Aging, Mental Retardation and With Mental Retardation Physical Fitness by James H. Rimmer, Ph.D., Director, Center on Health Promotion Research for Persons with Disabilities, and Principal Investigator of the Health Promotion Project, RRTC on Aging with Mental Retardation, Institute on Disability and Human Development, University of Illinois at Chicago The purpose of this fact sheet is to What is physical fitness? provide an overview of what physical fitness is and how it relates to older Physical fitness must be defined with people with mental retardation. The consideration for an individuals age and fact sheet will also provide some lifestyle. For a younger person, physical helpful guidelines for family fitness is defined as a physical condition members, support people, service that allows an individual to work without providers, and others interested in becoming overly fatigued, perform daily starting a program for older chores, and have enough energy left over individuals with mental retardation. to engage in leisure activities. For example, if an individual is unable toAging The fitness movement make it through an eight-hour work day or is too tired at the end of the day for The fitness movement in this nation leisure or household activities such as has risen to new heights. People gardening, walking, playing tennis or today are becoming more aware of cleaning, then he or she probably has too the need to participate in regular low a level of physical fitness. For the physical activity. Many Americans older person who may not necessarily be are joining fitness centers or working eight to ten hour days, physical purchasing home exercise fitness could be defined within the context equipment. This remarkable interest of being able to conduct the days chores in fitness stems from several (e.g., cleaning, dressing, shopping, doing research studies that have been laundry, climbing stairs) without becoming published over the last few years exhausted or tired. Stated another way, demonstrating the enormous health the person has enough energy to do daily benefits that can be obtained from a chores, and still has a reserve of energy higher level of fitness. These left over in order to participate in some studies have shown that the risk of type of leisure activity such as gardening health problems and death from or going for a walk. Physical fitness is disease, including heart disease, extremely important for the older cancer, diabetes, and stroke, drops population because as a person ages, as a persons fitness level improves. there is a higher level of fatigue and often pain resulting from arthritis, low back problems, or other ailments. As these conditions worsen over time, many older a national organization on mental retardation Authors note: This Rehabilitation Research and Training information is pertinent to Center on Aging with Mental Retardation many people with other Institute on Disability and Human Development developmental disabilities. University of Illinois at Chicago
people become more sedentary thinking that if To attain a good level of fitness, your physicalthey rest they will get better. On the contrary, fitness routines should focus on each of thesewhen older people rest and become more areas. Each part of physical fitness directlyinactive, they feel increasingly tired because they relates to the health of the individual and to thehave decreased their physical fitness. Thus, it is persons ability to get through the days activitiesa vicious cycle: disability and pain cause without becoming overly fatigued.decreased movement, and decreased movementresults in less fitness and a higher level of Importance of each part of fitness todysfunction. A good physical fitness level aging adultsregardless of the disabilityhelps older peoplemaintain their quality of life and can reduce their The four areas of fitness are all very important todependence on others to help with activities of a healthy lifestyle. In order for the body to movedaily living such as climbing stairs, bathing, and as efficiently as possible, and in order to preventdoing housework. those debilitating hypokinetic diseases, all four parts of fitness must be worked on at least on aThe second part of the definition for physical weekly basis.fitness can apply to both younger and olderindividuals. A moderate to high level of fitness Muscle strength and endurance is needed toreduces the incidence of hypokinetic diseases. complete activities of daily living. For example,Hypokinetic basically means a lack of movement being able to climb stairs, get in and out of aor too little movement. When the body doesnt bathtub or chair without relying too much on themove enough, it slowly deteriorates and arms, open jars, carry groceries, lift boxes, etc.,becomes vulnerable to disease. In essence, a all depend on an adequate level of musclesedentary lifestyle can contribute to or increase strength and endurance. As a person growsthe severity of such problems as hypertension older, strength declines