Research Article Physical Activity and Physical Fitness of ...downloads.hindawi.com/journals/aurt/2014/312163.pdf · Physical Activity and Physical Fitness of School-Aged ... Children

Research ArticlePhysical Activity and Physical Fitness of School-AgedChildren and Youth with Autism Spectrum Disorders

Kiley Tyler1 Megan MacDonald1 and Kristi Menear2

1 College of Public Health and Human Sciences Oregon State University Corvallis OR 97331 USA2 School of Education University of Alabama at Birmingham Birmingham AL 35294 USA

Correspondence should be addressed to Megan MacDonald meganmacdonaldoregonstateedu

Received 31 May 2014 Revised 16 August 2014 Accepted 20 August 2014 Published 16 September 2014

Academic Editor Geraldine Dawson

Copyright copy 2014 Kiley Tyler et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Autism spectrum disorder (ASD) is characterized by impairments in social communication deficits and the presence of restrictedand repetitive behaviors interests or activities Literature comparing the physical activity and fitness of children with ASD totypically developing peers is in need of attention The purpose of this investigation was to examine the physical activity and fitnessof school-aged childrenwithASD (119873 = 17) in comparison to typically developing peers (119873 = 12) Participants withASD completeddiagnostic and developmental assessments and a series of physical fitness assessments 20-meter multistage shuttle sit-and-reachtest handgrip strength and body mass index Physical activity was measured using accelerometry and preestablished cut-pointsof physical activity (Freedson et al 2005) MANCOVA revealed significant between-group effects in strength (119875 = 03) whileANCOVA revealed significant between-group effects in sedentary (119875 = 00) light (119875 = 00) moderate (119875 = 00) and totalmoderate-to-vigorous (119875 = 01) physical activity Children with ASD are less physically active and fit than typically developingpeers Adapted physical activity programs are one avenue with intervention potential to combat these lower levels of physicalactivity and fitness found in children with ASD

1 Introduction

As the incidence rate of autism spectrum disorder (ASD)increases so does the interest in the health and wellness ofthese individuals Similar to their typically developing peersyouth with ASD face increased rates of obesity [1 2] anddecreased engagement in physical activities [3] Reviews ofphysical activity patterns indicated that older adolescentswith ASD are less physically active than their younger peerswith ASD [4ndash6] The contributing factors to the obesity andphysical inactivity epidemic in this population may be bothdiagnosis-specific and environmental [7]

Profiles of motor skills and physical fitness in childrenand youth with ASD have documented delayed performancelevels Pan [8] assessed 62 adolescent males with (119899 = 31)and without (119899 = 31) ASD aged 10ndash17 years using theBruininks-Oseretsky Test ofMotor Proficiency (2nd edition)the BROCKPORT Physical Fitness Test and the bioelectricalimpedance analysis Results indicated that adolescents with

ASD had significantly lower scores on all motor proficiencyand fitness measures except body composition than adoles-cents without ASD and that the types of associations betweenthe two measures differed significantly across the groupsStaples and Reid [9] compared the fundamental movementskills of 25 children and youth with ASD (ages 9ndash12 years)to three typically developing groups of children using theTest of Gross Motor Development (TGMD-2) Their resultssuggested that children and youth with ASD experiencemorethan just delays in movement abilities but that movementdeficits in motor skill performance existed

Literature that compares the physical activity and fitnessof children and youth with ASD to their typically devel-oping peers is scarce but what does exist uses commonfitness measures such as the shuttle run sit-and-reach andhandgrip dynamometer [8] and activity measures such asaccelerometry [3] Health-related physical fitness which isembedded in physical activity through physical exercise con-sists of body composition aerobic fitness (aerobic capacity

Hindawi Publishing CorporationAutism Research and TreatmentVolume 2014 Article ID 312163 6 pageshttpdxdoiorg1011552014312163

2 Autism Research and Treatment

power and endurance) flexibility and muscular fitness(muscular strength and muscular endurance) [10ndash12] Ourstudy includes these physical fitness measures in additionto a physical activity measure The indicated measures areused to describe the physical activity and physical fitness ofschool-aged children with ASD in comparison to typicallydeveloping peers By using a similar age range to the studiescited above including both male and female participantswith a range of severity (as indicated through calibratedautism severity scores) and adding additional measures ofphysical fitness compared to other studies our study providesfurther evidence of the profiles of this population comparedto their typically developed peers as it relates to physicalactivity and physical fitness Thus the purpose of this studyis to determine the physical fitness and physical activity ofchildren with ASD compared to their typically developedpeers

