“Hey, Hun, is it cool if we push our moving date to March 1st?”

That was the question I raised to my wife Shani when notified that my presentation had been accepted for the first ever TEDx at Hickam Air Force Base in Hawaii. We were scheduled to move from Queens, NY to Charlotte NC the weekend of the event. Turns out a trip to Hawaii was about the only thing that could postpone our relocation.

The theme for the TEDx event, perhaps ironically, was 20/20 Vision; How to Create a Better Future. Clearly the irony lay in the global pandemic, political, and civil unrest that broadly defined the last year. Still, and arguably highlighted by the COVID-19 pandemic, the issue of fitness and quality of life takes precedence. What can we focus on and strive for with respect to health and well-being? How do we implement real, sustainable change in access to fitness programs for different populations?

“Okay, now let’s see a squat, I’m gonna go first and then you try.”

The above is a standard sentence during my PAC Profile assessments and it carries with it powerful proactivity. I just also serendipitously learned that “proactivity” is a real, bona-fide word. When we teach movement, it makes sense to demonstrate first. Explaining to anybody a physical activity they’ve never performed, or performed with questionable technique, will skew towards wheels-fall-off territory early. Proactive practices give us and our athletes more opportunity sooner, and reduce the need to backtrack.

The most efficient use of initial instruction time (the first time we are teaching an exercise) looks like this:

1. Label
2. Demonstrate
3. Provide supported performance

For the ASD (Autism Spectrum Disorder) population, labeling in particular can have interim or long-term benefit for language (productive and receptive), memory, and independence. If the athlete is familiar with the word “squat” and can equate it to the movement pattern that constitutes a squat (whatever their current ability level), the coach does not have to repeat and demonstrate and repeat and repeat and repeat. Because the athlete already knows. The word squat and the movement squat have been paired in a way that makes sense, and is memorable, for the athlete.

Labeling adds to the lexicon. It’s remarkable just how much functional language we can build through fitness programs. Not only exercise names “squat, press, pull-down, push throw, rope swings…” but objects “Sandbell, rope, cones, Dynamax ball, sandbag…” and abstract concepts including prepositions “in, on, under, right, left, up, down…” When our athletes are actively engaged in fitness activities teaching these terms/concepts is easily presented in a natural manner.

Demonstrating is crucial because it circumvents us and our athlete standing there and staring at one another (or off into the distance for those of our less-eye-contact-inclined friends). We always demonstrate a new exercise; this provides context and a framework for both the learning style and that athlete’s interpretation of what we just did. We’ll learn how they follow visual modeling and, often, how motivated they are to perform the thing they just saw.

Do they get right down to squatting? Are they hesitating? Overwhelmed? We will be given really good clues here.

Providing supported performance means that we are starting the athlete at a level of performance that they are sure to master quickly (if we have to progress the exercise immediately this is a good sign). If we wind up progressing an exercise five times during the first session then good. Good! This translates to the athlete having early successes that can be reinforced. We usually prefer to do the exercises that we’re good at, and our athletes with autism are not much of an exception.

We may provide a physical or guided prompt early on with an exercise to ensure safe and effective technical performance. With the squat this may mean having the athlete hold on to a resistance band attached to a secure, stable area and squatting to an elevated surface (we always use Dynamax balls propped up on cardio step risers).

Depending on physical, adaptive, and/or cognitive ability, we may be able to fade this support in the first session or it could take months.  I have some highly motivated athletes who, because of their physical needs, require longer practice with a given level of an exercise before they’ve reached mastery and can progress. The athlete should be held to the expectation of his/her best current level of performance (unless we’re talking about exceptional amounts of strength or power, because then programming changes a bit).

Efficient and effective coaching enables us to determine how best the athlete will learn a particular exercise. While it’s tempting to classify our athletes as “more visual” or “more kinesthetic” learners I’ve found that it is far better to approach this from an exercise-by-exercise basis. Some of my athletes need physical prompting through the end range of an overhead press but can “get” a band row when I demonstrate pulling my arms back while standing parallel to them.

“Don’t know how” is a misinterpretation of breakdown in effective coaching communication. We need to be instructing with less words, more action. More show than tell.

When our athletes, or any of us, don’t understand the direction, the contingency, or the expectation we freeze, get off-task, get frustrated, or a Lucky Charms marshmallow cornucopia concoction of all three.  Being proactive in coaching means giving our athletes the information they require delivered in a way that is useful.