and these tasks become(high blood pressure), obesity (excess fat), adult- more and more difficult. When it gets to the pointonset diabetes, osteoporosis (brittle bones), where the person does not have enough strengthdepression, and low back pain. Individuals who to climb stairs or get out of the bathtub, it oftenare poorly fit often end up with one or more of means that the person will be dependent onthese conditions, which impairs the individuals others for assisting them with their activities ofquality of life. daily living. Some experts believe that muscle strength and endurance is the most importantWhat are the different components of component of physical fitness for older adults.physical fitness? Research has shown that there is a significant loss in muscle strength starting at age 45 andThere are four parts to physical fitness: continuing up to age 65, and a further decline in the seventh and eighth decades of life. The lossl Muscle strength and endurance in strength is greater in men than women.l Flexibilityl Body composition (body fat)l Cardiovascular endurance (the ability of the heart, lungs and blood vessels to transport oxygen to working muscles) 2
Cardiovascular endurance keeps the heavy sandbags in your car. The extra weightcirculatory systemthe heart, blood vessels and puts more stress on the engine and causes alungsin good condition. The number one quicker deterioration. Just look around you.cause of death in this country is from heart There are not too many heavy people living intodisease. Research has shown that by their 80s and 90s. Most of the very old, includingmaintaining good cardiovascular endurance those over 100 years, are lean, and in somethroughout life, you can drastically decrease your cases, just plain skinny! When body fat levelschances of having a heart attack, stroke and are very high (which is called obesity ormany other diseases. Good cardiovascular overweight), a person is at greater risk for aendurance also allows people to have lots of variety of health problems, including arthritis,energy during the day, so that they dont become diabetes, depression, back pain, heart disease,fatigued from doing household activities or other stroke, and high blood pressure. Bodyphysical tasks such as climbing stairs or walking. composition has a lot to do with the amount of activity that you get during the day, as well as theFlexibility involves the stretching of connective type and amount of food you eat.tissues in our body, which includes the muscles,tendons and ligaments. Most older adults Do people with mental retardation havebecome very inflexible as they grow older, partly problems in these areas?due to a lack of physical activity. When musclesare not moved for a long period of time, they Yes. Research indicates that people with mentalgradually shorten to a point where it becomes retardation have very low levels of cardiovasculardifficult to reach for things or bend over to pick endurance. A lack of cardiovascular endurancesomething up from the floor. The older a person often means the individual is unable to sustaingets, the tighter his or her muscles become. long workdays or participate in leisure-timeFlexibility is often neglected in a fitness program. activities (e.g., hiking, swimming, biking) withoutMost people prefer to spend their time doing becoming fatigued. A poor cardiovascular fitnesscardiovascular activities such as riding a level also translates into a higher risk of disabilitystationary bike or walking. However, as a person and death.grows older, flexibility exercises becomeextremely important for preventing tightness in The strength levels of adults with mentalthe joints and muscles. retardation have also been shown to be very poor. Most studies have indicated that becauseBody composition is the fourth part of fitness of a lack of strength at such an early age, it willand has to do with the amount of fat that you be very difficult for people at 50 or 60 years ofstore in your body. There are numerous age to perform activities of daily living that requireresearch studies that have shown that the more a minimal level of strength. These includebody fat you have the worse your fitness and the climbing stairs, getting up from a chair or thequicker your body will age. This is because body floor, or carrying objects such as a tray filled withfat is dead weight and takes a heavy toll on all food.the systems of the body (e.g., bones, joints,heart, lungs) over time. Its sort of like carrying 3
