In this episode, we talk with Dr. Byron Lai. Dr. Lai is an Assistant Professor in the UAB Heersink School of Medicine Department of Pediatrics Division of Rehabilitation Medicine. He has 10 years of experience in exercise research for people with disabilities. From 2014 to 2021, Byron joined Dr. James Rimmer under the UAB School of Health Professions Research Collaborative, where he completed his PhD and two postdocs. His research interests shifted toward a focus on utilizing telehealth and innovative technology to improve the health and function of a variety of different disability groups.
Byron’s research interests focus on incorporating technology to provide enjoyable and accessible, evidence-based exercise programs for people with disabilities. Particular areas of interest include active video gaming, wearable monitoring devices, and therapeutic exercise with music.

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Episode Transcript

Quick Navigation (click the linked text below to jump to a new section)

• Intro
• Byron’s background and his research in cardiorespiratory fitness
• How cardiorespiratory fitness options are used to manage weight and blood-related health
• Virtual reality research
• Independent exercise for kids with disabilities
• How telehealth has expanded access and reduced financial barriers
• Biggest challenges and opportunities when using VR and similar technology
• The moments that have stayed with Byron the most as a researcher
• The benefits of assisted exercises and the research needed
• Key takeaways or practical recommendations to support physical activity for children and youth with disabilities

*Edited for clarity*

Host: 00:04

This is Wellness, Health and Everything Else: a NCHPAD Podcast.

Welcome to Wellness, Health, and Everything Else: a NCHPAD Podcast. NCHPAD is the National Center on Health, Physical Activity and Disability – the nation’s premier center dedicated to promoting the health and wellness of everyone. In each episode, we explore topics at the intersection of health, wellness and mobility limitations. If you have an idea for a topic, would like to learn more about a topic or are interested in our free resources, programs and partnership opportunities, email us at nchpad@uab.edu, give us a call at 866-866-8896 or check out our website at nchpad.org.

Music Interlude

In this episode, we talk with Dr. Byron Lai. Dr. Lai is an Assistant Professor in the UAB Heersink School of Medicine Department of Pediatrics Division of Rehabilitation Medicine. He has 10 years of experience in exercise research for people with disabilities. From 2014 to 2021, Byron joined Dr. James Rimmer under the UAB School of Health Professions Research Collaborative, where he completed his PhD and two postdocs. His research interests shifted toward a focus on utilizing telehealth and innovative technology to improve the health and function of a variety of different disability groups.

Byron’s research interests focus on incorporating technology to provide enjoyable and accessible, evidence-based exercise programs for people with disabilities. Particular areas of interest include active video gaming, wearable monitoring devices, and therapeutic exercise with music.

To get the episode started, Byron shares his background and what led to his research in cardiorespiratory fitness for children and youth with disabilities.

Dr. Byron Lai: 01:58

My background is in rehabilitation science. I have a PhD in rehabilitation science, but also, I have a Master’s in Adapted Physical Activity. My research focuses on developing exercise options to improve health among children and youth with disabilities. I’ve been a scientist for about 15 years now, even though I’m still technically early career faculty, but I’ve been a part of interventions, I guess you could say, intervention development, like developing programs, but also high-level reviews of the current state of the literature. 

And so, I’m hoping today’s talk is not really just about me and my background, but really, it’s more about the options or ways to improve weight and manage health among children and youth with disabilities. But it comes — everything I say today — is going to come from a scientist kind of perspective. So, I’m going to try not to make any recommendations unless I feel like they have enough evidence to be supported. But also, I’ll let you know, I feel like knowledge can also be interpreted differently by different people. So, I’ll let you know how confident I am in those recommendations. 

But I’m happy to be here. I have a four-year-old son, and so I know how precious having a child is. So, really, I hope today’s talk is really just a message for caregivers or the people, the kids, so that we can really start addressing this problem, which is really cardiovascular, cardiorespiratory, or aerobic, if you want to call it that, exercise options for people with mobility disabilities who can’t do the conventional walking, cycling, jogging, running that you know the doctors prescribe.