It is easy to take for granted the neurotypical ability to interpret nuance, abstraction, and implied information; the untold stuff between the clearly marked things. Giving our athletes the context and environment to succeed, especially in the first few sessions or when teaching a new exercises becomes our bridge to success in coaching and performance.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.

Is that hip tracking properly?

 Is he planning on flopping down to the mat after this next hurdle?

 Does Adam know what exercise is after these forward hurdle steps?

These are the series of questions that reverberate in my head as Adam completes the set of low hurdle steps as part of his warm-up. They’re the same questions that need to be mentally noted and checked off throughout a session with an individual on the autism spectrum.

Picture courtesy of Eric Chessen.

Fitness for special needs populations, particularly the autism and neurodiverse demographics, is gaining both awareness and more professionals are entering the sphere of practice. Some still overlap the autism spectrum disorder (ASD) population with other neurobiological disorders such as Downs Syndrome. They are different. And they need to be approached accordingly.

The most current statistics from the Centers for Disease Control (CDC) show an autism diagnosis occurring at 1 in 59 children. The statistics for teens and adults with autism are more difficult to find, though many individuals have been diagnosed retroactively as the criteria for diagnosis has changed/broadened with the DSM V (Diagnostic and Statistical Manual of Mental Illness Vol 5). Some of the most common, if not readily discussed, areas of deficit for those with ASD are gross motor deficits and low muscle tone (a catch-all phrase).

By way of intrepid professionals and dedicated parents/caregivers, the field of fitness for individuals with autism has grown in the last few years. As is the case across the fitness/wellness arena, programs and practices vary with no official standard or code of practice for those providing exercise programs to individuals with ASD.

Given the number of children, teens, and adults affected by autism and the evident need for professional fitness services, this is a burgeoning specialty area. While sport-specific, even vocation-specific training has existed in the fitness profession for decades, fitness programming for the ASD population is new and requires some important considerations.

Working with the autism population in a fitness capacity requires being a specialist turned generalist turned specialist. Allow me to expand on that.  A fitness professional working with the ASD population, ideally, has a conceptual background and practical skill set to assess movement skills and provide appropriate progressions and regressions for various exercises.

The adaptive/behavior challenges inherent to autism require more than a great fitness program “on paper”/in theory. Not only are the previously noted movement and strength deficits significant considerations, but behavior issues (off-task, maladaptive) must be addressed. The “Greatest Program Ever” is no match for a 17-year old who refuses to budge from lying face down on a yoga mat in the corner of the room.

So here we move from specialist to generalist; gaining an awareness and working knowledge of how different challenging behaviors present in the autism population, how to effectively manage those behaviors within scope of practice, and then how those behaviors may present with specific individuals. Some of our athletes (term used universally) with ASD may be off-task, wandering around the room for ninety-four percent of the session, while others are cooperative to a remarkable degree.  Understanding motivation and reinforcement both generally and with specific application to each individual is a necessity here.

Cognitive deficits are another hallmark of autism that requires both global and specific understanding and working knowledge. Our athletes with autism tend to be literal thinkers, having a great amount of difficulty with abstract concepts or directions that include analogies. “Run as fast as a Cheetah” won’t have the same connotation for an individual with ASD as it does for the neurotypical population. With respect to cognitive functioning we have one priority; ensure that our athletes are able to follow our directions to the best of current ability.

Fitness and Medical Fitness professionals considering working with the ASD population may find that the instructions, cues, and even the exercises they rely on with most clientele don’t quite work for individuals with autism. While the general best practices approach to strength, stability, and motor planning still apply (strengthen the large muscle groups first, build a healthy movement pattern before adding load), the path towards success may wind a bit.

In our Autism Fitness™ Certification Level I, we have a consistent cornucopia of professionals with backgrounds in fitness, occupational and physical therapy, behavior therapy, pediatrics, recreational therapy, and education (not to mention parents of individuals with ASD).  Each attendee brings in their own knowledge and experience with autism from their professional vantage point. The keys to success are taking the best practices from each area of ability (physical, adaptive, and cognitive), and having strategies that have wide-ranging application. Again, specialist-generalist-specialist.