2 Method

21 Participants Children and youth with ASD (119873 = 17M = 9 F = 8) and without ASD (119873 = 12 M = 6 F = 6)between the ages of 9 and 18 years were recruited for thisstudy Recruitment occurred through the dissemination ofstudy flyers autism-based programs local schools localrehabilitation facilities and word ofmouth Participants werenot excluded based on raceethnicity or gender

22 Procedure Each parentcaregiver of each participantcompleted a supplemental questionnaire which includeddemographic information such as age of participant mater-nal education income ethnicity and diagnosis of an ASDData collection took place in a lab-based setting whereparticipants completed the majority of assessments over thecourse of two days Each assessment session took into consid-eration the comfort and scheduling needs of each participantand family The order of assessments typically consisted ofthe diagnostic assessment and developmental assessmentfollowed by a series of physical fitness assessments in aerobicfitness muscular strength flexibility and anthropometricmeasures (height andweight) Physical activity wasmeasuredthrough accelerometryThe assessments are described below

221 Diagnostic Assessment Participants with ASD perparental report were administered the autism diagnosticobservation schedule (ADOS) [13ndash15] by a trained researchadministrator The senior investigator on this project wasresearch trained and reliable on ADOS administration Eachmember of the research team attained interrater reliabilityof ADOS administration exceeding 80 exact agreementover the course of three consecutive administrations beforethe study began with the senior investigator on this projectThus within site reliability was obtained The ADOS is asemistructured standardized assessment of communicationsocial interaction and play for individuals with autism spec-trum disorder or suspected of having autismThis diagnostictool is commonly used in practice and research and isconsidered the ldquogold standardrdquo in terms of standardized

diagnostic assessments [16] Calibrated severity scores [13]were used in this study to confirm diagnosis these scores areconsistent with ADOS-2 criteria [13]

222 Developmental Assessment The Stanford-Binet Intelli-gence Scale Fifth Edition (SB5) was administered to assesscognitive abilities of each participant [17] The SB5 is anindividually administered assessment of cognitive abilitiesfor individual of 2ndash85 years If the participant was unableto progress through the SB5 typically based on limited lan-guage the Differential Ability Scale Second Edition (DAS-II)was administered The DAS-II is a standardized comprehen-sive assessment of cognitive abilities [18]TheDAS-II consistsof a variety of subtests including verbal and visual workingmemory immediate and delayed recall visual recognitionand matching process and naming speed phonologicalprocessing and understanding of basic number concepts[18] Ratio verbal and nonverbal IQ scores were calculatedfrom the SB-5 and the DAS-II allowing for comparison ofverbal and nonverbal abilities across tests Ratio nonverbal IQwas calculated by dividing the average age equivalent acrossnonverbal subtest scales by chronological age inmonths andthenmultiplying by 100 Ratio verbal IQ was calculated in thesame manner using the verbal subtest

223 Aerobic Fitness Assessment Aerobic fitness was as-sessed using the 20-meter multistage shuttle run [19] The20-meter multistage shuttle run is a valid and reliable assess-ment of aerobic power in children [19] with good test-retest reliability for children (119903 = 89 119875 = 05) Eachparticipant was provided with a shuttle run demonstrationby the examiner as well as a practice trial before the trialsbegan During eachmeasured trial an undergraduate studentserved as the participantrsquos running partner in an effort tohelp with the pacing of each shuttle run The procedures forthe 20-meter multistage shuttle run include the participantrunning back and forth between two sets of cones (shuttles)spaced 20 meters apart The rate at which the participantruns is controlled by an audio recording that ldquobeepsrdquo whenthe participant should reach the opposing set of conesThe beeps are equally spaced within one-minute ldquostagesrdquostarting slowly and accelerating incrementally every minutethereafter If the participant was unable to complete twoconsecutive stages in accordance with the prompted ldquobeepsrdquothe test was terminated and the final distance was recordedThe velocity of the final shuttle completed by the individualwas used to determine the estimated maximal aerobic power(VO2max) for that individual [19] The 20-meter multistage

shuttle was converted into VO2max (119884 mL kgminus1minminus1) val-

ues These values were obtained from the maximal shuttlerun speed (119883119897119905 kmhminus1) and age (1198832 year rounded to thelower integer) for children between the ages of 6 and 18years (119910 = 31025 + 32381198831 minus 324811988310158402 + 01536119883119903111988310158402)[19]

