

Caloric Expenditure

Caloric expenditure specific to treadmill walking was

determined from equations established by the Ameri-

can College of Sports Medicine (ACSM, 2005) and

calculated in the following manner, (a) for each day,

VO2 was expressed in net terms (ml kg–1 min–1)

from the formula: VO2 = 0.1 (speed of tread-

mill) + 1.8 (speed of treadmill) (fractional grade of

treadmill) + 3.5, (b) net VO2, as calculated from the

last equation, was then converted to METS (i.e., met-

abolic equivalent) by dividing net VO2 by 3.5 ml kg–1

min–1; and (c) caloric expenditure per minute was then

calculated from the formula: kcal min–1 =

(METs · 3.5 · body weight in kg)/(200).

Daily logs of caloric expenditure were added to

obtain the sum of each week’s caloric expenditure.

Mean monthly caloric expenditures were determined

by dividing the total sum of weekly caloric expenditure

by the number of weeks per month.

Body weight was measured weekly and used for

weekly caloric expenditure calculations. The treadmill

was calibrated monthly.

Body Mass Index (BMI)

Body mass index is defined as body weight (kg) divided

by height (m) squared (kg m–2). Height (to the nearest

0.64 cm of ¼ inch) and weight (to the nearest .11 kg or

¼ lb) were measured on a standard physician’s scale

(Detecto�). Body mass index is shown to strongly

correlate with total fat content (ACSM, 2005). For

descriptive purposes we used the following BMI cutoff

Table 3 Initial and 9-month weight and BMI for treadmillwalking and control groups

Initial Month 9

Treadmillwalkinggroup

Controlgroup

Treadmillwalkinggroup

Controlgroup

Weight(kg)

98.0 ± 18.3 93.0 ± 32.3 92.9 ± 15.5 91.2 ± 30.9

BMI(kg m–2)

33 ± 7.82 30.9 ± 8.49 30.2 ± 6.33 30.0 ± 7.35*

* 9-Month treadmill walking group BMI significantly (P < .05)lower than initial month exercise group


123

points to classify the participants: overweight

(BMI ‡ 25.0 and < 29.9); and obese (BMI ‡ 30.0)

(Centers for Disease Control and Prevention, 2005).

Statistical Analysis

Means and standard deviations (±) were computed for

all variables. Initial body weight and BMI between

groups were compared using an independent sample

t-test. For the TWG, comparison between month 1

(baseline) and month 9 was made using one-tailed

paired sample t-tests for the following parameters:

BMI, weight (kg), treadmill speed (mph), duration on

treadmill (min), elevation of treadmill (%), METS,

and caloric expenditure (kcal min–1). For all analyses,

statistical significance was adjusted to control for Type

I errors using Holm’s sequential Bonferroni test

(Holm, 1979). Clinical significance for the main out-

come of interest, body mass index, was determined by

calculating effect sizes and the reliable change index.

Effect sizes were calculated using the following for-

mula: baseline minus month 9 divided by the standard

deviation of baseline. Effect sizes were interpreted

according to previously established standards: small

( < .41); moderate (.41–.70); and large (>.70) (Cohen,

1969). The reliable change index (RC) (Jacobson &

Traux, 1991) was calculated for each participant by the

following formula: RC = x2 – x1/Sdiff, where x2 and x1

represent a participant’s pre- and post-test scores,

respectively, and Sdiff represents the standard error of

difference between two test scores. The Sdiff is equal to

the:

ffiffiffiffiffiffiffiffiffiffiffiffiffiffi

2ðSEÞ2q

: The SE (standard error of measurement)

was calculated by: SE ¼ s1

ffiffiffiffiffiffiffiffiffiffiffiffiffiffi

1� rxx

p; where s1 is the

standard deviation of the control and experimental

group pre-test measure and rxx is the test–retest

reliability coefficient of the measure. For our analy-

sis, we used the Spearman Rank Order coefficient

(q) between baseline and month 1 measures. An RC

equal to or greater than 1.96 indicates significant

changes occurred in the measure, in this case BMI.

Given the limitations with the small sample size,

changes were graphically illustrated in outcome

variables for the TWG and CG over the 9-month

study.