Host: 03:42

We asked Byron how cardiorespiratory fitness options are used to manage weight and blood-related health, and how this work aims to provide a solution.

Dr. Byron Lai: 03:50

That is a good question. So, the question is, really, how do we improve weight and particularly cardiometabolic health among people with mobility disabilities, specifically children and youth? And so, when anyone gets involved in exercise, usually the number one thing they want to do is lose weight or manage their weight, right? But generally, as an exercise scientist, I’m very hesitant for that to be the goal, because we don’t want someone to be so focused on that goal and not succeed at that goal that they become discouraged from participating. And I’ll get to what that means in a little bit. 

But really, when I say cardiometabolic health, that means blood-related health, that means lipids, triglycerides, cholesterol, insulin, you name it. And I also mean body composition, as in not just body weight, but really percent fat to percent muscle. Ideally, you want more muscle and less fat, right? Generally, when you’re thinking about exercise benefits. Unfortunately, the evidence is not really strong — in terms of research evidence — that there are exercise modalities that are effective in managing body weight and cardiometabolic health in children and youth with disabilities. And what I mean by that is there is no high-level evidence that is strong enough for me to sit here and tell you, as a caregiver, as a child, or just as someone listening, a researcher, another health professional, that a specific modality can actually improve body weight, as in help someone with a mobility disability lose weight and improve their blood-related health. 

Now, why is that a problem? Because doctors will prescribe you, and you’ve probably heard this, “Oh yes, do 150 minutes of moderate-intensity exercise at home or in the community.” And you go, “Okay.” As a parent, well, how do I do that? And then you go, oh, you could try this, you could try that. But really, the truth is that there is no evidence way if you cannot walk, run, jog, or cycle. Okay, now with that being said, there are smaller research studies that have shown benefits. And really, I’m going to talk a lot about that today. But in terms of high-level evidence, there is currently no modality that we know is effective except for the arm bike. And if you’re not familiar with what an arm bike is, imagine grabbing onto a cycle, and you’re just pedaling in a circular motion with both arms or one arm, and you have to do that apparently for 150 minutes per week. If you’ve ever done it, it’s not easy to do for more than 10 minutes at a time, let alone for 150 minutes a week. And so, I’m going to talk today about options to try and get you there if you can only use your arms for exercise. And I’ll talk about some of the work we’ve done in terms of developing modalities for doing so and what I’ve seen in the literature as well.

Host: 06:56

One of Byron’s research avenues uses virtual reality to support physical activity. Byron describes how VR changes the experience of exercise for children and youth with disabilities.

Dr. Byron Lai: 07:06

So, I would say one exercise modality, aerobic exercise modality, that we’ve gotten the most traction on is virtual reality, extended reality, whatever you want to call it, mixed reality. We’ll call it virtual reality for the sake of this talk, exercise through head-mounted displays. That’s a fancy term for a headset that you put on your face, and you have vision, and you’re immersed in a virtual world. And so that has really gained traction recently because it is the new form of active video gaming. So, a lot of you listening might be familiar with the active video gaming consoles, like the Nintendo Wii and the Xbox Connect. But those are discontinued, as in you can’t even go to the store and purchase those. And so, the only real mainstream way of doing active video gaming is through these new headsets or gaming consoles, if you want to call it that, which are really head-mounted displays, virtual reality headsets, if you will. And these headsets, the technology in them is so amazing that it is essentially as powerful as a low-end gaming console. 

