Aging, Mental Retardation and Physical Fitness

1. 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 individual’s 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 to
Aging
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 day’s 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 person’s 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
Author's 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

2. people become more sedentary thinking that if To attain a good level of fitness, your physical
they rest they will get better. On the contrary, fitness routines should focus on each of these
when older people rest and become more areas. Each part of physical fitness directly
inactive, they feel increasingly tired because they relates to the health of the individual and to the
have decreased their physical fitness. Thus, it is person’s ability to get through the day’s activities
a vicious cycle: disability and pain cause without becoming overly fatigued.
decreased movement, and decreased movement
results in less fitness and a higher level of Importance of each part of fitness to
dysfunction. A good physical fitness level— aging adults
regardless of the disability—helps older people
maintain their quality of life and can reduce their The four areas of fitness are all very important to
dependence on others to help with activities of a healthy lifestyle. In order for the body to move
daily living such as climbing stairs, bathing, and as efficiently as possible, and in order to prevent
doing housework. those debilitating hypokinetic diseases, all four
parts of fitness must be worked on at least on a
The second part of the definition for physical weekly basis.
fitness can apply to both younger and older
individuals. A moderate to high level of fitness Muscle strength and endurance is needed to
reduces 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 a
or too little movement. When the body doesn’t bathtub or chair without relying too much on the
move 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 muscle
sedentary lifestyle can contribute to or increase strength and endurance. As a person grows
the 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 point
onset diabetes, osteoporosis (brittle bones), where the person does not have enough strength
depression, and low back pain. Individuals who to climb stairs or get out of the bathtub, it often
are poorly fit often end up with one or more of means that the person will be dependent on
these conditions, which impairs the individual’s others for assisting them with their activities of
quality of life. daily living. Some experts believe that muscle
strength and endurance is the most important
What 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 and
There are four parts to physical fitness: continuing up to age 65, and a further decline in
the seventh and eighth decades of life. The loss
l Muscle strength and endurance in strength is greater in men than women.
l Flexibility
l Body composition (body fat)
l Cardiovascular endurance (the ability of the
heart, lungs and blood vessels to transport
oxygen to working muscles)
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3. Cardiovascular endurance keeps the heavy sandbags in your car. The extra weight
circulatory system—the heart, blood vessels and puts more stress on the engine and causes a
lungs—in 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 into
disease. Research has shown that by their 80s and 90s. Most of the very old, including
maintaining good cardiovascular endurance those over 100 years, are lean, and in some
throughout life, you can drastically decrease your cases, just plain skinny! When body fat levels
chances of having a heart attack, stroke and are very high (which is called obesity or
many other diseases. Good cardiovascular overweight), a person is at greater risk for a
endurance also allows people to have lots of variety of health problems, including arthritis,
energy during the day, so that they don’t become diabetes, depression, back pain, heart disease,
fatigued from doing household activities or other stroke, and high blood pressure. Body
physical 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 the
Flexibility 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 have
become very inflexible as they grow older, partly problems in these areas?
due to a lack of physical activity. When muscles
are not moved for a long period of time, they Yes. Research indicates that people with mental
gradually shorten to a point where it becomes retardation have very low levels of cardiovascular
difficult to reach for things or bend over to pick endurance. A lack of cardiovascular endurance
something up from the floor. The older a person often means the individual is unable to sustain
gets, the tighter his or her muscles become. long workdays or participate in leisure-time
Flexibility is often neglected in a fitness program. activities (e.g., hiking, swimming, biking) without
Most people prefer to spend their time doing becoming fatigued. A poor cardiovascular fitness
cardiovascular activities such as riding a level also translates into a higher risk of disability
stationary bike or walking. However, as a person and death.
grows older, flexibility exercises become
extremely important for preventing tightness in The strength levels of adults with mental
the joints and muscles. retardation have also been shown to be very
poor. Most studies have indicated that because
Body composition is the fourth part of fitness of a lack of strength at such an early age, it will
and has to do with the amount of fat that you be very difficult for people at 50 or 60 years of
store in your body. There are numerous age to perform activities of daily living that require
research studies that have shown that the more a minimal level of strength. These include
body fat you have the worse your fitness and the climbing stairs, getting up from a chair or the
quicker your body will age. This is because body floor, or carrying objects such as a tray filled with
fat is “dead weight” and takes a heavy toll on all food.