Results

The primary outcomes of interest, body weight and

body mass index (BMI), for month 1 (i.e., baseline)

and month 8 for the TG and CG are presented in

Table 1. Monthly body weight and BMI for both

groups are shown in Fig. 1. At baseline, there were no

significant differences between groups for body weight

or BMI. Comparisons between baseline and month 8

for the TG and CG, separately, demonstrated the

following, (a) a significant decrease in BMI for the

TWG, t (4) = 3.23, P = .016, whereas no significant

changes in BMI for the CG, t (4) = 1.149, P = .315; and

(b) a non-significant reduction in weight for the TWG,

t (4) = 1.904, P = .065 and the CG, t (4) = 0.879,

P = .215 (see Table 2).

The effect size (ES) for change in BMI over the

duration of the study indicated a modest effect for the

TG (ES = .38) and a minimal effect for the CG

(ES = .03). The reliable change index (RC) indicated

that three of the five TG participants reliably reduced

their BMI (RC range 2.45–3.65) over the duration of

the study (see Table 1). Interestingly, one of the CG

participants also reduced their BMI during this same

195

200

205

210

215

220

1 2 3 4 5 6 7 8 9

Month

Bo

dy

Wei

gh

t (l

bs)

28

29

30

31

32

33

34

Bo

dy M

ass Ind

ex (kg/m

2)

Exp Wht Cont Wht Exp BMI Cont BMI

Fig. 1 Exercise group versuscontrol group BMI and bodyweight


123

time (RC = 2.82). The relative percent change in BMI

from baseline indicated that a minimum of 2.8%, up to

a 17.2% reduction in BMI occurred with the TG. For

the CG, three participants reduced their BMI (percent

change range 3.0–9.6%); while two participants in-

creased their BMI (percent change 1.7–3.8%). The

percent changes are graphically illustrated in Fig. 2.

Discussion

The primary purpose of this study was to determine the

efficacy of a supplemental treadmill walking program

on the exercise capacity and BMI reduction of youth

with severe developmental disabilities including aut-

ism. For this study, efficacy was defined as a significant

progression in treadmill walking frequency, speed,

elevation (i.e., exercise capacity), monthly calories

expended and a reduction in BMI. For the participants

in the TWG, the treadmill walking program used in

this study resulted in a significant increase in exercise

capacity and monthly caloric expenditure coupled with

a decrease in BMI.

In a similar study, Lotan et al. (2004) perform a

2-month treadmill walking program with 4 children

(8.5–11 years) with Rett syndrome. Although the

present study and that by Lotan et al. (2004) substan-

tiate the efficacy of incorporating a treadmill walking

program into the daily activities of two different groups

of individuals with developmental disabilities, signifi-

cant differences existed in methodology and, therefore,

outcomes. Obvious differences were seen in partici-

pants’ mean age (10 years vs. 16.6 years), disability

(Rett syndrome versus Autism with mild to severe

mental retardation), and duration of the studies (i.e.,

2 months vs. 9 months). In addition, Lotan et al. (2004)

did not report (a) specific clinical diagnosis, or medi-

cation, and (b) individual or group mean weekly or

monthly initial and incremental increases in treadmill

speed, grade or walking duration. However, the major

methodological difference between studies concerned

determination of caloric expenditure. In the present

study, caloric expenditure was determined from equa-

tions established by the American College of Sports

Medicine (ACSM, 2005) and calculated accordingly.

The validity of the formula used by Lotan et al. (2004)

to determine caloric expenditure was not established

(i.e., no reference(s) were given). That is, according to

ACSM (2005) equations, and using Lotan et al. (2004)

highest reported treadmill speed (1.5 k h–1) and grade

(1%), average weekly duration (19.9 min), and an

estimated weight of 45 kg (although body weight was

not reported), the total caloric expenditure would be

24.1 calories for that session. Lotan et al. (2004)

reported an average of 213.5 calories per session, an

885% difference. Even if one increased or decreased

the estimated body weight of 45 kg by 50%, this would

not account for the significant differences in estimating

caloric expenditure.

