Physical Activity for Autistic Adults: Recommendations for a Shift in Approach

Implementation of Peer-Assisted Physical Activity Via Telehealth for Adults on the Autism Spectrum: A Mixed Methods Feasibility Study

OBJECTIVE

Adults on the autism spectrum are at risk for physical inactivity, obesity, and related health conditions. Physical activity provides physical, social, and mental health benefits across the lifespan. Previous research examined feasibility and effectiveness of physical activity intervention in autistic children, but very few studies target autistic adults. This study examined the feasibility and acceptability of Physical Activity Connections via Telehealth, implemented during the coronavirus disease 2019 (COVID-19) pandemic lockdown as an alternative to in-person programming for autistic adults aged 18 to 32.

METHODS

The 10-week intervention utilized telehealth and remote technologies to deliver a theoretically grounded program to improve physical activity. Strategies included peer-guidance, coaching, individualized wellness goals, customized exercise programs, and wearable activity trackers. Feasibility and acceptability were examined using a mixed-methods design including observational and survey data collection, as well as participant interviews. Data were analyzed using descriptive statistics and content analysis.

RESULTS

Findings support feasibility and acceptability of telehealth to promote physical activity among autistic adults who have cognitive capacity and ability to utilize remote technology, with applicability beyond pandemic-imposed challenges.

CONCLUSION

Telehealth delivery of physical activity interventions is a viable alternative to in-person programs and may enable autistic adults to overcome barriers to physical activity participation and access.

IMPACT

As the rate of autism continues to rise globally, rehabilitation professionals will play a significant role in promoting health and wellness for autistic individuals across the lifespan. Findings promote informed practice based on the health needs of this growing segment of society.

"Just Invite Us": Autistic Adults' Recommendations for Developing More Accessible Physical Activity Opportunities

Background

Autistic adults engage in lower levels of physical activity (PA) than their nonautistic peers, and over 60% do not meet national guidelines for PA. In addition, autistic adults face myriad barriers to PA participation that can make accessing activities challenging. To support the inclusion of autistic adults in PA, this study sought to explore first-hand recommendations for PA participation from autistic adults' perspective.

Methods

We interviewed 23 autistic adults aged 18 to 75 years about their PA experiences across their lifespan, including querying the participants' recommendations for supporting autistic adults in PA. A qualitative descriptive design with a constructivist lens guided the thematic analysis.

Results

The analysis resulted in two overarching themes: (1) It's helpful to have someone there to support; and (2) It's that sensory thing, it always is. Each theme includes participant-provided recommendations to guide professionals in the field of PA.

Conclusions

The autistic adult voice, long absent from conversations about PA, is a valuable and needed addition to understand how to improve PA experiences for this population. Recommendations from this study include (1) listening to the perspectives and insight of autistic adults, (2) consideration of sensory stimulus when planning for PA participation, and (3) encouraging and providing social supports for PA participation.

Lay summary

Why was this study done?: Autistic adults have many health concerns such as anxiety, depression, and obesity. Physical activity can improve these health concerns. Yet, professionals lack knowledge about how to provide optimal physical activity experiences for autistic individuals. Very little research has engaged autistic adults to directly ask their recommendations about their own physical activity needs.What was the purpose of this study?: This study wanted recommendations from autistic adults on how to make physical activity more accessible and enjoyable. By doing this, the authors hope to increase the voices of autistic adults in physical activity research.What did the researchers do?: The researchers asked 23 autistic adults for their recommendations on how to improve physical activity experiences.What were the results of the study?: Participants' responses were grouped into two categories: (1) It's helpful to have someone there to support and (2) It's that sensory thing, it always is. The first theme highlights the social supports that many autistic adults feel they need to be successful. Supports include individuals within the close social circles of the autistic adults, such as parents, friends, and other close people. They can also include professionals, such as teachers or exercise trainers. The second theme highlights the need to address the sensory sensitivities of the individual before activity can take place; if an environment or activity is not "sensory friendly" or is not accommodating, then autistic adults are less likely to engage.What do these findings add to what was already known?: Autistic adults face many barriers to physical activity participation. These findings offer first-hand accounts by autistic adults about how to improve their physical activity experiences. These results also offer ideas on how to increase physical activity engagement for autistic individuals. Other research has focused on improving physical activity in those who are autistic, but this research is rarely from the perspective of the autistic individual. This study is one of a very small number of studies that has done this and is the first to ask autistic adults to give recommendations for physical activity participation.What are potential weaknesses in the study?: This study only interviewed autistic adults who prefer to communicate verbally, and so the study sample is not representative of all autistic adults. Many participants in the sample were from the United States, and autistic adults in other countries may have different opinions about physical activity participation. Finally, the researchers may have recruited individuals with an interest in physical activity-autistic adults who are not interested or dislike physical activity may have different recommendations.How will these findings help autistic adults now or in the future?: This study will help professionals provide more appropriate physical activity experiences to autistic adults. Also, this research could help practitioners and researcher make physical activity spaces more welcoming and enjoyable for autistic adults.

An investigation of the diet, exercise, sleep, BMI, and health outcomes of autistic adults

BACKGROUND

Studies of autistic children suggest that restricted eating, reduced physical activity, and sleep disorders are common; however, no studies attempt to broadly describe the diet, exercise, and sleep patterns of autistic adults or consider relationships between lifestyle behaviors and the widely reported increased risks of obesity and chronic conditions. To address this, the authors developed the largest study of lifestyle patterns of autistic adults and assessed their relationships to body mass index, health outcomes, and family history.

METHODS

We administered an anonymized, online survey to n = 2386 adults (n = 1183 autistic) aged 16-90 years of age. We employed Fisher's exact tests and binomial logistic regression to describe diet, exercise, and sleep patterns; mediation of seizure disorders on sleep; body mass index (BMI); relationships of lifestyle factors to BMI, cardiovascular conditions, and diabetic conditions; and sex differences among autistic adults.

RESULTS

Autistic adults, and particularly autistic females, exhibit unhealthy diet, exercise, and sleep patterns; they are also more likely to be underweight or obese. Limited sleep duration and high rates of sleep disturbances cannot be accounted for by epilepsy or seizure disorders. Lifestyle factors are positively related to higher risk of cardiovascular conditions among autistic males, even more than family history.

LIMITATIONS

Our sample may not be representative of all autistic and non-autistic people, as it primarily comprised individuals who are white, female, have a high school education or higher, and reside in the UK. Our sampling methods may also exclude some individuals on the autism spectrum, and particularly those with moderate to severe intellectual disability. This is a cross-sectional sample that can test for relationships between factors (e.g., lifestyle factors and health outcomes) but cannot assess the direction of these relationships.

CONCLUSIONS

Autistic adults are less likely to meet minimal health recommendations for diet, exercise, and sleep-and these unhealthy behaviors may relate to excess risk of cardiovascular conditions. Although the present study can only provide preliminary, correlational evidence, our findings suggest that diet, exercise, and sleep should be considered and further investigated as key targets for reducing the now widely reported and dramatically increased risks of health comorbidity and premature death among autistic individuals compared to others. Physicians should work cooperatively with patients to provide health education and develop individualized strategies for how to better manage challenges with diet, exercise, and sleep.