What’s really fascinating is that not even several years ago, as in right around the COVID era, before that period, such technology that we have today did not exist. And to get a real virtual reality experience, you needed a $3,000 computer and put in the virtual reality headset. You’re looking at a $4,000 setup. But nowadays, you can get a serious virtual reality gaming experience for $300, even cheaper than that if you buy it used. And so, it’s marvelous where the technology is. And that has allowed us to develop a new way to do exercise using only the arms while someone is in a seated position with virtual reality gaming. And we don’t even develop like novel games. We essentially come up with an exercise prescription using commercialized games that can be picked up at any major retailer or even through the headset itself through the cloud server they have to purchase games. And you can have a serious therapeutic exercise gaming prescription that can hopefully improve your health. 

And so, we actually have an NIH R03-funded trial, a clinical trial. It was a randomized controlled trial comparing virtual reality exercise for 12 weeks to a weightless control. And what we found was that kiddos who did the exercise in the headset apparently had slightly better blood-related health than kiddos who did not do the virtual reality exercise for 12 weeks. And specifically, that improvement was to fasting insulin as well as triglycerides, I believe, off the top of my head. And so a little bit of signal there. I should note that there was no benefit to weight, and we’ll come back to that. 

So, what am I trying to tell you in short is that we actually had a small, randomized control trial. It was only about 30 people, and we had a little bit of data to suggest that virtual exercise using only the arms can get kids to a moderate intensity of exercise, to hopefully lead to some benefit to health. We had qualitative investigations, so we interviewed them after, and a lot of them said that they improved their energy levels, though that’s not confirmatory. I do not doubt, just from my personal opinion, that these things can be used (those devices, those headsets) can be used to improve cardiorespiratory fitness, as in their energy levels. That I’m really not questioning because the Nintendo Wii, the Xbox Connect, those things could do that too. But what’s really good about these virtual reality headsets is that they can hold on to these handheld devices, or you can strap their hands into them. And the tracking is good enough, but it’s not so good that you don’t need a full range of motion to actually participate in the games while also feeling like you’re heavily immersed in the game. So, the great thing for children and youth is that it provides a high level of immersion and engagement while also being accessible, assuming we give them the right prescription. And we’re still learning to optimize these prescriptions, and we have a bigger grant under review right now to try to confirm that a prescription will actually improve blood-related health. But these headsets have a strong promise. The great news is that if you’re a parent listening or you’re a kid or an adult listening with a mobility disability and you’re looking for a new way to do aerobic exercise, you can literally go to Amazon, any other major retailer, and purchase a MetaQuest headset. Actually, now, the latest one is the MetaQuest III as of this recording, and you can go into the headset, buy the game for like 20 bucks a game, and you are off to the races, assuming you get the right prescription. And so virtual reality has a really strong promise. And to be honest with you, from even my perspective, it’s one of the only ways to improve cardiorespiratory fitness. And maybe, we’re not there yet, blood-related health, if you cannot do the conventional forms of exercise that we mentioned before.

Host: 12:36

Byron describes how the relationship to exercise can change for kids when they realize they can exercise independently.

Dr. Byron Lai: 12:42

A good question. So just taking from that one randomized controlled trial we did, I think the happiest thing for me out of that trial was not even those results and those findings, but really when we interviewed the kids and the parents, we found that about 85 to 90 percent of the children who did the program, and I believe it was 32 or something like that. Don’t quote me on the numbers, but around that many kiddos who did that program. 85-90% had never participated in an exercise program of that kind of volume in their entire life. 12 weeks of exercise. And they actually did — we objectively measured this via a heart rate monitor — they actually did about 70 minutes of exercise of moderate intensity per week across the entire 12-week program. And then the actual amount of total exercise, that means low intensity too, was about 110 minutes, I believe. Don’t quote me on that number, but around 110 minutes on average, actually, it might have been higher, it might have been like 130-ish minutes of total exercise across the whole thing. And so, they essentially almost met the exercise guidelines from doing this headset exercise, which is really cool. Guidelines would be 150 on moderate, so they fell short of the moderate, but they did the total exercise, or at least really close to it on average. And we were still learning how to do it then. I know now we can do it a lot better, prescription-wise. 