Perhaps the most disturbing findings pertain to What happens to the body as we age?the fitness levels of adults with mental retardationin regard to their body fat levels. Whereas a third The body goes through several changes as weof all Americans are overweight, close to one-half age. First, there is a loss in muscle tissue and aof all people with mental retardation are gain in fat tissue. Unfortunately, this is aoverweight. When we separate women from negative change because fat does not perform amen, we find that many more women with mental function like your muscles which contract in orderretardation are overweight compared to men with to move the body. Therefore, fat just adds to ourmental retardation. The high levels of obesity body weight, making it more difficult to move.(excess fat) found in people with mentalretardation expose them to a higher risk for many Bones start to lose their mineral content (calciumdifferent types of diseases that are associated and phosphorus) as we grow older. This leadswith high levels of body fat. These include Type II to one of the biggest health problems in thediabetes, hypertension, heart disease, stroke, elderly, osteoporosis. Osteoporosis causesarthritis, respiratory diseases, and cancer. compression fractures, which are small cracks in the bones. This usually occurs in three areas:What are the fitness levels of older the hips, vertebrae (bones in the back) and wrist.adults with mental retardation? When osteoporosis gets progressively worse, a hip fracture can occur.Although there havent been any studiescompleted on aging adults with mental Our cardiovascular system, consisting of theretardation, the research on younger adults with lungs, heart and blood vessels, takes a heavymental retardation has shown that as a group, toll as we grow older. A great deal of thethey have very poor fitness levels. To be quite deterioration to the cardiovascular system has tofrank, the fitness levels of adults with mental do with lifestyle. There is an accumulation ofretardation, in general, are terrible. So, as plaque (calcium, cholesterol, fats) inside theyounger people with mental retardation age, their blood vessels which over time can lead to ageneral lack of physical fitness on top of health blockage or a ruptured artery. When this occurs,problems that older people generally face a person will sustain a heart attack or stroke.increases the likelihood that many will have health The number one cause of death in this country isproblems beyond those of their nondisabled due to cardiovascular disease.peers. The last thing that slowly starts to deteriorate isResearch (Rimmer, 1994) has noted that adults the central nervous system. Our reflexes andwith mental retardation are at risk for all kinds of reactions become slower, and we lose speed inhypokinetic diseases that result from physical doing things that require agility. Catchinginactivity. One researcher went as far as saying ourselves from a slip or fall becomes morethat people with mental retardation are a difficult.population at risk because of their sedentarylifestyle (Petetti and Campbell, 1991). 4
Should older people with mental What are the steps to becoming more fitretardation become more active? for the aging adult with mental retardation?Yes. People with mental retardation who lackphysical fitness are more likely to incur other Here is a list of recommended steps for starting adisabling conditions as they age. It is important structured exercise program for an aging adultfor these individuals to start to look for with mental retardation.opportunities to increase their physical activity.Health care providers, staff and family members Step 1 - Get Physician Approval to Start anshould also take an active role in supporting Exercise Programphysical fitness in the aging adult with mentalretardation. For example, physical fitness could Because of the high risk of injury in starting anbe included as part of an individuals habilitation exercise program for an older adult who hasplan. been inactive for much of his or her life, it is important that the person have a physical toResearch has shown that even the frail elderly, make sure that it is safe to begin an exercisewhich includes people in their 80s or 90s, can program. Even though a person may have highimprove their fitness level. One study blood pressure, arthritis, and obesity, an exercisedocumented large increases in strength and program can and should be started. Afunction after a weight-training program in 90- precaution is that the physician gives his or heryear old people living in a Boston area nursing approval before starting the exercise program.home. Other studies have shown significantincreases in cardiovascular endurance after Step 2 - Increase Physical Activityperforming an exercise program that involved Throughout the Daylarge muscle groups. We often fail to realize that increasing physicalClearly, one of the best ways to get an older activity levels throughout the day can expend aperson with mental retardation involved in larger number of calories. This is especiallyphysical activity would be to join a structured important for individuals who wont or do not wantexercise program. This would help maintain to participate in a structured physical fitnessregularity to the program, and keep the person program. Some helpful tips include the following:on a consistent schedule. So often exerciseprograms are started only to be stopped a short l Get rid of the remote control and get up andwhile after they begin. A structured program down when changing television channels.offers the consistency that so many individuals l Use weights (e.g., milk jugs filled with water) toneed in order to continue exercising. lift and lower several times a day to build strength and flexibility.For more information on fitness programs,contact your local YMCA/YWCA, senior center or l Use stairs instead of the elevator, especiallyprivate fitness center in your community. when only going up or down one or two floors. l While watching television, perform stretching exercises during commercials. 5