The U.S. Surgeon General (U.S. Department of

Health and Human Services, 1996) along with the

Centers for Disease Control and Prevention and the

American College of Sports Medicine recommend a

minimum duration of 30 min of moderate intensity,

physical activity for 5–7 days of the week (Pate et al.,

1995). Brisk walking (i.e., 3–4 mph) has been recog-

nized as a type of moderate activity and has been

shown to substantially reduce the risks for heart dis-

ease, stroke, and type 2 diabetes (Gregg, Gerzoff,

Caspersen, Williamson, & Narayan, 2003; Hakim et al.,

1999; Hu et al., 1999; Lee, Rexrode, Cook, Manson,

20

22.5

25

27.5

30

32.5

35

1 2 3 4 5 6 7 8 9Month

Bo

dy

Mas

s In

dex

(kg

/m2)

0

200

400

600

800

1000

1200

1400

Averag

e caloric exp

end

iture p

er week

Exp BMI Exp CE

Fig. 2 Mean body mass index(BMI) versus mean averagecaloric expenditureper month


123

& Buring, 2001; Manson et al., 1999, 2002; Sesso,

Paffenbarger, & Lee, 2000; Tanasescu et al., 2002). For

this study, the treadmill walking program did not attain

the minimum recommendations for duration or fre-

quency (Table 4, month 9), but did achieve recom-

mended speed (3.86 ± 0.12 mph, Table 4, month 9) to

be classified as moderate intensity.

Although the causative variables that contribute to

overweight/obesity can be intricate (i.e., neuroendo-

crine, genetic, etc.), diet and physical inactivity are still

considered the primary causes for overweight/obesity

(National Institutes of Health and National Heart,

Lung, and Blood Institute, 1998). Given the clinical

needs of their disability, daily (i.e., 24 h) activity levels

and dietary intake for the participants in this study

were closely monitored and controlled. While holiday

breaks did occur (e.g., Thanksgiving and Christmas

Holidays), the participants spent approximately 95%

of the study time within the campus of the residential/

school treatment facility. The fact that the CG dem-

onstrated a slight reduction in body weight and BMI,

although not statistically significant, substantiates that

care was taken by the staff of the facility to ensure

caloric balance for their clientele. For the TWG, the

gradual drop in monthly BMI was seen in conjunction

with a gradual increase in monthly caloric expenditure

(Fig. 2). This suggests that the treadmill walking pro-

gram was a contributor to the significant reduction in

BMI for the TWG. Further support for the treadmill

walking program is the reduction of baseline BMI, with

initial levels well above the obesity criteria (i.e., >30),

to borderline obesity status (mean BMI = 30.2) by

month 9.

Obesity, in and of itself, is a primary risk factor for

heart disease (National Institutes of Health and Na-

tional Heart, Lung, and Blood Institute, 1998). Because

excessive weight gain is easier to prevent than to reverse

(Institute of Medicine, 2004), practitioners have called

for modest reductions (5–10%) in BMI and weight for

individuals who find substantial weight loss difficult to

achieve (De Levia, 1998). The percent reduction in

BMI for the TWG averaged 8.4% while weight reduc-

tion an average of 4.8%. The sustained and gradual

weight loss experienced by the participants would likely

have contributed to a reduction in the risk associated

with the complications due to diabetes, hypertension,

hyperlipidemia, and cardiovascular disease (Pasanisi,

Contaldo, de Simone, & Mancini, 2001). However,

Table 4 Average treadmill walking speed, time, elevation and METS per exercise group participant per month

Participant Month 1 Month 2 Month 3

Freq Speed Time ElVN METS Freq Speed Time ElVN METS Freq Speed Time ElVN METS

1 1.8 2.35 8.50 .00 28.25 4.8 2.91 16.29 .07 184.46 2.8 3.23 14.03 .34 139.392 3.0 3.02 16.55 .00 114.61 3.8 3.10 17.50 .00 154.49 6.0 3.17 15.10 .10 236.953 1.8 3.00 17.63 .00 68.19 3.0 3.07 19.50 .08 147.54 2.3 3.22 20.08 .88 198.254 2.3 3.50 20.21 .17 146.04 2.3 3.44 20.96 .00 163.81 3.0 3.54 22.38 .31 213.855 3.5 2.78 20.00 .06 151.31 4.5 2.94 18.85 .10 210.73 4.0 3.14 18.83 .46 237.53Mean 2.5 2.93 16.57 .05 101.68 3.7 3.09 18.62 .05 172.21 3.6 3.26 18.08 .42 205.19SD .8 .42 4.78 .07 52.71 1.0 .21 1.80 .05 25.63 1.5 .16 3.48 .29 40.33