I want to say it was truly a rewarding experience when we heard that 90 to 85% have never done this kind of exercise before. And how did it make them feel from the quality interviews? They felt accomplished, they felt like they achieved something that they’ve never done before, that most of them, those people who reported that, did not feel they were even capable of. So, it was really interesting. We asked them, how confident were you that you could do this amount of modern intensity exercise, particularly in a virtual reality headset, before you started? And then how did that change after? And the interesting thing was that like half of them were like, “Oh, I thought I maybe could, but like once I got into it for the first couple weeks, I knew this was something that felt good, and I could do it.” And so, their confidence improved very quickly once they got into it, which was really exciting. And a lot of them felt like they really accomplished something at the end because again, they had never done this much exercise in their entire life. And in some cases, maybe they did, but it was all the way when they were like a young, young kid getting pediatric therapy in the hospital or something like that. 

And so, it was really rewarding in that sense that this modality is capable, is accessible, it’s usable, and it’s a good experience. But there are downsides to it, of course. Nothing’s perfect, but for those who like that kind of modality, I would say it has the potential to work for improving cardiorespiratory fitness, for which we don’t really have strong evidence for it. It’s honestly very weak evidence. Just from my personal opinion, I would say I don’t doubt that it can. But for cardiometabolic health, as in losing body weight and also improving blood-related health, I would say that we are unsure of just yet.

Host: 16:15

We asked how delivering fitness and health programs through telehealth has expanded access and reduced the financial barrier to expensive technology for families and youth with disabilities.

Dr. Byron Lai: 16:24

My specialty, I would say, even though we’re developing aerobic exercise modalities, is really still telehealth. And that is through my mentor, James Rimmer. I learned so much about telehealth, and we’ve been doing telehealth exercise trials for people with disabilities for many years now. And I do believe telehealth is the way to go. And so all of the ways we test our new exercise modalities are through telehealth because it’s really hard to get enough people on one site or one little laboratory to get these big enough sample sizes so that I can come to you here and provide you with strong evidence, right? And even then, the trials I’m presenting, the research I’m presenting to you from our work is still small sample sizes, but they were still utilizing telehealth. And so how we do it is we go, okay, we’re going to use telehealth, we’re going to do a small sample size now just to see if it works, and then we’re going to go big in the future. And so currently we have a large grant that’s pending review by the National Institutes of Health. And then in that one, we’re actually going to start providing more confirmatory evidence that, for example, the virtual reality exercise can improve cardiometabolic health specifically. 

But, I will say that one cool thing we have tested, and it’s another telehealth intervention, is a vigorous intensity virtual reality exercise program. So, we did do that moderate intensity one that I was talking about, but this next telehealth one we did, and that was through the University of Alabama at Birmingham, CEDHARS center, which is the Center for Engagement in Disability Health and Rehabilitation Sciences, we had a small grant there to do a vigorous intensity program. So basically, we said earlier that, hey, we got them doing moderate intensity, and we saw some beneficial signals to health. But now, what if we really push just four kids, but push them through the most vigorous program possible? 

So, what is possible for kids with mobility disabilities, and we’re talking various kids, we had a kid who could walk, we had a kid who was sitting, and we had a kid who used a manual wheelchair and a kid who used a power wheelchair, for example. And so what we found is that we pushed these kids to the maximum. Their goal was to get 150 minutes of vigorous intensity. We’re not even talking modern. And if you’re not sure what vigorous intensity is, that is like you are breathing very, very hard. You’re likely heavily sweating, and this is pretty high up there. Your heart is beating pretty rapidly here. If not very rapidly. And we got them to do about an average of, I would just say, 130 minutes on average of vigorous-intensity minutes per week using these headsets and a slightly different program. And it was really great to know that they could do it because that was one of the things we were trying to see. Was it safe? The good news is that no one had an injury, though we did have to worry about shoulder injuries. When you’re using your arms so much and so hard, we did have to watch out for that a little bit, but no one got injured. So that’s good. So likely safe. But the really interesting thing is that it didn’t improve body weight. We’re still analyzing the blood-related health, but it did not improve body weight, which was honestly fascinating to us. I know no other research study out there that has done this much volume of exercise for kids. And I believe they were teenagers, I would say 13 to 21, I believe was the age range. So, youth, I would say around that age range. And I know no other study that put them through this much and this intense exercise. It was a telehealth program done at home. So, we didn’t have to monitor them. It’s very cheap because you don’t need a health professional to watch them every day. So, it’s something you can just give them and do. And it was so interesting that it didn’t improve body weight, even though we likely believe in improved cardiorespiratory fitness, which is fascinating. 

