Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
The Center for Discovery
The Janet and Gerald Carrus Institute for Families
The Center for Discovery is remarkable for its more than 60 years of service to
children and adults with severe disabilities. The Center offers educational,
clinical/health, residential, family supports in addition to other programs and
services. The Center features universally designed facilities specifically built to meet
the physical, intellectual, emotional, social, and creative needs of children and
adults it serves.
The Carrus Institute for Families
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
National Center on Physical Activity and Disability (NCPAD)
The University of Illinois at Chicago (UIC), through its Department of
Disability and Human Development and in collaboration with several major
organizations in physical activity, rehabilitation and disability, operates
the National Center on Physical Activity and Disability (NCPAD). The
primary focus of NCPAD is to improve the health, wellness, and quality of
life of people with disabilities by promoting and facilitating increased
participation in physical activity and recreation. NCPAD is a proven and
effective online health promotion resource center supplemented by
personalized services fully accessible to people with disabilities.
The mission of the National Center on Physical Activity and Disability
(NCPAD) is to promote substantial health benefits that can be gained from
participating in regular physical activity. The slogan of NCPAD is Exercise
is for EVERY body, and every person can gain some health benefit from
being more physically active. This site provides information and resources
that can enable people with disabilities to become as physically active as
they choose to be.
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Current Research
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Rate of obesity (1997-2000) – 34.6% in persons with intellectual disabilities
20.6% in the general population
Among adults with intellectual disabilities living in group homes and family
homes- rates are 47.5% and 37.5% respectively (Yamaki, 2005)
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Studies of physical activity of adults with intellectual disabilities found that only
between 17.5% to 33% of these adults engaged in the standard recommended
amount of physical activity (Stanish, Temple and Frey, 2006)
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Several studies indicate individuals with intellectual disabilities tend to consume
diets that are high in fat and low in fruit and vegetable intake. Results indicate
that only 0 to 6% of residents of group homes consumed the recommended five
or more fruits and vegetables per day (Heller, McCubbin, Drum and Peterson,
2011)
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Components of Physical Fitness
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There are four main parts to physical fitness:
1.
2.
3.
Muscle strength and endurance
Flexibility
Body composition (body fat- amount of activity you get, type and amount of
food you eat)
Cardiovascular endurance (the ability of the heart, lungs and blood vessels to
transport oxygen to working muscles)
4.
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In order for the body to move as efficiently as possible, and in order to
prevent debilitating disease, all for parts of fitness must be worked on at least
a weekly basis.
(Rimmer, J. RRTC on Aging with Mental Retardation, Institute on Disability
and Human Development, The University of Illinois at Chicago)
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Pilot Study
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Fourteen adults, ranging in age from 40 to 86, who present with
significant multiple disabilities.
Individuals reside in two Intermediate Care Facilities (ICF’s) and attend
a Day Habilitation Program at the Center.
Multi-Component Program- flexibility, muscle strength and endurance,
cardiovascular fitness and a nutrition program that promotes healthy
eating with an emphasis on whole foods.
Pre and post assessment measures- weight, BMI, resting heart rate,
goniometric data, satisfaction survey.
Three physical activity sessions and one nutrition lesson per week.
Team approach- individuals, recreational therapy, residential and day
staff, nursing/clinical staff.
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Physical Activity Component
NCPAD team analyzed current participants physical abilities, job expectations, and unique
medical circumstances in developing breathing techniques combined with flexibility
exercises, strength exercises, and cardiovascular exercise.
•Flexibility- Began with routine relaxation breathing, continuing breathing through an upper
body extremity routine.
•Strengthening- Weight training routine
-Individual weights selected based on grasping abilities, and strength capabilities
-Weekly assessments and modifications based on individual achievements
-Adapted exercises for participants based on range of motion.
-Varying expectations for our most medically challenged participants.