224 Flexibility Assessment Flexibility was assessed usingthe sit-and-reach test [20] The sit-and-reach test is a validand reliable measure used to determine trunk and lower

Autism Research and Treatment 3

Table 1 Participant demographic information

Children with autism (119873 = 17) Children without autism (119873 = 12)119865 value 119875

M plusmn SDfrequency Minndashmax M plusmn SDfrequency MinndashmaxAge 126 plusmn 23 9ndash17 90 plusmn 18 9ndash14 149 023Ratio verbal IQ 601 plusmn 252 16ndash110 1123 plusmn 990 45ndash385 220 014Ratio nonverbal IQ 657 plusmn 400 16ndash172 731 plusmn 193 49ndash105 142 024CSS 86 plusmn 154 4ndash10Weight (kg) 520 plusmn 271 24ndash128 462 plusmn 141 31ndash81 381 006Height (cm) 1544 plusmn 1538 128ndash184 1539 plusmn 141 134ndash176 035 085Gender M = 9F = 7 M = 6F = 6Maternal educationethnicity

4 no college12 college12 Caucasian4 other


Note M mean SD standard deviation lowast119875 le 005

Table 2 Physical fitness by group


M plusmn SD Minndashmax M plusmn SD MinndashmaxVO2max 399 plusmn 58 31ndash57 420 plusmn 53 32ndash53 007 093Strength 175 plusmn 87 6ndash38 211 plusmn 111 10ndash40 47 003lowast

Flexibility 237 plusmn 83 12ndash41 315 plusmn 100 15ndash44 35 006BMI (kgm2) 204 plusmn 66 11ndash34 191 plusmn 43 14ndash30 030 058lowast119875 ge 005

body flexibility in children [21] Standardized protocols werefollowed [20] in addition to several bouts of verbal andnonverbal direction (ie reminders to keep the legs straightduring the stretch forward) Each participant was initiallyshown how to perform the sit-and-reach test by the examinerand was provided a practice trial before the trials began

225 Strength Assessment Strength was measured using ahandgrip strength assessment In this test the participant wasasked to stand and grip a JamarHydraulic HandDynamome-ter [22] with the dominant hand The participant forcefullysqueezed the dynamometer while holding the arm at 90degrees of flexion and continued squeezing the instrumentwhile straightening the arm to full flexion The entire actionwas performed over the course of three separate trials Eachparticipant was providedwith an initial practice trial and taskdemonstration During the three trials each participant wasencouraged to squeeze the instrument to full potential whilesimultaneously straightening their arm to full flexion Themaximal force production derived from the average of allthree trials was recorded by the examiner Handgrip strengthis a valid and reliable measure of upper-body muscularstrength (119903 = 90) in typically developing children ages of 6ndash12 years [23]

226 Physical Activity Assessment Physical activity wasmeasured using an accelerometer the ActiGraph GTX3+(Pensacola FL) over a seven-day period This is a validand reliable measure of physical activity for children withdisabilities [24] All participants were asked to wear the

monitor for all waking hours of the day on the right hipusing an elastic belt The monitor was worn for all activitiesexcept swimming showeringbathing and sleeping and wasindicated through self-report logs The parentscaregivers ofthe participants were providedwith a self-report log to recordany times when the monitor was not worn (ie forgetting toput it on in themorning taking it off for comfort or any otherreasons for which it may have been removed) Accelerometrydata was compared to parent logs and reduced to phys-ical activity categories of sedentary light moderate andmoderate-to-vigorous these were derived from establishedcut-points [25] Data were reduced into average time spent inthe physical activity categories described Zero activity countslasting for a period longer than 5 minutes were considereda nonwear period and therefore excluded from data analysis[26]

227 Anthropometric Measures Height and weight of eachparticipant was measured without shoes Each participantwas provided with an initial task demonstration and practicetrial if needed Height was measured in centimeters to thenearest tenth of a millimeter with the portable stadiometermodel SECAS-214Weight wasmeasured in kilograms to thenearest gram with the Health OMeter H-349KL digital scaleEach participantrsquos body mass index (BMI) was calculatedusing the standard formula bodymass (in kilograms) dividedby height squared (in meters) [12 27] BMI is a valid andreliable (119903 = 90) means of assessing body composition(height in relation to weight) in children [12] Measurementswere taken twice at each site and rounded to the nearest tenthof a millimeter