And so what that means is perhaps at least through virtual reality exercise, but I would honestly say through arm exercise, and this is one of the messages I did want to talk about today, is that maybe arm exercise alone, even at the guidelines that are recommended, is not enough to lose body weight. It might be enough to manage body weight, though. What’s interesting is that in another one of our trials, we have another NIH-funded trial, and that one is not virtuality per se, but it’s another telehealth program that’s actually a movement to music program that is near maximal intensity, very high intensity. That one’s really cool because it only takes about like 35 to 40 minutes an entire week, so it’s not a high burden to the family. But that one had really amazing findings. It did improve cardiorespiratory fitness, but it was a smaller sample size, too, though. I should say this was a pilot, so it’s about 40 kids. But what was interesting is that we found that from that one, body weight did not improve statistically for the exercise group, but for the weightless control group, who really didn’t participate in the exercise, while the other group did at that duration or that window, they actually gained weight, the weight list control group by a little bit. Now, I know I should note that that was not statistically significant between groups. What does that mean? It’s just that the difference was not large enough to really say that happened, but it looked like a trend.

And so, what I’m trying to tell you is that exercise alone, at least based off our preliminary research, suggests that arm exercise alone, moderate or maybe even high intensity, alone might not be enough to lose body weight. But on the positive side, it might be enough to help kids manage body weight so that as they age, they’re not gaining weight.

It’s natural for anyone, disability or not, to gain weight as they age throughout their teen years, and particularly in adulthood, after you get out of high school and all that kind of thing, for everyone to gain weight. But for our kiddos with disabilities, unfortunately, the problem my research team is really trying to address is that when kids are kids, as in children up to age 17, they honestly have a really great support system. They’re supported by their school’s physical activity program, which is required by law now, nowadays. They have excellent children’s programs through children’s hospitals and other community programs that are now available, which is fantastic. But as they age into adulthood, the system changes. And a lot of them are thrown into the same general system that all adults are put into. And so, it’s a big shakeup. And so, what we’re trying to do is help develop strategies to get kiddos engaged early so that when they age into adulthood, they don’t have those issues. So, weight prevention and weight management are also crucial. So improving weight, great, and cardiometabolic health, but managing and preventing are also important. And telehealth programs, I do believe, are the key to doing this because, as you know as a parent, it’s hard to find a specialist, an exercise disability specialist, local to your area, I imagine. So, having resources like NCHPAD that are web-based or telehealth professionals to get to you and help you remotely is the way to go when we are in a niche area, I would say. So, telehealth is super important, I believe, for the families, the people, but also for research in general. But you know, I would encourage everyone to seek telehealth opportunities because they do exist. 

Now, for people, you know, I’ve een focused heavily on like telehealth, but for those of you who have great outdoor, in-person, non-home-based methods of exercise, please keep doing those because I don’t want everyone to be in the home if possible. But the reality is for a lot of people, particularly even during, well, particularly during COVID, but even after the COVID-19 pandemic era, a lot of people are still confined to the home or are isolated from their community. And so, really, what I think the main benefit of telehealth is linking those people, not just to health professionals, but to other people in general. And that can be peers of children with disabilities or just peers, adults, whoever. And so, telehealth has fantastic potential for everyone.