Odds are that if you’re reading this or have been researching fitness programming for autism, a parent or school has approached you about running a 1-to-1 or group program. You may be starting next month, or next week, or in two hours. So I’ll spend the last of this article providing some practical, go-to strategies within each of the physical, adaptive, and cognitive (PAC Profile™) framework.

Physical

Focus on basic, essential movement patterns (pushing, pulling, crawling, squatting, carrying, and locomotion)

Have appropriate progressions and especially regressions for each exercise

Don’t add variety where it is not needed. Keep programming as simple as possible.

Adaptive

Let the athlete know what they’ll be doing and what’s coming after that. Anxiety levels tend to be high among those with ASD. Providing a “what’s happening next” can deescalate.

Provide opportunities for choice; “Do you want to do push throws or overhead throws first?”

This establishes that the athlete will be doing one of those two throws AND they get to choose which one

Use contingencies; “First hurdle steps, then you can take a break for a minute.” This creates a natural timeline and enables the athlete to know the specific beginning and end of the sequence and what the expectation is.

Cognitive

Label the exercise and demonstrate. Avoid extraneous language.

Teach exercises one at a time. Use a lot of repetition.

Fitness is a life skill, one that is tremendously needed by the autism population of all ages and ability levels. For professionals who choose to offer fitness services to those with ASD, it is imperative that best practices, all around, be used. When we know what we are looking at, what outcomes are realistic, and what strategies to employ, we can meet our athletes where they are at and enhance quality of life.

Eric Chessen, M.S., is the Founder of Autism Fitness. An exercise physiologist with an extensive background in Applied Behavior Analysis (ABA), Eric has spent nearly two decades developing and implementing fitness and adapted PE programs for individuals of all ages and ability levels. Eric is the creator and Lead Instructor for the Autism Fitness Certification and has presented at TEDx on the subject of fitness for those with ASD. He is also the Co-Founder of strength equipment company Stronger than U. He is New York native and very new resident to Charlotte, NC.

“First, which hand?”

“Right hand”

“That’s your left. Which one is your right hand?”

Debbie holds up her right hand.

“That’s your right hand! Alright, cool, walking band pulls with your right hand.”

Coaching fitness programs for the autism population is taking the art of Bonsai to strength and conditioning. We eliminate noise, static, whatever you want to label as extraneous. Successful fitness and adapted PE programs with the autism population require a keen sense of senses.

How is Karl responding to directions for performing a bear walk? Can I fade my hand-over-hand prompt for Jack’s single arm Sandbell press and maintain the integrity of the movement? Is Kelvin going to get over-anxious if introduced to a new variation of the squat? Herein are some of the essential considerations for successful fitness sessions.

We start with three questions: What’s going on physically? What’s going on adaptively? What’s going on cognitively?

The answers provide a flow chart-style of contingency-based decisions? If this; then that. Autism is complicated. The strength and motor planning deficits are complicated. The odd, occasionally near-light speed escalation of anxiety and off-task behavior is complicated. What works is a rational and reliable strategy for each situation to support growth and development in each area of ability (physical, adaptive, cognitive). Taking the guesswork, or most of it, out of programming clears the path to short- and long-term benefits for the athlete.

The two most common coaching errors with respect to the ASD population are over-coaching and exercise selection (typically too progressed). Over-coaching is, by proxy, over-explaining and providing too many verbal directions at once. We often need to simplify verbal instruction for athletes with ASD as short-term recall is an issue of particular deficit. Here’s one set of directions likely to be problematic;

“First hurdle steps, then Sandbell slams, then bear walk from the blue cone to the green cone.”

Many of the athletes I’ve coached will start with bear walks. They’re not being deliberately off-task or defiant, it’s simply a matter of hard-wiring. The verbal directions were too extensive and our athlete was unable, at least for now, to hold them in place.

In the Autism Fitness Level I Certification we teach a strategy called “Label/Demo/Do & Cue” as an efficient way to teach and facilitate learning different exercises with safety, efficiency, and comprehension. Labeling refers to naming the exercise. Demonstrating is our showing the athlete proper form and performance, and Do/Cue gets them into the activity quickly so that we can coach as they learn.

In real life (IRL, LOL!) we would take each one of the aforementioned exercises (hurdle steps, Sandbell slams, and bear walks) and teach/instruct them separately. Consider that physical and adaptive skills can be mutually exclusive. An athlete might have proficiency with all three exercises, yet still require verbal direction at each stage;

“First hurdle steps”

Athlete performs hurdle steps.