Month 4 Month 5 Month 6

1 4.8 3.46 18.59 .96 484.04 4.3 3.47 20.19 1.34 528.86 1.8 3.29 17.13 .19 111.752 3.3 3.24 19.44 .76 272.67 4.0 3.13 19.21 1.57 464.68 4.3 3.08 18.60 1.08 394.043 2.0 3.36 21.61 1.25 231.19 3.3 3.33 21.51 2.60 628.14 3.8 3.46 21.27 3.47 928.834 1.5 3.55 19.46 1.46 278.08 2.3 2.66 17.33 2.29 411.20 1.0 2.80 15.50 2.44 299.195 5.3 3.20 20.30 .44 375.93 4.3 3.27 20.49 1.58 564.33 2.8 3.28 20.12 1.48 386.36Mean 3.4 3.36 19.88 .97 328.38 3.6 3.17 19.75 1.87 519.44 2.7 3.18 18.52 1.73 424.03SD 1.7 .15 1.14 .40 101.94 .9 .31 1.58 .54 84.61 1.4 .25 2.30 1.26 304.24


1 4.0 3.40 19.84 2.03 600.08 6.5 3.58 18.89 1.75 861.99 4.0 3.90 18.61 1.68 584.702 6.0 3.19 18.75 1.14 603.73 5.5 3.50 19.21 1.85 784.39 4.3 3.93 19.94 2.00 747.063 4.0 3.38 20.25 2.21 660.37 4.0 3.54 20.17 2.00 639.32 4.3 3.79 15.36 1.75 511.114 2.8 3.54 18.48 2.10 464.09 3.3 3.68 19.53 1.75 559.10 3.5 4.00 17.38 1.83 444.205 5.3 3.25 19.25 1.28 517.29 4.5 3.53 20.60 1.80 680.92 4.5 3.70 18.43 1.26 436.66Mean 4.4 3.35 19.31 1.75 569.11 4.8 3.57 19.68 1.83 705.14 4.1 3.86 17.94 1.70 544.75SD 1.2 .14 .74 .50 77.78 1.3 .07 .70 .10 119.51 .4 .12 1.71 .28 127.92

ElVN, Percent (%) elevation of treadmill


123

bio-markers (e.g., fasting blood glucose) indicating re-

duced risk for these diseases were not collected in the

current study. Nevertheless, the overall percent reduc-

tion in BMI and weight suggests the health profiles of

the participants were positively impacted.

The significant decrease in BMI by the TWG becomes

even more noteworthy when considering that two par-

ticipants in the TWG (#1 and #2) were taking daily doses

of 1 mg of risperdal (risperidone, Table 2). Resperidone

has been shown to have efficacy for treating aggression,

self-injury, and property destruction for persons with

developmental disabilities, including adolescents and

young adults with autism (APA, 2000). However, it was

found that significant weight gain was a limiting side

effect when using daily dosages of reperidone, similar to

the daily dosages used by participants #1 and #2 (i.e.,

1 mg/day) (Hellings, Zarcone, Crandall, Wallace, &

Schroeder, 2001). As stated by Hellings et al. (2001),

‘‘...the drug treatment (resperidone) may be stopped

prematurely because of weight gain in spite of good

efficacy (on behavior), without any trials of nutritional

consultation and exercise intervention.’’ Participant #1

demonstrated a reduction in body weight (212–188 lbs)

and BMI (30–25.6), while the body weight and BMI for

participant #2 remained constant (body weight of

204 lbs, and BMI of 28.6). These results suggest that the

treadmill walking program, if implemented for persons

with autism taking resperidone, could be beneficial as an

exercise intervention in controlling body weight and

BMI.

In this study, intensity of exercise was determined by

treadmill walking speed. However, the American

College of Sports Medicine (ACSM, 2005) has estab-

lished 60–90% of heart rate (HR) maximum (220-

age = HR maximum), based upon a minimum of

20 min of exercise in one session, as the appropriate

intensity for developing and maintaining cardiorespi-

ratory fitness. Heart rate monitors were offered to each

participant but they did not cooperate in its placement

(e.g., immediately removed the device or moved away

when offered). Therefore, no further attempt was

made to teach the participants to wear the monitors.

In addition to their regular activity classes (i.e.,

15–30 min, Monday–Wednesday–Friday), the TWG

was also given time to voluntarily walk on the treadmill

during the other weekdays (i.e., Tuesday and Thursday),

in the evenings, and on weekends. Monthly mean caloric

expenditure at these locations is found in Table 5.