23 Data Analysis Multivariate analysis of covariance(MANCOVA) was used to determine each physical fitnessvariable of aerobic fitness flexibility strength and BMI ofschool-aged participants with an ASD compared to typicallydeveloping peers Analysis of covariance (ANCOVA) wasused to determine the physical activity of school-agedparticipants with an ASD compared to participants withoutan ASD Covariates for all analyses included age IQ washighly correlated with age thus only age was used in theseanalyses

3 Results

A total of 17 participants with an ASD (119899 = 9 males and119899 = 8 females) and 12 participants without an ASD (119899 = 6males and 119899 = 6 females) between the ages of 9 and 17years (mean = 126 years) were included in this study Demo-graphic information is presented in Table 1 There were norelationships between physical fitness and income maternaleducation or ethnicity Missing values were resolved throughsingle mean substitution [28] by group for the variable ofinterest Missing variables of physical fitness accounted forless than 10 of missing data The most common missingvariable was physical activity less than 20 of data weremissing in this variable

31 Physical Fitness MANCOVA was used to determine thephysical fitness of school-aged participants with ASD andtypically developing peers Age was used as a covariate inthismodel because the distribution of age was different acrossgroups Participants with an ASD hadmore 15-year-olds thanany other age whereas participants without an ASD had ahigher distribution of 9-year-olds The MANCOVA revealednonsignificant effects (F = 159 119875 = 21) between groupsindicating that no significant differences existed in physicalfitness between participants with an ASD and participantswithout an ASD Between-group effects reached significancein strength (119875 = 03 F = 35) suggesting that participantswith ASD have lower strength compared to participantswithout an ASD Flexibility BMI and VO

2max (calculatedfrom the 20-meter multistage shuttle run) did not have asignificant result Physical fitness by group is presented inTable 2

32 Physical Activity ANCOVA resulted in between-groupeffects in sedentary (119875 = 00) light (119875 = 00) moderate(119875 = 00) and moderate-to-vigorous (MVPA) (119875 = 01)physical activity Children with ASD spent less time in lightmoderate and moderate-to-vigorous physical activity andspent more time in sedentary behavior when compared totypically developing peers Physical activity results by groupare presented in Table 3

4 Discussion and Future Directions

Children with an ASD are less physically fit in the strengthdomain and less physically active than their peers withoutdisabilities Yet physical fitness in flexibility aerobic fitness

(VO2max) and BMI demonstrates similar results compared

to peers without disabilities Although these results providefurther evidence that children with an ASD face knownhealth disparities they also indicate that aspects of physicalfitness are attainable and comparable to peers without ASD

Our data indicated that children and youth with anASD performed the shuttle run at only slightly lower levelsthan their peers without an ASD This finding althoughdiscrepant is encouraging given the potentially negativeoverall health impact of low cardiovascular endurance Thisfinding further suggests that children with an ASD are moresimilar to their peers in this area thus physical educationcommunity-based programs and other physical activityopportunities may provide an opportunity to further bridgethe gap and health disparity between children with an ASDand their peers without an ASD Supporting the use of peermentoring in data collection efforts was an encouraging toolfor success (ie children with ASD completing the task)Knowledge of how shuttle-run performance ultimately peakoxygen uptake associates with gender BMI age height andweight in children and youth with ASD may further aidin better understanding where to intervene and how toimprove the fitness of school-aged children with ASD [29]

The finding of lower levels of strength (strength with ASDM = 203 F = 143 without ASD M = 264 F = 159)indicated a weak area of physical fitness for children with anASD Based on the results of this study strength is in needof improvement suggesting a clear starting point for physicalfitness-based interventions

It is important to note the practical implications of thisresearch methodology as it relates to physical educationThe physical fitness and physical activity assessments weemployed are common approaches used by physical educa-tors Too often students with disabilities and particularlystudents with an ASD are left out of physical fitness assess-ment data collection Our participants with an ASD wereable to complete all assessments as were their peers Notonly does federal special education law (ie Individuals withDisabilities Education Act and 20 USC sect 1400) addressesthe right of students with disabilities to participate in physicaleducation but also research indicates that children and youthwith an ASD have a higher prevalence of obesity compared tochildren without an ASD [2 30] Additionally Memari et al[5] found a substantial reduction in physical activity acrossthe adolescent years in youth with an ASD Therefore weencourage parents teachers and administrators to includestudents with an ASD in physical fitness and physical activityassessments and provide them with individualized informa-tion about associated behaviors that can impact their healthinto adulthood