•Cardiovascular exercise
-Reck Bike
-Walking
-Dancing
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Physical Activity Component
Name:_________________________ Week #___________
Name:_________________________ Week #___________
Strengthening
Shoulder press
Bicep Curls
Tricep Curls
Side raises
Seated Chest Flies to be adapted
in seated position
Session 1 Date: __
Number of reps
desired ______
Session 2 Date: ___
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desired ______
Session 3 Date: ___
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completed ____
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completed ____
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Comments:
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Strengthening
Shoulder press w/
adapted weights
Bicep Curls
Tricep Curls
Side raises
Chest Flies to be
adapted in the seated
position
Session 1 Date: __
Number of reps
desired ______
Session 2 Date: ___
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Session 3 Date: ___
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Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Nutrition Component
The Center is home to Thanksgiving Farm – an organic farm that produces a variety of
vegetables and pasture raised animal products.
Food at the Center for Discovery:
Whole Foods
Plant Based
Seasonal Menus – local if possible; 3 week cycle
Made from Scratch
Wellness based, counter-cultural food environment –
focus on cooking, vegetables, and whole foods
with limited exposure to outside processed foods.
Chefs prepare meals daily in home environment to maximize the influence
of food in the house: smells, sounds, and resident participation as appropriate.
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Nutrition Component
With limited choice for residents, nutrition goals of NCPAD were:
•Bring consciousness to food and making healthy choices when able (dining out)
•Basic nutrition education
•Acceptance of the menu
•Improved weight control was a secondary goal but not expected to change greatly
due to length of the program and the Center’s already relatively low rates of obesity.
General Population
(CDC 2007/ 2008)
General Disabled Population
(Yamaki 2005)
The Center for Discovery
(2009)
NCPAD Participants
(2011)
33.8%
47.5%/37.5%
6%
35.7%
Each Week:
•RD to houses for nutrition lesson/ game (Think your Drink; Vegetable Color Cards)
•Focus on healthy eating and identification of vegetables
•Highlight connection to farm: Seed to Belly Initiative
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Nutrition Component
Findings:
•Remarkable weight loss
12/14 participants lost weight (1 outlier)
Participants lost a total of 63 pounds (avg 4.5 lbs/person)
3% drop in overall body weight; average BMI drop from 28.6 to 27.8
Obesity rate of group now at 14% (3 individuals no longer BMI>30)
•Increased water consumption
•Individual goals attained
Eat breakfast regularly
Increased intake of vegetables
Healthy choices when dining out
Discussions/activities voluntarily focused around nutrition
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Nutrition Component
Implications for future nutrition projects/ goals:
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Targeted intervention for residents for weight control
Agency wide wellness programming
Attitude changes toward menu (counter cultural)
Currently online to target ASD kids and families
Food and Farm based learning for improved health
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Other Program Components
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Team names/tee-shirts
Varied music and cardio routines
Personal celebrations/group
celebrations throughout the 14
weeks
Midpoint celebration and awards
Midpoint outing to community
restaurant
Staff training and involvement
Collaboration with Nursing and
participants specific therapists.