Table 5 Average caloric expenditure per exercise group participant per week by month and location

Participant Month 1 Month 2 Month 3

Class Resd Wkend Total Class Resd Wkend Total Class Resd Wkend Total

1 28.5 .0 20.0 48.5 233.8 20.0 57.3 311.5 222.8 0.0 13.0 235.82 169.0 19.0 0.0 188.0 242.0 0.0 10.0 252.0 267.0 82.3 37.3 386.53 155.3 .0 .0 155.3 334.8 .0 .0 334.8 449.3 .0 .0 449.34 207.3 .0 .0 207.3 175.5 .0 .0 175.5 339.3 .0 .0 339.35 209.8 33.0 .0 242.8 282.0 42.5 12.3 336.8 335.3 16.5 24.3 376.0

Mean ± SD 168.38 ± 74.1 Mean ± SD 282.12 ± 68.7 Mean ± SD 357.38 ± 78.7


1 741.8 55.0 9.5 806.3 783.5 57.8 28.5 869.8 177.8 .0 .0 177.82 417.8 .0 21.0 438.8 657.8 97.0 6.8 761.5 546.8 36.5 54.0 637.33 522.3 .0 .0 522.3 1411.8 .0 .0 1411.8 2082.0 .0 .0 2082.04 209.3 .0 .0 209.3 689.3 .0 .0 689.3 403.5 .0 .0 403.55 562.3 .0 26.8 589.0 831.5 53.8 .0 885.3 574.8 38.0 .0 612.8

Mean ± S.D. 513.14 ± 217.7 Mean ± S.D. 923.54 ± 284.5 Mean ± S.D. 782.68 ± 749.5


1 1089.5 .0 40.3 1129.3 1005.8 247.0 40.0 1292.3 858.5 .0 16.3 874.82 1015.5 45.0 84.8 1145.3 1219.3 .0 127.3 1346.8 1213.8 .0 .0 1213.83 1446.0 .0 111.3 1557.3 1492.5 .0 .0 1492.5 1084.5 .0 .0 1084.54 820.8 .0 .0 820.8 667.0 .0 .0 667.0 754.0 .0 .0 754.05 796.3 92.5 43.5 932.0 934.8 137.5 .0 1072.3 585.3 31.3 22.8 646.0

Mean ± S.D. 1116.94 ± 281.4 Mean ± S.D. 1174.18 ± 321.2 Mean ± S.D. 914.62 ± 233.4

Class = 8:00 a.m.–3:00 p.m. (Monday–Friday)

Resd = Residential: 3:15 p.m.–8 p.m. (Monday–Thursday)

Wkend = Weekend: 3:15 p.m.–7:45 a.m. (Friday–Monday)


123

The calories expended on Tuesdays and Thursdays were

combined with those expended on the other weekdays

and are part of the total calories found under the ‘‘Class’’

column. Those expended during the weekdays after

3:15 pm were under ‘‘Residential’’ and those on the

weekends are listed under the ‘‘Weekend’’ column. For

all the participants in the TWG, the majority of calories

(>96%) were expended during the regular class hours.

For this study, therefore, participants were more willing/

able to engage in treadmill walking during their regular

class hours than at other times of the week.

A limitation of this study concerns number of par-

ticipants. Of the 42 clients residing in the facility, only

10 (24%) were selected according to a selection criteria

based on the work by Pitetti et al. (1999). Of the 10

that met these criteria, only 5 participated in the TWG.

Given that it was not the scope of this study to deter-

mine whether on not those in the CG would have

demonstrated the same results of the TWG, only 5

(12%) of the clients residing in this facility actually

participated in the treadmill walking program. Future

studies should expand the selection criteria to deter-

mine if more individuals with severe developmental

disabilities can actively engage in an exercise program

of similar intensity.

Conclusion

Although prior research has established the positive

impact of antecedent exercise programs on behavioral

outcomes for adolescents with multiple disabilities,

including autism, none have established whether a lon-

gitudinal study with this population could be feasible

and result in increasing exercised capacity along with a

reduction in BMI. The treadmill walking program was

successful in achieving significant reductions in BMI in

combination with an increase in caloric expenditure.

The program also positively impacted the exercise

capacity (i.e. treadmill walking frequency, speed, and

grade) of the participants. The results of this study indi-

cate that for persons with autism living in a community

residential/school treatment facility, a treadmill walking

program could improve or control their health profiles.

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