Host: 25:25

Byron discussed the biggest challenges and opportunities when using VR and similar technology for disability-inclusive exercise programs.

Dr. Byron Lai: 25:32

Yeah, that’s a good question. No, I would say, you know, I do a lot of virtual reality talks because that is really what’s picked up traction. We do other exercise modalities too, like the movement to music, but for virtual reality specifically, and really every exercise modality, there is no one size fits all. As in, there’s no one exercise method that’s going to work for everybody. That’s the same for the general population as it is for people with disabilities. I, for example, do not like running or cycling. And so, I have to find something that I actually enjoy. And that was a virtual reality exercise for a long, long, long time. I don’t exercise these days, but that’s another question for another day. 

But what specifically are the issues with virtual reality technology? Well, it’s not perfect for everyone. For example, kiddos might require assistance to put on the headset and select the games if they’re not able to navigate like the in-game menus and the controllers very well. But the good news is, there are adaptations that we can do for resolving that. And I don’t really have time to get into the details of all those. But, for example, as one on a tablet, a computer tablet, you can mirror the screen of what the kid sees in the headset. So, we had caregivers or parents, you know, help you can actually launch the game from a tablet, so the kid doesn’t even have to navigate the menus. They can launch the game specifically from the tablet and get going. Now, the use of controllers is required, but also, you know, there is the obvious thing of if you are prone to seizures, which is very common in our groups, you have to watch out for what games you play. That’s probably, you know, virtuality gaming is probably not the best way, if that is a major concern, right? We don’t want to trigger any seizures, of course, but obviously, complete blindness is not going to work as well. So, it’s not the perfect solution. There are populations it will not work for, and some kids just don’t like video games, and some kids just don’t like putting something on their face, and we’ve had several cases of that happening. 

And so, it’s not perfect, but for the kids for whom it does work for, and to be honest with you, there are a lot of kids who play games these days, whether it be on your phone or computer, or a gaming console. And so, what we found is that you know, largely kids, you know, pick up on it very well, and honestly, they pick up the headset and use it better than a lot of adults that we’ve worked with. So, it works, and it doesn’t. But I could say that for any modality, really, but specifically for VR, there are issues.

Host: 28:14

For many participants, VR exercise is the first time they’ve ever experienced a true workout. Byron describes the moments that have stayed with him the most as a researcher.

Dr. Byron Lai: 28:24

For me, I think of research differently from most others. I like to view research, at least the exercise research we do, as service, not research. And what I mean by that is we’re not just doing a program to find something, publish a paper on it — that not many people will see — pat ourselves on the back, and call it a day. No, we’re really trying to develop things that work and can readily work in the community and that anyone can replicate. So, all the programs we create are low-cost, things that even other researchers can straight copy us and do. I don’t want to say steal, but they could literally just go out there and copy us and compete with us. And I’m a-okay with that because that just means that people will get it faster. 

And so, what really is the most rewarding to me is the connection between the families. When we have a family, and I really mean the child and a caregiver, you know, a participant in one of our studies, we build a bond with them. And I would like to say a friendship. And we’ve contacted, we have several, I would say repeat “customers”, not customers obviously, but we have several people who have been with us for like five years because they know we’re there for them. We’re just trying to help. We pay them to help us test these programs, and we’re really trying to help them when we do it. So, when we’re interacting with the family, we’re not treating them as subjects, right? It’s like participation with them, and we’re trying to provide them with a service, but that’s rewarding in itself, the bond we create with these kids and families as we grow. We’ve seen some kids go from being actual children to teenagers and a lot of teenagers to adults. So it’s really exciting to see them grow, and that is rewarding. But again, one of the biggest things is that notion we talked about before, where gosh, a lot of these kids have never done it before, and to make them feel different about exercise. 