“Great hurdle steps and getting your knees up! Now you have eight Sandbell slams.”

Athlete performs 8 Sandbell slams

“Those were some powerful Sandbell slams! Now bear walk from the blue cone to the green cone.”

Athlete completes the bear walk

Using this strategy we avoid overwhelming the athlete and having to back-track. We want to Label/Demo/Do & Cue because it provides the coach with more time to teach the exercise rather than explaining it. Our goal is to maximize “down” time and increase on-task behavior, wherein the athlete is learning and mastering each exercise. Given the strength, stability, and motor planning deficits common to the autism population, it is imperative that as much of a session as possible is dedicated to them being in action.

Labeling the exercise has a secondary benefit. As the athlete becomes more familiar with the name of a movement, he/she can request in or make an informed, motivated decision when an instructor provides options. We use this strategy with consistent success, asking athletes whether they would prefer to do “push throws or overhead throws first” during our medicine ball warm-up.

The structure here is key. Providing choice between exercises sets up a few important contingencies. First, the coach is giving structure. Both medicine ball throws will be performed, however, the athlete gets to choose the order.

The open-ended option “What do you want to do?” could be overwhelming or the athlete may choose something entirely outside the realm of exercise (“bathroom” and “break” are common inserts here). Providing choice within structure enables us to teach what needs teaching and coach what needs coaching while still leading towards autonomy. Over time, many of our athletes wind up “designing” their own sessions with frequent choices being offered, usually with respect to the order of exercises.

Exercise selection is crucial. Focusing on the foundation of movement patterns (locomotion, pushing, pulling, squatting, hinging, and crawling) we are able to address some of the most pervasive physical deficits common to this demographic. It is not about variety, rather building baseline skills that transfer or generalize to novel environments and situations. It can take some time for these movement skills to establish. In multiple cases learning to hinge properly during the scoop throw has taken our athletes a few years to master.

Focusing on a few exercises also gives our athletes the opportunity to learn the name and typical order in which the exercises can be performed. Whereas our warm-up/mobility section nearly always features hurdle steps, overhead resistance band walks, bear walks/crawls, and medicine ball throws (push, overhead, and scoop), our strength/focus section includes squats, presses, pulls, farmers walks, and heavy carries.

Using a “limited” selection of exercises enables our athletes to master the baseline skill (physical), become accustomed to the name and instructions around the exercise (cognitive), and be familiarized enough with each exercise that it can become reinforcing, where the athlete is motivated (adaptive) to engage.

The art of empathetic coaching requires us to ask one overarching question; What is it like for you to be coached by me right now? We acknowledge our athlete’s current abilities and make well-guided plans for their successes.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.

“Kettlebell and the sandbag,” Nico states as I’m preparing for him to do squats.

“You want to do farmers carries?”

“Yes,” he says in a soft voice but with an assurance that tells me he’s not just randomly calling out an object in the room.

“Awesome. Yes, you can definitely do farmers carries right after this set of squats, okay?”

“Yes,” he says, in the same low but definitive tone. I’m thrilled. Farmers carries involve roughly 3 steps; Pick something(s) heavy up, carry them while maintaining an upright, healthy posture, and put them down with control, sometimes with less control than other times. Farmers carries have fantastic generalization to other life skills, yes, carrying things of course, in addition to maintaining trunk stability and gait pattern (think climbing two or three flights of steps).

When we consider fitness as a life skill rather than something individuals with ASD and related special needs either “like” or “don’t like” the focus becomes less on “if/should” and more on “how/what.” We’re not just talking about young populations either. Fitness over the lifetime has immense benefits for both short- and long-term development, both proactive and reactive qualities.

That fitness and physical activity are only for young populations disregards the true value of progressive movement programs. As we age, the importance of strength, stability, and motor planning increases, as these are skills that degenerate with age and dis- or non-use. The result is costly, both in quality of life and financially. Consider the healthcare costs for a 55 year old individual with pervasive Autism Spectrum Disorder (ASD), diabetes, and compromised mobility. Two out of these three complications are entirely avoidable. They are also, with the proper fitness and nutritional interventions, reversible.

Quality of life can be a general, not-certain-what-we-mean-by-this-but-sounds-good term unless we consider it with respect to what those in our care can do and what skills will allow them to be more independent, healthier (physically and emotionally), and enable them to connect with others (building community) in meaningful ways. We also want to consider stress levels and longevity. What does life look like and feel like for a non-verbal individual in his/her 20’s? 30’s? 60’s? How can we ensure the best possible present and future for them?