Our ability to complete physical fitness and physicalactivity assessments of children and youth with an ASDhas additional educational implications The relationshipbetween academics and physical activity is a current topicof discussion in the United States [31ndash33] and federalinitiatives aimed at improving the fitness of our youthhave been implemented nationwide with health and edu-cation in mind (eg Letrsquos Move Healthy People 2020)Eveland-Sayers et al [34] investigated physical fitness and


Table 3 Daily average time spent in physical activity by group


M plusmn SD Minndashmax M plusmn SD MinndashmaxSedentary 4521 plusmn 1005lowastlowastlowast 218ndash572 36914 plusmn 1057 143ndash518 139 000lowast

Light 1046 plusmn 361lowastlowastlowast 54ndash195 1227 plusmn 222 66ndash159 334 000lowast

Moderate 1549 plusmn 501lowastlowastlowast 85ndash263 2108 plusmn 511 139ndash304 164 000lowast

Total MVPA 1659 plusmn 587lowastlowast 86ndash286 2183 plusmn 656 143ndash358 137 001lowast

Note M mean SD standard deviation lowast119875 le 005lowastlowast119875 ge 001lowastlowastlowast119875 ge 0001

academic achievement in elementary school children andfound a link between specific components of physical fit-ness and academic achievement Future research mightconsider applying a similar approach for students with anASD

In this study participants with ASD were less physicallyfit in the strength domain and less physically active thantheir peers without disabilities Similarly previous researchconfirms these findings [8 35] Our participants met the2008 Physical Activity Guidelines set by the US Depart-ment of Health and Human Services of 60 minutesday ofmoderate-to-vigorous physical activity but had significantlylower activity time than their peers without disabilitiesTheseresults are not tremendously different from those of Bandiniet al [3] who found that children with an ASD and thosewithout an ASD spent a similar amount of time in moderateand vigorous physical activity Contributing factors to thephysical activity health disparity present in children withASD may be the result of diagnostic and environmentaldeterminants [7] Yet there are many known determinantsof physical inactivity in children more research is neededon the physical activity determinants specific to childrenwith ASD In conclusion our results are encouraging asthey indicate that children and youth with an ASD showcapacity to meet daily guidelines for physical fitness andactivity

41 Limitations Limitations to this study include unequalsample sizes and unmatched controls however these limita-tions were accounted for in analyses This sample of childrenwith ASD consisted of more females (119873 = 17 males = 9females = 8) than would be expected given the current ratio 5males 1 female [36] Participants completed all assessmentyet individual accommodations were implemented whenneeded (ie all assessments were performed in a single dayor assessments were split over two days based on partici-pantfamilial needs) Finally this study consisted of a smallsample size thus additional studies with larger sample sizesare needed

5 Conclusion

These results provide further evidence that children withan ASD face known health disparities and efforts to

promote physical activity in school and through publichealth initiatives need to include children and youth with anASD

Ethical Approval

Consentassent process parentalcaregiver consent and par-ticipant assent were obtained from all participants Allmethods and procedures were approved by the InstitutionalReview Board at Oregon State University

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

Acknowledgments

The contents of this presentation were developed undera grant from the US Department of Education noH325D100061 However the contents do not necessarilyrepresent the policy of the US Department of Educationand you should not assume endorsement by the FederalGovernment Project Officer Louise Tripoli Funding for thisproject was also awarded to Dr MacDonald from the OregonState University General Research Fund

References

[1] C Curtin M Jojic and L G Bandini ldquoObesity in children withautism spectrum disorderrdquo Harvard Review of Psychiatry vol22 no 2 pp 93ndash103 2014

[2] A M Egan M L Dreyer C C Odar M Beckwith and C BGarrison ldquoObesity in young childrenwith autism spectrumdis-orders Prevalence and associated factorsrdquo Childhood Obesityvol 9 no 2 pp 125ndash131 2013

[3] L G Bandini J Gleason C Curtin et al ldquoComparisonof physical activity between children with autism spectrumdisorders and typically developing childrenrdquoAutism vol 17 no1 pp 44ndash54 2013

[4] M MacDonald P Esposito and D Ulrich ldquoThe physicalactivity patterns of children with autismrdquo BMC Research Notesvol 4 article 422 2011

