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NCHPAD - Building Healthy Inclusive Communities

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I. Cardiovascular Fitness


One of the most challenging aspects of a physical fitness program for persons with developmental disabilities is improving cardiovascular fitness (Rimmer, 1994). To see improvements in cardiovascular fitness, a person must exercise moderately or vigorously. These terms are associated with the heart rate at which a person exercises. When the training heart rate reaches a sufficient level during exercise, a training effect occurs. This results in physiological benefits that include lowered blood pressure, decreased resting heart rate, greater stroke volume (stronger heart pump), and improved circulation (Haskell, 1997).

One of the ongoing debates in the exercise science literature is determining if physical activity must be performed moderately or vigorously to confer health benefits. Haskell (1997) noted that the greatest reduction in health risk is achieved by those individuals who are the least active and who then become slightly active. In this regard, clientele such as a large segment of persons with developmental disabilities, will gain substantial improvements in health by engaging in moderate physical activity. However, for persons who are already moderately active, performing vigorous activity will probably confer greater health benefits provided the activity is performed safely. A few studies have shown physically inactive persons who perform vigorous activity may be more susceptible to a coronary event (Lee & Paffenbarger, 1997).

Getting some adults with developmental disabilities to exercise at a sufficient intensity level for 20 to 30 minutes to attain these physiological changes may be difficult. Under these circumstances, it is best to start off slowly and gradually increase the workload. Begin with a 5- or 10-minute bout of activity and determine the client's intensity level by measuring heart rate. This can be performed at the carotid (neck) artery. Use the index and middle finger to record heart rate and count for 15 seconds. Multiply this number by four to obtain the heart rate for one minute.

A. Calculating Exercise Intensity

Although performing any type of physical activity is going to have health benefits, if an individual is capable of exercising within a certain range of his or her maximum heart rate, there will be greater health benefits. The American College of Sports Medicine (ACSM) (1998) recommends a target heart rate (the heart rate that the person should exercise at) between 55% to 90% of maximum heart rate. The ACSM notes that for individuals who are unfit, 55% to 64% of the maximum heart rate is a good starting point. The formula for computing a person's target heart rate (THR) is shown below. It is important to start off at a lower intensity (45% to 55%) and gradually increase the intensity as the person's fitness and motivation levels improve.

Formula for Computing Target Heart Rate

  1. Subtract the person's age from 220.
  2. Subtract the person's resting heart rate from this value.
  3. Multiply this number by the intensity at which you want your client to exercise. This should range between 45% and 75%. In order to arrive at a whole number, change the percentage to a fraction (e.g., 50% would be .50).
  4. Add this value to the person's resting heart rate. The number you obtain is the target heart rate that you should try to achieve during exercise.

Example: 25 year-old client with developmental disabilities.
Goal: Exercise at 60% of maximum heart rate. Resting heart rate = 75 beats per minute.

  1. 220 (fixed number) - 25 (age) = 195
  2. 195 - 75 (resting heart rate) = 120
  3. 120 X .60 (60% intensity level - change 60% to .60) = 72
  4. 72 + 75 (resting heart rate) = 147
    The person's target heart rate is 147 beats per minute.

In some instances where heart rate is difficult to measure (e.g., obese individuals), you might be able to teach higher-functioning adults how to rate the intensity of the exercise by using a scale known as Rating of Perceived Exertion (RPE) (Borg, 1982). This scale requires the person to provide a numeric rating of how hard he/she is working. The scale runs from 6 to 20, and persons who engage in light to moderate exercise usually give a score between 10 and 13. Vigorous exercise usually ranges from 14 to 17. The most accurate way to monitor heart rate is with a portable heart rate monitor. They can be purchased for about $75. However, purchasing them for several residents in a group home may be too costly.