Let’s take away “Doesn’t like to exercise.” Let’s get rid of that. In fact, I don’t even know what that means. Our definitions and perspectives on exercise programs may a “little” different. I get this interaction a lot;

“Kevin hates exercise.”

“What do you mean by exercise?”

“Oh, well we had him run on the treadmill for five minutes and he hated it and doesn’t want to do it again.”  

The fault isn’t in the trying. There is no fault. There is, however, a lack of information about the components of an appropriate fitness program. So here are the rules;

• We use exercises that will have the greatest benefit/generalization to life skills. These include squatting, pushing, pulling, carrying, and locomotion.
• We get a baseline understanding of what an individual can currently do.
• We progress exercises and movements once an individual demonstrates mastery.

What do we do? What do we doooooooooooooo? What exercises do our athletes need? What’s age appropriate? Are there super special special needs exercise?

The thing about fitness is that we’re doing it with human beings (goat yoga being a hideous exception). Since we’re doing it with human beings, we’re looking at human movement patterns and our individuals with ASD and related special needs are no exception.

The key is learning to what degree an exercise or movement needs to be simplified (regressed) or made more challenging (progressed). This is where baseline comes into play. If where know where our athlete is starting with an overhead Sandbell press, we can decide on an appropriate course of progression, maybe increasing the weight by 4lbs once they can complete 10 repetitions independently.

Understanding how each movement relates to quality of life is helpful. So let’s review that.

Squatting:

• Maintaining healthy posture when sitting/standing
• Increasing low body strength for walking/climbing (stairs, etc.)
• Sustaining healthy posture
• Prevention of low back pain
• Increased trunk/core stability

Pushing:

• Shoulder stability when reaching/placing items overhead
• Trunk stability and postural control when holding weighted objects
• Increasing general upper body stability for fine motor movements

Pulling:

• Development of upper back muscles to decrease forward posture
• Increased range of motion for shoulders
• Trunk stability when opening doors, dragging laundry bags
• Increased control when grabbing objects from above or below

Carrying:

• Being able to move objects from one place to another independently
• Increasing postural control and strength endurance (the ability to do a task for a longer period of time)
• Gait patterning
• Groceries/laundry/boxes/etc.

Locomotion:

• Getting from point A to point B with minimal discomfort
• Establishing coordination and motor planning for multi-step activities and ADLs (cooking, taking out the garbage, showering)
• Decreasing latency (catching the bus, getting to the car in less time)

The reasons why our Autism Fitness programming focuses primarily on developing strength, stability, and motor planning in these movement patterns is because these are the most common deficits and will have the greatest short- and long-term benefit for our athletes. We want to build a physical ability and progress as the athlete demonstrates their improved capabilities.

Programming, for individuals and groups, should include each of these exercises at a level of challenge where the athlete can perform the movement safely and with good technical form. We don’t just have our athletes move a lot, but coach healthy movement. This is why regressions in exercises are so critical and why we spend so much time with them in the Autism Fitness Level I Certification seminars.

As professionals working with and enhancing the lives of individuals with ASD and other developmental disabilities, there is a responsibility to provide life-enriching skills and opportunities. So much of this can be found in effective fitness programming. In both reducing the instances of health complications and increasing independent life skills, we can used the development of strength, stability, and motor planning to help build our athlete’s futures.

Photos provided by Eric Chessen.

Eric Chessen, M.S., is an Exercise Physiologist with an extensive background in Applied Behavior Analysis. Eric provides on-site and distance consulting worldwide. He is the founder of Autism Fitness®, offering courses, tools, resources and a community network to empower support professionals to deliver adaptive fitness programming to anyone with developmental deficits to create powerful daily living outcomes that last a lifetime.

“Okay, I have some Dynamax balls, some resistance bands, a few Sandballs, what do you want to try first?” This is usually my first question after I’ve met a new athlete and I begin the PAC Profile assessment. I want to know if there is any particular piece of equipment or movement pattern that they gravitate towards. Yes I want to optimize squatting patterns and trunk stability, and that will occur over time with patience and consistency. The objective within the first few sessions is developing an amiable repoire with the athlete and introducing new activities.