[5] A H Memari B Ghaheri V Ziaee R Kordi S Hafizi and PMoshayedi ldquoPhysical activity in children and adolescents with


autism assessed by triaxial accelerometryrdquoPediatricObesity vol8 no 2 pp 150ndash158 2013

[6] C-Y Pan and G C Frey ldquoPhysical activity patterns in youthwith autism spectrum disordersrdquo Journal of Autism and Devel-opmental Disorders vol 36 no 5 pp 597ndash606 2006

[7] S M Srinivasan L S Pescatello and A N Bhat ldquoCurrentperspectives on physical activity and exercise recommendationsfor children and adolescents with autism spectrum disordersrdquoPhysical Therapy vol 94 no 6 pp 875ndash889 2014

[8] C-Y Pan ldquoMotor proficiency and physical fitness in adolescentmales with and without autism spectrum disordersrdquo Autismvol 18 no 2 pp 156ndash165 2014

[9] K L Staples and G Reid ldquoFundamental movement skills andautism spectrumdisordersrdquo Journal of Autism andDevelopmen-tal Disorders vol 40 no 2 pp 209ndash217 2010

[10] J R Morrow Jr J S Tucker A W Jackson S B Martin C AGreenleaf andTA Petrie ldquoMeeting physical activity guidelinesand health-related fitness in youthrdquo The American Journal ofPreventive Medicine vol 44 no 5 pp 439ndash444 2013

[11] F B Ortega J R RuizM J Castillo andM Sjostrom ldquoPhysicalfitness in childhood and adolescence a powerful marker ofhealthrdquo International Journal of Obesity vol 32 no 1 pp 1ndash112008

[12] J P Winnick and F X Short ldquoConceptual framework forthe brockport physical fitness testrdquo Adapted Physical ActivityQuarterly vol 22 no 4 pp 323ndash332 2005

[13] K Gotham A Pickles and C Lord ldquoStandardizing ADOSscores for a measure of severity in autism spectrum disordersrdquoJournal of Autism and Developmental Disorders vol 39 no 5pp 693ndash705 2009

[14] C Lord M Rutter P DiLavore and S Risi Autism DiagnosticObservation Schedule Manual Western Psychological ServicesLos Angeles LA USA 1999

[15] C Lord S Risi L Lambrecht et al ldquoThe Autism DiagnosticObservation Schedulemdashgeneric a standard measure of socialand communication deficits associated with the spectrum ofautismrdquo Journal of Autism andDevelopmental Disorders vol 30no 3 pp 205ndash223 2000

[16] J L Matson and M Sipes ldquoMethods of early diagnosis andtracking for autism and pervasive developmental disorder nototherwise specified (PDDNOS)rdquo Journal of Developmental andPhysical Disabilities vol 22 no 4 pp 343ndash358 2010

[17] G H Roid Stanford-Binet Intelligence Scales Technical ManualRiverside Publishing Rolling Meadows Ill USA 5th edition2003

[18] C D Elliot Differential Ability Scales-Second Edition TechnicalManual Pearson Minneapolis Minn USA 2007

[19] L A Leger D Mercier C Gadoury and J Lambert ldquoThemultistage 20 metre shuttle run test for aerobic fitnessrdquo Journalof Sports Sciences vol 6 no 2 pp 93ndash101 1988

[20] W Liemohn G Sharpe and J Wasserman ldquoCriterion relatedvalidity of sit-and-reach testrdquoThe Journal of Strength amp Condi-tioning Research vol 8 no 2 pp 65ndash124 1994

[21] F Ayala P S de Baranda M de Ste Croix and F SantonjaldquoComparison of active stretching technique in males withnormal and limited hamstring flexibilityrdquo Physical Therapy inSport vol 14 no 2 pp 98ndash104 2013

[22] V Mathiowetz D M Wiemer and S M Federman ldquoGrip andpinch strength norms for 6- to 19-year-oldsrdquo The AmericanJournal of Occumpational Therapy vol 40 no 10 pp 705ndash7111986

[23] L A Milliken A D Faigenbaum R L Loud and W L West-cott ldquoCorrelates of upper and lower body muscular strength inchildrenrdquo Journal of Strength and Conditioning Research vol 22no 4 pp 1339ndash1346 2008