So, for example, if I lost my job tomorrow, and that’s very likely in research, if you’re not aware of that, we have to keep getting grant funding to keep a job when you’re in full-time research. And so if I lost my job tomorrow, I would leave happy knowing we’ve helped in those NIH-funded clinical trials, so government-funded clinical trials, about 75 to 80 kids we’ve worked with total. Just among those two trials alone, and we’ve had several other clinical trials through a variety of grants. And just from those two alone, I could retire happy and go, we’ve helped with some kids, and we’ve worked with them, and we made them feel different about exercise and feel better about themself. I can die happy. 

Now, there’s a lot more work to be done, so I’m not saying I’m retiring or ready for that, but know that I will retire happy when there are several options that kids, children, and youth can choose from to improve their health, and there’s strong enough evidence that their doctor can go, “You can lose weight and you can improve your blood glucose, your blood sugar, your triglycerides, your cholesterol from doing this or this or this. You have multiple options, and you can do that at home very easily. Now, if you want to do these outdoor options, we have that too.” We have to start somewhere, though, so we’re first developing telehealth, kind of home-based. But know that, you know, outdoor, indoor, everything’s good. But when they have several, and I mean several, evidenced options that we know are “proven” to work, I will retire happy. That’s been our focus recently. And telehealth is a big component of that because it allows us to help people nationally, not just local to our state.

Host: 32:19

Here’s Byron discussing the benefits of assisted exercises and the research needed.

Dr. Byron Lai: 32:24

Now, I wanted to make sure. So, as a scientist, it’s very easy to critique things, and when I’m criticizing literature, as in, I’m saying things don’t work here and there, and it’s a lot of negativity. But I really want to emphasize positivity and that, wow, there is so much research alone in the past 10 years. So, this field is very new, exercise research for people with disabilities. 30 years ago, clinicians would think exercise was generally not safe for people with disabilities. Actually, maybe 40 years ago now, time flies. But essentially nowadays we know, and I can tell you for a fact that exercise, high intensity, low intensity, moderate intensity is safe for everyone with disabilities, not just kids, but children, youth, and adults with disabilities, as long as they’re healthy, as in they don’t have like a heart condition that prevents them from exercise, just like the general population would. 

So, what I’m saying is, and this is based upon the reviews I’ve been a part of, that I have found in all the published literature, no serious adverse event. And that’s scientifically, lingo for no serious bad thing that’s happened from participation in an exercise program. As far as I know, no one has, for example, passed away from participating in an exercise program at all, from all the literature I’ve seen. Okay, and that should be amazing because we’re talking 40, maybe 40 plus years of research. So know that exercise is safe, assuming other conditions that might prevent you from participating don’t. And so positive in that regard, and alone in the past 10 years, there have been more randomized controlled trials, and that’s just a fancy term for stronger research interventions where we develop these new kinds of programs that do work, than alone in the 30 years prior to it. And so, research in this area is growing exponentially. So, hopefully, if you’re listening and you’re a parent, know that by the time you hear another one of these talks, I will or we will be able to come to you and say, “Hey, we have two programs now we know will work to manage body weight, reduce body weight, and improve your blood-related health.” Like that’s hopefully what will happen a few years from now. 

But for practical recommendations, I would say for aerobic exercise — we’re not talking strength exercise — I would say anyone can do strength exercise, assuming you’re with an adapted exercise professional who can help modify the exercise for you. Aerobic exercise, that’s one that’s harder. But I would say it’s very simple. Really, aerobic exercise is simple if you know the physiology behind it. It’s really just you’re trying to get muscles to repeatedly contract and consistently contract for a long period of time, a repeated number of times. And so, for example, our movement to music program that seemed to work, I don’t want to say did work because it was a small sample size, but that seemed to work was really simple movements. It was repetitive punching as hard and as fast as they could. Now, that was a maximal intensity program, so it’s a little more complicated than that. But the activities were simple. It was punching, it was fake box breaking, like punching in the air like you’re breaking Mario box coins, which the kids loved. It was a fake example of an exercise. We did web shooting like Spider-Man, where they’re just reaching forward and back. So simple, repetitive punching, reaching forward and back, arm circles, shoulder circles. Those simple movements done repetitively can be exercise. And those are aerobic exercises. That’s essentially what we did. Very simple movements. We didn’t use some fancy piece of equipment.