Final celebration and presentation
of certificates
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Pre, Midpoint, and Post Study Measurements
NCPAD VITAL STATISTIC COMPARISON
Initiation of program
Week of 2/25/2011
OTIS ARMSTRONG BP Resting/End/Recovery WT
106/66 ~ N/A ~ N/A ~ N/A WT ~ 131.2
MA
126/66 ~ N/A ~ N/A ~ N/A WT ~ 92.8
SC
110/70 ~ 97 ~ N/A ~ 113 WT ~ 185.4
BC
94/60 ~ 94 ~ 108 ~ 93
WT ~ 140.2
LC
104/62 ~ 98 ~ N/A ~ 128 WT ~ 146.8
DD
126/84 ~ 75 ~ 76 ~ 74
WT ~ 141.5
GK
126/64 ~ 66 ~ 72 ~ 71
WT ~ 143
HM
96/50 ~ 86 ~ 89 ~ 86
WT ~ 246
MH
SPRUCE
FA
115/83 ~ 73 ~ N/A ~ 100 WT~125.9
FB
116/90 ~ 94~ N/A ~ 83 WT~129.7
KE
117/75 ~ 73 ~ N/A ~ 83 WT~154.1
MN
96/64 ~ N/A ~ 77 ~ 56 WT~110.0
KH
112/84 ~ 119 ~ N/A ~ 125 WT~108.9
NS
114/69 ~ 101 ~ N/A ~ 105 WT~222.8
Updated as of 5/25//11
Midpoint
Week of 4/12/2011
BP Resting/End/Recovery
116/60
110/54
100/54
110/70
114/70
106/64
116/60
96/50
~ N/A ~ N/A ~ N/A
~ N/A ~ N/A ~ N/A
~ 96 ~ 128 ~ 104
~ 86 ~ 106 ~ 93
~ 96 ~ 106 ~ 128
~ 100 ~ 120 ~ 110
~ 73 ~ 79 ~ 70
~ 89 ~ 85 ~ 80
123/82 ~ 89 ~ 88 ~ 90
130/88 ~ 86 ~ 104 ~ 103
114/70 ~ 77 ~ 95 ~ 91
90/59 ~ 64 ~ 70 ~ 68
125/99 ~ 89 ~ 88 ~ 90
141/93 ~ 92 ~ 90 ~ 86
WT
End of program
Week of 5/24/2011
BP Resting/End/Recovery WT
WT~ 130
WT~ 88.5
WT~185.2
WT~ 136.5
WT~ 142.6
WT~ 140.5
WT~ 139.5
WT~ 227.5
100/60
98/54
118/64
106/60
108/70
110/68
116/70
100/68
~ N/A ~ N/A ~ N/A
~ N/A ~ N/A ~ N/A
~ 81 ~ 129 ~ 90
~ 88 ~ 105 ~ 95
~ 91 ~ 109 ~ 80
~ 80 ~ 91 ~ 89
~ 65 ~ 64 ~ 66
~ 72 ~ 79 ~ 78
WT ~ 125
WT~ 95.5
WT~ 184
WT~ 137
WT ~ 141.8
WT ~ 135.9
WT~ 138
WT ~ 230.5
WT~131.8
WT~137.6
WT~143.4
WT~106.3
WT~108.5
WT~223.6
100/69
126/74
119/71
97/64
113/84
119/77
~ 102 ~ 113 ~ 96
~ 97 ~ 109 ~ 92
~ 78 ~ 105 ~ 75
~ 64 ~ 83 ~ 70
~ 93 ~ 103 ~ 96
~ 91 ~ 106 ~ 91
WT ~ 125.2
WT~ 134.2
WT~ 143
WT~ 104.6
WT ~106.7
WT ~ 222.1
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Sample Goniometric Comparison
2/24 Left
4/13 Left
5/31 Left
Flexion
0-180
0-135
0-140
0-150
Extension
0-60
0-20
0-20
Abduction
0-180
0-165
Horizontal Abd.
0-90
Horizontal Add.
0-45
Shoulder
2/24 Right
4/13
Right
5/31 Right
Flexion
0-180
0-130
0-135
0-140
0-20
Extension
0-60
0-5
0-10
0-5
0-170
0-170
Abduction
0-180
0-150
0-155
0-155
0-80
0-80
0-80
Horizontal Abd.
0-90
0-55
0-55
0-59
0-35
0-40 with
discomfort
noted
0-45 no
discomfort
reported
Horizontal Add.
0-45
0-40
0-40
0-45
0-135
0-135
15-135
Elbow and
Forearm
Extension/Flexion
0-150
Shoulder
Elbow and
Forearm
15-125
10-130
8-148
Extension/Flexion
0-150
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Sample Goniometric Comparison
2/24 Left
4/13 Left
5/31 Left
Flexion
0-180
0-98
0-100
0-138
Extension
0-60
0-30
0-30
Abduction
0-180
0-120
Horizontal Abd.