[24] S-Y Kim and J Yun ldquoDetermining daily physical activity levelsof youth with developmental disabilities days of monitoringrequiredrdquo Adapted Physical Activity Quarterly vol 26 no 3pp 220ndash235 2009

[25] P Freedson D Pober and K F Janz ldquoCalibration of accelerom-eter output for childrenrdquo Medicine and Science in Sports andExercise vol 37 no 11 pp S523ndashS530 2005

[26] I Jeong Measuring physical activity in youth with Downsyndrome and autism spectrum disorder Identifying data-basedmeasurement conditions [PhD thesis] 2012

[27] L D Hammer H C Kraemer D M Wilson P L Ritter and SM Dornbusch ldquoStandardized percentile curves of body-massindex for children and adolescentsrdquo The American Journal ofDiseases of Children vol 145 no 3 pp 259ndash263 1991

[28] D Howell Statistical Methods for Psychology Wadsworth 7thedition 2010

[29] S Agiovlasitis K H Pitetti M Guerra and B FernhallldquoPrediction of vo

2119901119890119886119896from the 20-m shuttle-run test in youth

with down syndromerdquo Adapted Physical Activity Quarterly vol28 no 2 pp 146ndash156 2011

[30] C Curtin S E Anderson A Must and L Bandini ldquoTheprevalence of obesity in children with autism a secondary dataanalysis using nationally representative data from the NationalSurvey of Childrenrsquos Healthrdquo BMC Pediatrics vol 10 article 112010

[31] D N Ardoy J M Fernandez-Rodrıguez D Jimenez-Pavon RCastillo J R Ruiz and F B Ortega ldquoA physical education trialimproves adolescentsrsquo cognitive performance and academicachievement The EDUFIT studyrdquo Scandinavian Journal ofMedicine and Science in Sports vol 24 no 1 pp e52ndashe61 2014

[32] J N Booth S D Leary C Joinson et al ldquoAssociations betweenobjectivelymeasured physical activity and academic attainmentin adolescents from a UK cohortrdquo British Journal of SportsMedicine vol 48 no 3 pp 265ndash270 2014

[33] P Correa-Burrows R Burrows C Ibaceta Y Orellana and DIvanovic ldquoPhysically active Chilean school kids perform betterin language and mathematicsrdquo Health Promotion International2014

[34] B M Eveland-Sayers R S Farley D K Fuller D W Morganand J L Caputo ldquoPhysical fitness and academic achievementin elementary school childrenrdquo Journal of Physical Activity andHealth vol 6 no 1 pp 99ndash104 2009

[35] E Borremans P Rintala and J A McCubbin ldquoPhysical fitnessand physical activity in adolescents with asperger syndrome acomparative studyrdquo Adapted Physical Activity Quarterly vol 27no 4 pp 308ndash320 2010

[36] J Baio ldquoPrevalence of autism spectrum disorder amongchildren aged 8 yearsmdashautism and developmental disabilitiesmonitoring network 11 sites United States 2010rdquo MMWRSurveillance Summaries vol 63 no 1 pp 1ndash21 2014

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power and endurance) flexibility and muscular fitness(muscular strength and muscular endurance) [10ndash12] Ourstudy includes these physical fitness measures in additionto a physical activity measure The indicated measures areused to describe the physical activity and physical fitness ofschool-aged children with ASD in comparison to typicallydeveloping peers By using a similar age range to the studiescited above including both male and female participantswith a range of severity (as indicated through calibratedautism severity scores) and adding additional measures ofphysical fitness compared to other studies our study providesfurther evidence of the profiles of this population comparedto their typically developed peers as it relates to physicalactivity and physical fitness Thus the purpose of this studyis to determine the physical fitness and physical activity ofchildren with ASD compared to their typically developedpeers

2 Method

21 Participants Children and youth with ASD (119873 = 17M = 9 F = 8) and without ASD (119873 = 12 M = 6 F = 6)between the ages of 9 and 18 years were recruited for thisstudy Recruitment occurred through the dissemination ofstudy flyers autism-based programs local schools localrehabilitation facilities and word ofmouth Participants werenot excluded based on raceethnicity or gender

22 Procedure Each parentcaregiver of each participantcompleted a supplemental questionnaire which includeddemographic information such as age of participant mater-nal education income ethnicity and diagnosis of an ASDData collection took place in a lab-based setting whereparticipants completed the majority of assessments over thecourse of two days Each assessment session took into consid-eration the comfort and scheduling needs of each participantand family The order of assessments typically consisted ofthe diagnostic assessment and developmental assessmentfollowed by a series of physical fitness assessments in aerobicfitness muscular strength flexibility and anthropometricmeasures (height andweight) Physical activity wasmeasuredthrough accelerometryThe assessments are described below