the systems of the body (e.g., bones, joints,
heart, lungs) over time. It’s sort of like carrying
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4. Perhaps the most disturbing findings pertain to What happens to the body as we age?
the fitness levels of adults with mental retardation
in regard to their body fat levels. Whereas a third The body goes through several changes as we
of all Americans are overweight, close to one-half age. First, there is a loss in muscle tissue and a
of all people with mental retardation are gain in fat tissue. Unfortunately, this is a
overweight. When we separate women from negative change because fat does not perform a
men, we find that many more women with mental function like your muscles which contract in order
retardation are overweight compared to men with to move the body. Therefore, fat just adds to our
mental retardation. The high levels of obesity body weight, making it more difficult to move.
(excess fat) found in people with mental
retardation expose them to a higher risk for many Bones start to lose their mineral content (calcium
different types of diseases that are associated and phosphorus) as we grow older. This leads
with high levels of body fat. These include Type II to one of the biggest health problems in the
diabetes, hypertension, heart disease, stroke, elderly, osteoporosis. Osteoporosis causes
arthritis, 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 haven’t been any studies
completed on aging adults with mental Our cardiovascular system, consisting of the
retardation, the research on younger adults with lungs, heart and blood vessels, takes a heavy
mental retardation has shown that as a group, toll as we grow older. A great deal of the
they have very poor fitness levels. To be quite deterioration to the cardiovascular system has to
frank, the fitness levels of adults with mental do with lifestyle. There is an accumulation of
retardation, in general, are terrible. So, as plaque (calcium, cholesterol, fats) inside the
younger people with mental retardation age, their blood vessels which over time can lead to a
general 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 is
problems beyond those of their nondisabled due to cardiovascular disease.
peers.
The last thing that slowly starts to deteriorate is
Research (Rimmer, 1994) has noted that adults the central nervous system. Our reflexes and
with mental retardation are at risk for all kinds of reactions become slower, and we lose speed in
hypokinetic diseases that result from physical doing things that require agility. Catching
inactivity. One researcher went as far as saying ourselves from a slip or fall becomes more
that people with mental retardation are a difficult.
“population at risk” because of their sedentary
lifestyle (Petetti and Campbell, 1991).
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5. Should older people with mental What are the steps to becoming more fit
retardation become more active? for the aging adult with mental
retardation?
Yes. People with mental retardation who lack
physical fitness are more likely to incur other Here is a list of recommended steps for starting a
disabling conditions as they age. It is important structured exercise program for an aging adult
for 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 an
should also take an active role in supporting Exercise Program
physical fitness in the aging adult with mental
retardation. For example, physical fitness could Because of the high risk of injury in starting an
be included as part of an individual's habilitation exercise program for an older adult who has
plan. been inactive for much of his or her life, it is
important that the person have a physical to
Research has shown that even the frail elderly, make sure that it is safe to begin an exercise
which includes people in their 80s or 90s, can program. Even though a person may have high
improve their fitness level. One study blood pressure, arthritis, and obesity, an exercise
documented large increases in strength and program can and should be started. A
function after a weight-training program in 90- precaution is that the physician gives his or her
year old people living in a Boston area nursing approval before starting the exercise program.
home. Other studies have shown significant
increases in cardiovascular endurance after Step 2 - Increase Physical Activity
performing an exercise program that involved Throughout the Day
large muscle groups.
We often fail to realize that increasing physical
Clearly, one of the best ways to get an older activity levels throughout the day can expend a
person with mental retardation involved in larger number of calories. This is especially
physical activity would be to join a structured important for individuals who won't or do not want
exercise program. This would help maintain to participate in a structured physical fitness
regularity to the program, and keep the person program. Some helpful tips include the following:
on a consistent schedule. So often exercise
programs are started only to be stopped a short l Get rid of the remote control and get up and
while 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) to
need 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, especially
private fitness center in your community. when only going up or down one or two floors.
l While watching television, perform stretching
exercises during commercials.