0-90
Horizontal Add.
0-45
Shoulder
2/24 Right
4/13 Right
5/31Right
Flexion
0-180
0-135
0-140
0-135
0-32
Extension
0-60
0-35
0-35
0-35
0-125
0-130
Abduction
0-180
0-138
0-140
0-160
0-90
0-90
0-80
Horizontal Abd.
0-90
0-90
0-90
0-80
0-10
0-15
0-15
Horizontal Add.
0-45
0-18
0-20
0-20
50-135
45-135
40-142
Elbow and
Forearm
Extension/Flexion
0-150
Shoulder
Elbow and Forearm
62-140
60-140
50-150
Extension/Flexion
0-150
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Sample Goniometric Comparison
Shoulder
Flexion
0-180
2/24 Left
4/13 Left
5/31 Left
0-90
0-90
0-110
Extension
0-60
Limited by wheelchair mold
Shoulder
Flexion
0-180
2/24 Right
4/13 Right
5/31Right
0-70
0-75
0-110
Extension
0-60
Limited by wheelchair mold
Abduction
0-180
0-95
NT
0-100
Abduction
0-180
0-110
NT
0-115
Horizontal Abd.
0-90
0-60
0-70
0-60
Horizontal Abd.
0-90
0-45
0-45
0-45
Horizontal Add.
0-45
0-8
0-10
0-15
Horizontal Add.
0-45
0-10
0-12
0-15
60-138
60-140
56-150
Elbow and Forearm
Extension/Flexion
0-150
Elbow and Forearm
55-125
50-130
48-145
Extension/Flexion
0-150
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Summary of Findings- Objective
•All Spruce group participants demonstrated an ability to exercise at an
increased intensity at the conclusion of the 14 week program, as
evidenced by pre and post-exercise HR measures
•Trend toward increased ability to actively flex shoulders as well as flex
and extend elbows in individuals presenting with significant AROM
impairment
•Documented weight loss in 12 of the 14 participants
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Summary of Findings- Subjective
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13/14 participants demonstrated overall positive response and active
participation in all components of the program.
Many participants verbally indicated positive attitude changes and
satisfaction with the program (pride, self-confidence, motivation)
Participants described impact of the program on their daily lives
(improved sleeping, more range of motion)
Participants expressed desire to continue with the program.
Active participation by staff in the program.
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
Future Directions
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Continue with present groups incorporating participants and staff as
coaches.
Look at longer term health benefits for present participants.
Expansion of program to additional residences at the Center.
Development of training component for staff.
Application of program to other aging populations.
Physical Activity and Nutrition for Adults Aging with Multiple Disabilities
References
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Heller,T., McCubbin, J.A., Drum, C., & Peterson, J. (2011). Physical activity and
nutrition health promotion interventions: what is working for people with
intellectual disabilities? Intellectual and Developmental Disabilities, 49, 26-36.
Podgorski, C.A., Kessler, K., Cacia, B., Peterson, D.R., & Henderson, C.M.
(2004). A fitness intervention for older adults with developmental disabilities:
report on a pilot project. Mental Retardation, 42, 272-283.
Rimmer, J. Aging, mental retardation, and physical fitness.
Strenghthforcaring.com - Caring for Others, 2-9.
Rimmer, J. Introduction to achieving a beneficial fitness for persons with
developmental disabilities. The National Center on Physical Activity and
Disability/Condition, 1-17.
Stanish, H., Temple, V.A., & Frey, G. (2006). Health-promoting physical activity
of adults with mental retardation. Mental Retardation and Developmental
disabilities Research Review, 12, 13-21.
Yamaki, K. (2005). Body weight status among adults with intellectual disability in
the community. Mental Retardation, 43, 1-10.