B. Establishing Frequency and Duration

The Surgeon General has recommended that all Americans engage in moderate exercise daily (U.S. Department of Human Services, 1996). Moreover, the recently published 2008 Physical Activity Guidelines for Americans describe the types and amounts of physical activity that offer substantial health benefits to all Americans, including those with disabilities. On days when there is little time, shortening the exercise period is better than not exercising at all. A good philosophy to remember is the "eat every day/exercise every day" principle. Since we rapidly accumulate calories through food consumption, we must either "burn" them up through exercise or store them in our body as fat. The only way to maintain a caloric balance and avoid the creeping onset of obesity is to cut calories or increase physical activity. When you consider that eating an extra cookie a day containing 50 calories will result in an extra pound of fat in 10 weeks and 5 extra pounds in a year (there are 3,500 calories in one pound of fat), it is clear that gaining weight is a lot easier than losing it. Therefore, missing a day of physical activity could put you in a state of caloric surfeit and result in a gradual accumulation of body fat.

The duration of activity should last a minimum of 30 minutes. The ideal program would be closer to 60 minutes (30 cardiovascular - 20 strength - 10 flexibility), but this may not be feasible for some individuals who are working full-time or have a poor motivation level. Keep in mind that exercise can be performed at regular intervals during the day and does not have to be done in one session to incur health benefits. A person could exercise 20 minutes in the morning, 20 minutes during lunch time, and 20 minutes before dinner to achieve this 60-minute goal.

C. Exercises to Improve Cardiovascular Fitness

Almost any activity that uses large muscle groups can be used to improve cardiovascular fitness. The more muscle groups used, the greater the return on fitness. Effective activities should be rhythmical, repetitive and simple in nature.

  • Walking

    Several studies have shown that walking is one of the most preferred activities for developing cardiovascular fitness in persons with developmental disabilities (Anchuthengil, Nielsen, Schulenburg, Hurst, & Davis, 1992; Croce, 1990). It is easy to do, does not require special clothing or equipment, and can be performed almost anywhere. It can also be done for longer periods of time compared to other activities that may be more vigorous in nature, such as stationary cycling, jogging or aerobic dance. The one problem, however, is that inclement weather usually prevents the person from exercising. Many people walk during the spring and summer months and spend time indoors doing other activities during the fall and winter months unless they live in a year-round climate that is conducive to outdoor walking.

    Mall walking has become a popular pastime for many seniors who live in parts of the country where it is difficult to walk outdoors (e.g., weather, crime, damaged sidewalks). The benefit of walking in a mall in the early morning hours is that there are relatively few people around and the floor is clean and free of cracks and debris. However, getting to a mall may require special transportation.

    When walking in groups, one way to increase the intensity of the activity in order to obtain a training effect in individuals who are in good condition is to have them walk with light weights. This will increase their heart rates and tax their cardiovascular system to a greater degree. If weights aren't available, ask them to carry grocery bags with a few pounds of sugar or sand.

  • Stationary Cycling

    Stationary cycling is an excellent activity that can be performed indoors on a regular basis or during inclement weather. You can often purchase older stationary cycles in garage sales for a few dollars. A group home director could probably equip his or her residence with several stationary cycles after a few weeks of visiting garage sales. Local community colleges, universities, and fitness centers are also good sources for finding inexpensive and sometimes free equipment. Stationary cycles and other types of fitness equipment are constantly being upgraded. Fitness facilities like to maintain the latest models and will often donate older equipment to charity. The benefit of stationary cycling is that the person can perform the activity while watching television or listening to the radio. The downside is that stationary cycling can be boring and is probably best used by combining it with another activity (e.g., 15 minutes on the bike and a 15-minute dance video) to achieve your targeted duration.

  • Dance Videos

    Dancing is an excellent cardiovascular activity that many adults with developmental disabilities will enjoy. All forms of dance can be used to enhance fitness. There are also many popular dance videos on the market that a person can use in his or her residence. These videos are developed for varying levels of fitness. Maintain a library of videos and use different ones every few weeks to reduce boredom.

  • Miscellaneous Activities

    There are many other activities that can be used to improve cardiovascular fitness, including jogging, swimming, hiking, bicycling, arm cycling, stair-climbing, rowing and skating. These activities will either require a certain skill level or a local gym to perform the exercise. In some communities, the staff from group homes will transport several adults to a local YMCA (YMCA Link). Some fitness facilities offer membership discounts during off-peak hours.

The Special Olympics (SO Link) also provides opportunities to participate in various sports events. Use these activities to add variety to the program. Participating in a basketball or volleyball tournament on the weekends will be an enjoyable change of pace from the usual fitness routine and may be highly motivating for certain individuals.


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