So, what I’m trying to tell you as a parent, as a child, is keep moving. Okay, it doesn’t have to be fancy. Don’t be disheartened because the exercise fitness facility near you doesn’t have options that you find suitable. Create your own at home. Repetitive movement while you’re watching that TV show that you binge all the time, or you’re going to binge all the time. Maybe move your arms while you’re watching, right? Punch along with something that you’re doing. But every little bit counts. And for aerobic exercise, it’s really about repeating that for a long enough duration. I would say you don’t have to do 150 minutes. I’ve seen in the literature, and we’ve published a review on this in The Lancet, which is a very high-level journal, that we’ve seen for cardiovascular fitness — now we’re talking energy levels, which is far easier to improve than body weight and cardiometabolic health — we’ve seen benefits from as little as 20 minutes a day, three times a week. So that’s one hour of aerobic exercise per week. So, I would say, and I show this to medical residents, that I don’t prescribe to people 150 minutes unless it’s a research program and they’re just starting. I would say as little as 20 minutes three times a week of aerobic exercise. Heck, that could be just like it could be repetitive punching as a gross example, just in a wheelchair, just punching anything, punching air, punching like a bag, a punching bag. It doesn’t have to be punching; it’s just one example. Doing that 20 minutes three times a week, that alone is aerobic exercise, and it could improve your energy levels. So, think simple. Don’t be disheartened because you know the conventional modalities aren’t appropriate. Come up with your own, get resistance bands, and work out something, you know, exciting and fun. Really, that’s what we’re trying to develop in our lab. Fun and engaging ways to do these simple exercises, because we want to keep the exercise simple so everyone can replicate it. We’re not trying to develop something secret here. And so, really, again, repetitive, simple movements, but even starting small is great and likely beneficial based upon research evidence. But then progress, I would say, up to the guidelines, which is 150 minutes a week. We have a research study pending funding from NIH, which is the government, and we’re going to actually try and “prove” that the guidelines do or do not improve blood-related health. To be honest with you, I suspect it doesn’t. As in, you might need to do more than 150, but let’s not worry about that now. We’ll find that out hopefully a few years from now. But for now, start small, build up to the guidelines, which is 150 minutes of modern intensity activity, doing just simple, repetitive tasks, and you’re likely to see benefit.

Host: 39:06

For parents, educators, or practitioners listening, Byron has some key takeaways or practical recommendations to support physical activity for children and youth with disabilities.

Dr. Byron Lai: 39:16

Now, I’ve been focusing a lot on arm exercise for kiddos with mobility disabilities, and that really means kiddos who can’t walk, job, run, or cycle for exercise. Now, if your kid can do all those things, participate in community-based exercise, go for it. Outdoor, group-based, community exercise is the way to go, right? And I’ve already talked a lot about, for example, the kiddos who can do arm exercise, but what I haven’t talked about is even more severe than that, where independent arm exercise is actually not a thing. And so, what’s really interesting is that I think the next step for us in our lab is really developing assisted exercise where the caregiver moves with the kiddo to assist them in the range of motion that’s necessary to get these kinds of exercises. So, know that any kind of movement where they’re assisted, independent, is still beneficial. So, more movement is good. But I should note that the current research evidence is really mostly based on kids who are ambulatory, as in kids, like really the common modality of aerobic exercise that you see that shows benefits, and there are benefits from aerobic exercise that are documented. They really heavily include ambulatory kiddos, doing treadmill walking, community walking, or cycling. And so that’s really why we need more research to figure out ways to get kiddos who can’t really participate fully in those kinds of exercises we just talked about to improve their health.

Host: 40:53

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