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Applying the Research: Exercise as an Evidence-Based Practice for Reducing Challenging Behavior and Increasing Engagement

To continue the dissuasion about the new Evidence-based Practices (EBP) for Autism report, I thought I would start by focusing on some of the interventions that have been added as evidence-based practices in the new report and talk what the research says about how they can be used and for whom they are effective.  If you missed previous posts, I talked about the overall report itself HERE and about the criteria for determining if it was an EBP HERE.

This summary is based, in part, on the Fact Sheet from the NPD report that can located HERE (Cox, 2013).    

Exercise is one of the interventions that has been added as having enough research behind it to make it an EBP.  The fact sheet cited above has a list of the articles that were found to match the criteria for EBP.  There actually is some early research from the 1980s (Baumeister & MacLean, 1984; Kern, Koegel, & Dunlap, 1984; Kern, Koegel, Dyer, Blew, & Fenton, 1982; McGimsey & Favell, 1988) that looked at the use of exercise to prevent challenging behavior, essentially to use it as an antecedent intervention.  There was some evidence that it was effective to have individuals with developmental disabilities (including but not limited to autism) engage in aerobic types of exercise prior to being asked to work and found reductions in challenging behaviors (McGimsey & Favell, 1988) and stereotypical behaviors (e.g., Baumeister & MacLean, 1984).  The research used in the current report is more recent and focused on 6 studies that met the criterial for EBP.  Overall they found that having students exercise in programmed and structured exercise activities, that typically involved a warm up and cool down routine and took place on a regular basis reduced challenging behavior, increased appropriate behavior and also improved motor skills and physical fitness.  The exercise could include aerobic exercise in combination with strength training and/or stretching exercises (Cox, 2013).  for instance, Cannella-Malone, Tullis, & Kazee (2011) used 20-minute exercise routines that included a variety of exercises like jumping on a trampoline, scooter boards, jogging, stretching, and arm curls with weights twice a day (beginning of the day and after lunch.  In addition, the students engaged in 1-minute exercise breaks once per hour that included, for instance, 1 minute of yoga poses or 1 minute of jogging in place.  They found that this routine conducted on a daily basis reduced a variety of forms of challenging behavior to zero or near zero levels.  Cox (2013) points out that exercise is often combined with other interventions as part of a behavioral package, but has been shown to be an effective element on its own.  The research reviewed targeted students in elementary ages and middle school, so there is still limited research for those older and younger, but I believe it’s reasonable to expect similar responses regardless of age.  Some of the earlier research included individuals who were adults.  

Applying the Evidence

So, what does this mean for you and your classroom?  It means that structuring in exercise breaks in your classroom makes sense.  Given the increasing evidence of the health risks of sitting for too long, this is important for improved health, but it may also increase engagement and decrease a variety of challenging behaviors.  It also teaches a life-long leisure skill.  I wrote some ideas for how to include exercise into your day in the classroom in this post HERE.  Those are ways to include it in the routine.  This is what you want to think about in creating those activities.

1.  Design a plan for the exercise 

So that it isn’t a complete free for all and doesn’t leave the students trying to figure out what to do, you want to have a regular routine that they follow with a variety of exercises.

2.  Aim for 1-2 15 to 20-minute exercise times with shorter breaks more often

We don’t have enough research at the moment to say exactly how much exercise is beneficial.  There is a good chance it is different for each individual.  However, the Cannella-Malone et al. (2011) study found that their 2 20-minute periods of aerobic exercise along with 1-minute breaks each hour was effective, so that might be a good model to adopt.  It also fits with the daily recommendations of health advocates and doctors in terms of getting out of their seat and moving.

3.  Include both aerobic exercise and strength/flexibility training

Most of the research used some type of vigorous aerobic activity and we know for good health 30 minutes of aerobic exercise per day is recommended.  However, based on my experience with this population, many of our students have not developed the strength, flexibility and muscle tone they will need to have stamina in a job when they graduate.  Standing for long periods of time, carrying materials from place to place, and other activities require a certain amount of strength that we should think about addressing before they move on.  Having the physical capability to do a job is as important as the job skills themselves. 

4.  Take data

Take data for a few purposes in this case.  First, take data on the behaviors you are trying to address and possibly on engagement in activities to make sure that your routine is working.  However, I would also suggest taking data on the students’ abilities of how long they participate, how many reps they can do, how long or what level they can ride a stationary bike and other accomplishments.  Then celebrate those accomplishments.  Setting goals for exercise is a good way to motivate people to work harder at it.  Sometimes I think the only thing that keeps me on my bike (besides I have to ride back to where I started) is that I want to beat yesterday’s mileage.  It’s a real motivator for me to see the improvement, and it will be for your students too.

5.  Make it fun and mix it up.

Remember just like your exercise routine gets boring, it can to the students too.  So have a variety of ways that they can exercise built into different days and mix it up periodically.  (And of course, I like lists of 5!).

So, how do you use exercise in your classroom?  Do you find it helps to keep your students focused and problem behaviors down?  

Until next time,

References:

Baumeister, A. A., & MacLean, W. E. (1984). Deceleration of self-injurious and stereotypic responding by exercise. Applied Research in Mental Retardation, 5, 385–393.

Cox, A. W. (2013). Exercise (ECE) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.

Kern, L., Koegel, R. L., & Dunlap, G. (1984). The influence of vigorous versus mild exercise on autistic stereotyped behaviors. Journal of Autism and Developmental Disorders, 14, 57–67.
Kern, L., Koegel, R. L., Dyer, K., Blew, P. A., & Fenton, L. R. (1982). The effects of physical exercise on self-stimulation and appropriate responding in autistic children. Journal of Autism and Developmental Disorders, 12, 399–419.

McGimsey, J. K., & Favell, J. E. (1988). The effects of increased physical exercise on disruptive behaviors in retarded persons. Journal of Autism and Developmental Disorders, 18, 167–179.

Cannella-Malone, H. I., Tullis, C. A., & Kazee, A. R. (2011). Using antecedent exercise to decrease challenging behavior in boys with developmental disabilities and an emotional disorder. Journal of Positive Behavior Interventions, 13(4), 230–239. doi:10.1177/1098300711406122

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