l Go for short five to ten minute walks two to discriminate against persons with disabilities. If three times a day and work toward increasing the program doesnt fit the needs of the client, pace and duration to benefit cardiovascular then its the responsibility of the director to endurance. develop a program that does fit the individuals needs. Never take no for an answer. Therel While lying in bed, lift and lower each leg are professionals in adapted physical education several times and then lift and lower each arm or exercise physiology who have a background in several times. developing exercise programs for people withl Stand against a wall with arms outstretched mental retardation. If the YMCA/YWCA or fitness and palms flat against the wall. Bend elbows director does not have the expertise to meet the and bring face close to the wall and then needs of the consumer, then point them to local extend arms again. This is called a wall push- adapted physical education instructors located in up. public schools or other experts that can help them develop the program.l Shoot a basketball, play catch, go ice-skating and participate in other informal sports and Step 4 - Exercise a Minimum of Three Days a physical activities. Weekl Get involved in community recreation and Once you select the right setting for your exercise formal sports programs during the year, such program, its important to exercise at least three as senior arthritis exercise classes offered by days a week. The exercise program should the YMCA/YWCA, low impact aerobic dance, consist of the following components: yoga classes, swimming or Special Olympics cardiovascular endurance, muscle strength and Internationals Unified Sports® programs. endurance, and flexibility. Each of these components should be developed, but moreStep 3 - Choose the Right Exercise Program emphasis should be placed on the weakest areas of fitness. For example, if a person has very lowThere are a variety of exercise programs that are levels of arm muscle strength and poor flexibilityoffered in most communities. It is important to in the hamstrings, then that person should spendselect one that fits the specific needs of the a little more time during each exercise sessionindividual. Most YMCA/YWCAs offer exercise working on those areas by perhaps lifting lightclasses for older adults and so do senior centers. weights or stretching the hamstrings. However,However, these classes are often very structured its important to work on all areas of fitness, soand may not fit the needs of some older adults the person would also want to includewith mental retardation. Ask the director of the cardiovascular exercise during each session,program if there is a slower moving aerobic perhaps by riding a stationary bike or using adance class, or if a weight training program could treadmill. Try to also add some extra activity onbe adapted for a group of older adults living in the days when the person does not go to aone setting (e.g., group home). It is important structured fitness program. For example, gothat directors of fitness centers understand that hiking, swimming, bike riding or participate inthey cannot intentionally or unintentionally various sports. (Note: There are adult-size tricycles for people unable to ride a bicycle.) 6
Step 5 - Keep the Program Fun and APAC is a council within AAALF, a division ofRewarding AAHPERD. APAC can be contacted at the address, telephone or e-mail address above, and is theThe exercise program must be enjoyable if the primary contact for information on physical fitness and people with mental retardation. APAC canperson is going to continue with the program for provide materials pertaining to adapted physicalany length of time. If you notice that the person fitness education.is getting tired of doing the same exercises, askthe fitness instructor to create a new program Special Olympics International (SOI)using different types of equipment and exercises. Unified Sports®Sometimes fitness instructors get locked into the 1325 G Street, N.W., Suite 500same exercise routines and the person gets Washington, DC 20005-3104bored and drops out. There are lots of different (202) 628-3630ways to develop each area of fitness and a SOIs Unified Sports® program brings athletes ofcreative instructor can keep people interested in similar abilitiy, with and without mental retardation,the program. For example, a before and after together on the same teams.photograph