221 Diagnostic Assessment Participants with ASD perparental report were administered the autism diagnosticobservation schedule (ADOS) [13ndash15] by a trained researchadministrator The senior investigator on this project wasresearch trained and reliable on ADOS administration Eachmember of the research team attained interrater reliabilityof ADOS administration exceeding 80 exact agreementover the course of three consecutive administrations beforethe study began with the senior investigator on this projectThus within site reliability was obtained The ADOS is asemistructured standardized assessment of communicationsocial interaction and play for individuals with autism spec-trum disorder or suspected of having autismThis diagnostictool is commonly used in practice and research and isconsidered the ldquogold standardrdquo in terms of standardized

diagnostic assessments [16] Calibrated severity scores [13]were used in this study to confirm diagnosis these scores areconsistent with ADOS-2 criteria [13]

222 Developmental Assessment The Stanford-Binet Intelli-gence Scale Fifth Edition (SB5) was administered to assesscognitive abilities of each participant [17] The SB5 is anindividually administered assessment of cognitive abilitiesfor individual of 2ndash85 years If the participant was unableto progress through the SB5 typically based on limited lan-guage the Differential Ability Scale Second Edition (DAS-II)was administered The DAS-II is a standardized comprehen-sive assessment of cognitive abilities [18]TheDAS-II consistsof a variety of subtests including verbal and visual workingmemory immediate and delayed recall visual recognitionand matching process and naming speed phonologicalprocessing and understanding of basic number concepts[18] Ratio verbal and nonverbal IQ scores were calculatedfrom the SB-5 and the DAS-II allowing for comparison ofverbal and nonverbal abilities across tests Ratio nonverbal IQwas calculated by dividing the average age equivalent acrossnonverbal subtest scales by chronological age inmonths andthenmultiplying by 100 Ratio verbal IQ was calculated in thesame manner using the verbal subtest

223 Aerobic Fitness Assessment Aerobic fitness was as-sessed using the 20-meter multistage shuttle run [19] The20-meter multistage shuttle run is a valid and reliable assess-ment of aerobic power in children [19] with good test-retest reliability for children (119903 = 89 119875 = 05) Eachparticipant was provided with a shuttle run demonstrationby the examiner as well as a practice trial before the trialsbegan During eachmeasured trial an undergraduate studentserved as the participantrsquos running partner in an effort tohelp with the pacing of each shuttle run The procedures forthe 20-meter multistage shuttle run include the participantrunning back and forth between two sets of cones (shuttles)spaced 20 meters apart The rate at which the participantruns is controlled by an audio recording that ldquobeepsrdquo whenthe participant should reach the opposing set of conesThe beeps are equally spaced within one-minute ldquostagesrdquostarting slowly and accelerating incrementally every minutethereafter If the participant was unable to complete twoconsecutive stages in accordance with the prompted ldquobeepsrdquothe test was terminated and the final distance was recordedThe velocity of the final shuttle completed by the individualwas used to determine the estimated maximal aerobic power(VO2max) for that individual [19] The 20-meter multistage

shuttle was converted into VO2max (119884 mL kgminus1minminus1) val-

ues These values were obtained from the maximal shuttlerun speed (119883119897119905 kmhminus1) and age (1198832 year rounded to thelower integer) for children between the ages of 6 and 18years (119910 = 31025 + 32381198831 minus 324811988310158402 + 01536119883119903111988310158402)[19]

224 Flexibility Assessment Flexibility was assessed usingthe sit-and-reach test [20] The sit-and-reach test is a validand reliable measure used to determine trunk and lower



















3 Results
























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Ethical Approval




Acknowledgments


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5 Conclusion



Ethical Approval




Acknowledgments


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OncologyJournal of





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Journal of

ObesityJournal of



























5 Conclusion



Ethical Approval




Acknowledgments


References














































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OncologyJournal of





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Journal of

ObesityJournal of
























































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OncologyJournal of





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Journal of

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Documents

Research Article Physical Activity and Physical Fitness of ...downloads.hindawi.com/journals/aurt/2014/312163.pdf · Physical Activity and Physical Fitness of School-Aged ... Children