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6. 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 doesn’t fit the needs of the client,
pace and duration to benefit cardiovascular then it’s the responsibility of the director to
endurance. develop a program that does fit the individual’s
needs. Never take “no” for an answer. There
l 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 with
l 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. Week
l Get involved in community recreation and
Once you select the right setting for your exercise
formal sports programs during the year, such
program, it’s 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
International's Unified Sports® programs.
endurance, and flexibility. Each of these
components should be developed, but more
Step 3 - Choose the Right Exercise Program
emphasis should be placed on the weakest areas
of fitness. For example, if a person has very low
There are a variety of exercise programs that are
levels of arm muscle strength and poor flexibility
offered in most communities. It is important to
in the hamstrings, then that person should spend
select one that fits the specific needs of the
a little more time during each exercise session
individual. Most YMCA/YWCAs offer exercise
working on those areas by perhaps lifting light
classes for older adults and so do senior centers.
weights or stretching the hamstrings. However,
However, these classes are often very structured
it’s important to work on all areas of fitness, so
and may not fit the needs of some older adults
the person would also want to include
with 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 a
dance class, or if a weight training program could
treadmill. Try to also add some extra activity on
be adapted for a group of older adults living in
the days when the person does not go to a
one setting (e.g., group home). It is important
structured fitness program. For example, go
that directors of fitness centers understand that
hiking, swimming, bike riding or participate in
they cannot intentionally or unintentionally
various sports. (Note: There are adult-size
tricycles for people unable to ride a bicycle.)
6

7. Step 5 - Keep the Program Fun and APAC is a council within AAALF, a division of
Rewarding AAHPERD. APAC can be contacted at the address,
telephone or e-mail address above, and is the
The exercise program must be enjoyable if the primary contact for information on physical fitness
and people with mental retardation. APAC can
person is going to continue with the program for provide materials pertaining to adapted physical
any length of time. If you notice that the person fitness education.
is getting tired of doing the same exercises, ask
the 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 500
same exercise routines and the person gets Washington, DC 20005-3104
bored and drops out. There are lots of different (202) 628-3630
ways to develop each area of fitness and a SOI's Unified Sports® program brings athletes of
creative 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 help
him or her see the progress being made in Eichstaedt, C. B., & Lavay, B. W. (1992). Physical
weight 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) 747-5698
modify 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) 338-3987
Resources
Sherrill, C. (1998). Adapted physical activity,
National Consortium for Physical Education and
recreation and sport. WCB McGraw-Hill.
Recreation for Individuals with Disabilities
(800) 338-3987
Adapted Physical Education National Standards
P. O. Box 6639
Winnick, J. P. (1995). Adapted physical education
Charlottesville, Va. 22906-6639
and sport. Champaign, Illinois: Human Kinetics
(888) APENS-EX
Publishers. (800) 747-5698
The Consortium can provide technical support
concerning adapted physical education. References
Pitetti, K.H. & Campbell, K.D. (1991). Mentally
American Alliance for Health, Physical Education,
retarded individuals: A population at risk? Medicine
Recreation, and Dance (AAHPERD)
and Science in Sports and Exercise: 23, 586-593.
American Association for Active Lifestyles and
Fitness (AAALF)
Rimmer, J. H. (1994). Fitness and rehabilitation
Adapted Physical Activity Council (APAC)
programs for special populations. Dubuque, Iowa:
1900 Association Drive
WCB McGraw-Hill. (800) 338-3987
Reston, Va. 22091
(703) 476-3430; aaalf@aahperd.org (e-mail)
7

8. 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 jrimmer@niu.edu (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
thearc@metronet.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 and
Rehabilitation Research of the U.S. Department of Education, grant #H133B0069. The opinions in this publication are those of the grantee and
do not necessarily reflect those of the U.S. Department of Education.