of the person can be taken to helphim or her see the progress being made in Eichstaedt, C. B., & Lavay, B. W. (1992). Physicalweight loss, improved posture and increased activity for individuals with mental retardation.muscle gain. A good fitness instructor will also Champaign, Illinois: Human Kinetics Publishers.notice early signs of burnout or boredom and will (800) 747-5698modify the program before the person drops out. Rimmer, J. H. (1994). Fitness and rehabilitation programs for special populations. WCB McGraw-Hill.Professional Associations and (800) 338-3987Resources Sherrill, C. (1998). Adapted physical activity,National Consortium for Physical Education and recreation and sport. WCB McGraw-Hill.Recreation for Individuals with Disabilities (800) 338-3987Adapted Physical Education National StandardsP. O. Box 6639 Winnick, J. P. (1995). Adapted physical educationCharlottesville, Va. 22906-6639 and sport. Champaign, Illinois: Human Kinetics(888) APENS-EX Publishers. (800) 747-5698The Consortium can provide technical supportconcerning adapted physical education. References Pitetti, K.H. & Campbell, K.D. (1991). MentallyAmerican Alliance for Health, Physical Education, retarded individuals: A population at risk? MedicineRecreation, and Dance (AAHPERD) and Science in Sports and Exercise: 23, 586-593.American Association for Active Lifestyles andFitness (AAALF) Rimmer, J. H. (1994). Fitness and rehabilitationAdapted Physical Activity Council (APAC) programs for special populations. Dubuque, Iowa:1900 Association Drive WCB McGraw-Hill. (800) 338-3987Reston, Va. 22091(703) 476-3430; email@example.com (e-mail) 7
The Center on Health Promotion Important Information Research for Persons with Disabilities Many people use a fitness center or exercise Located in the Institute on Disability and program to keep fit. If you are assisting a relative Human Development at the University of or friend with mental retardation, keep these Illinois at Chicago, the Center has recently questions in mind to help locate the most been funded by the Centers for Disease appropriate program. Control and Prevention (CDC) to establish a health promotion program for persons 1. Is the center or program aware of how to with disabilities. Principal investigator of accommodate people with disabilities under the project is James H. Rimmer, Ph.D, and the Americans with Disabilities Act? co-principal investigator is Glenn Hedman, 2. Does it have anyone on staff who has a M.Eng. Secondary health conditions will background in working with people who have be studied including lack of fitness, disabilities? obesity, poor nutrition, emotional 3. Does it have accessible equipment? dependence, depression, behavioral problems and family stress. The 4. Does it offer individualized training sessions at intervention component will be comprised no extra cost or at a minimal cost? of exercise sessions, nutritional training, 5. Would it be willing to send one of its instructors cooking instruction, weight management, to a training course or workshop on learning stress reduction, and peer support. The more about fitness and disability? Center will begin operation in January 1998 and will include a collaborative 6. Do instructors have any training in project with the RRTC on Aging with rehabilitation, adapted physical education or Mental Retardation. For more information, exercise physiology for special populations? contact Dr. Rimmer at the address, 7. Do instructors have a positive attitude toward telephone number or e-mail listed below. working with people who have disabilities? Are they open to learning more about a disability? Author: 8. Do instructors put the individual through an James H. Rimmer, Ph.D., is Director of the Center assessment to determine the specific on Health Promotion Research for Persons strengths and weaknesses of the person in the with Disabilities, Institute on Disability and Human area of fitness? Development, University of Illinois at Chicago. Dr. Rimmer can be contacted at: 9. Do instructors change the program periodically (312) 413-9651 (voice), (312) 413-3709 (fax), to prevent boredom or burnout? (312) 413-0453 (TDD) or firstname.lastname@example.org (e-mail). November 1997 The Arc of the United States RRTC on Aging with Mental Retardation 500 E. Border St., S-300 Institute on Disability and Human Development Arlington, Texas 76010 University of Illinois at Chicago 817/261-6003, 817/277-0553 (TDD) 1640 West Roosevelt Road, Chicago, Illinois 60608-6904 email@example.com (E-mail) 1-800-996-8845 (V), 1-800-526-0844 (Illinois Relay Access) http://TheArc.org/welcome.html (WWW) http://www.uic.edu/orgs/rr tcamr/index.html (WW W)The Rehabilitation Research and Training Center (RRTC) on Aging with Mental Retardation is funded by the National Institute on Disability andRehabilitation Research of the U.S. Department of Education, grant #H133B0069. The opinions in this publication are those of the grantee anddo not necessarily reflect those of the U.S. Department of Education.