The Carrus Institute for Families The Center for Discovery The Janet and Gerald Carrus Institute for Families Physical Activity and Nutrition for Adults

The Carrus Institute for Families

The Center for Discovery

The Janet and Gerald Carrus Institute for Families

Physical Activity and Nutrition for Adults Aging with Multiple Disabilities

The Center for Discovery is remarkable for its more than 60 years of service to children and adults with severe disabilities. The Center offers educational,

clinical/health, residential, family supports in addition to other programs and services. The Center features universally designed facilities specifically built to meet

the physical, intellectual, emotional, social, and creative needs of children and adults it serves.

National Center on Physical Activity and Disability (NCPAD)


The University of Illinois at Chicago (UIC), through its Department of Disability and Human Development and in collaboration with several major organizations in physical activity, rehabilitation and disability, operates the National Center on Physical Activity and Disability (NCPAD). The primary focus of NCPAD is to improve the health, wellness, and quality of life of people with disabilities by promoting and facilitating increased participation in physical activity and recreation. NCPAD is a proven and effective online health promotion resource center supplemented by personalized services fully accessible to people with disabilities.

The mission of the National Center on Physical Activity and Disability (NCPAD) is to promote substantial health benefits that can be gained from participating in regular physical activity. The slogan of NCPAD is Exercise is for EVERY body, and every person can gain some health benefit from being more physically active. This site provides information and resources that can enable people with disabilities to become as physically active as they choose to be.

Current Research


• Rate of obesity (1997-2000) – 34.6% in persons with intellectual disabilities

20.6% in the general population

Among adults with intellectual disabilities living in group homes and family homes- rates are 47.5% and 37.5% respectively (Yamaki, 2005)

• Studies of physical activity of adults with intellectual disabilities found that only

between 17.5% to 33% of these adults engaged in the standard recommended amount of physical activity (Stanish, Temple and Frey, 2006)

• Several studies indicate individuals with intellectual disabilities tend to consume

diets that are high in fat and low in fruit and vegetable intake. Results indicate that only 0 to 6% of residents of group homes consumed the recommended five or more fruits and vegetables per day (Heller, McCubbin, Drum and Peterson, 2011)

Components of Physical Fitness


• There are four main parts to physical fitness:

1. Muscle strength and endurance2. Flexibility3. Body composition (body fat- amount of activity you get, type and amount of

food you eat)4. Cardiovascular endurance (the ability of the heart, lungs and blood vessels to

transport oxygen to working muscles)

• In order for the body to move as efficiently as possible, and in order to prevent debilitating disease, all for parts of fitness must be worked on at least a weekly basis.

(Rimmer, J. RRTC on Aging with Mental Retardation, Institute on Disability and Human Development, The University of Illinois at Chicago)

Pilot Study


• Fourteen adults, ranging in age from 40 to 86, who present with significant multiple disabilities.

• Individuals reside in two Intermediate Care Facilities (ICF’s) and attend a Day Habilitation Program at the Center.

• Multi-Component Program- flexibility, muscle strength and endurance, cardiovascular fitness and a nutrition program that promotes healthy eating with an emphasis on whole foods.

• Pre and post assessment measures- weight, BMI, resting heart rate, goniometric data, satisfaction survey.

• Three physical activity sessions and one nutrition lesson per week.

• Team approach- individuals, recreational therapy, residential and day staff, nursing/clinical staff.

Physical Activity Component


NCPAD team analyzed current participants physical abilities, job expectations, and unique medical circumstances in developing breathing techniques combined with flexibility exercises, strength exercises, and cardiovascular exercise.

•Flexibility- Began with routine relaxation breathing, continuing breathing through an upper body extremity routine.

•Strengthening- Weight training routine

-Individual weights selected based on grasping abilities, and strength capabilities

-Weekly assessments and modifications based on individual achievements

-Adapted exercises for participants based on range of motion.

-Varying expectations for our most medically challenged participants.

•Cardiovascular exercise

-Reck Bike

-Walking

-Dancing

Physical Activity Component


Name:_________________________ Week #___________ Strengthening Session 1 Date: __ Session 2 Date: ___ Session 3 Date: ___ Shoulder press

Number of reps desired ______ Number of reps completed ____ Comments:



Bicep Curls




Tricep Curls




Side raises




Seated Chest Flies to be adapted in seated position




Name:_________________________ Week #___________ Strengthening Session 1 Date: __ Session 2 Date: ___ Session 3 Date: ___ Shoulder press w/ adapted weights




Bicep Curls




Tricep Curls




Side raises




Chest Flies to be adapted in the seated position




Nutrition Component


The Center is home to Thanksgiving Farm – an organic farm that produces a variety of vegetables and pasture raised animal products.

Food at the Center for Discovery:

Whole Foods

Plant Based

Seasonal Menus – local if possible; 3 week cycle

Made from Scratch

Wellness based, counter-cultural food environment – focus on cooking, vegetables, and whole foods with limited exposure to outside processed foods.

Chefs prepare meals daily in home environment to maximize the influence of food in the house: smells, sounds, and resident participation as appropriate.

Nutrition Component


With limited choice for residents, nutrition goals of NCPAD were:

•Bring consciousness to food and making healthy choices when able (dining out)

•Basic nutrition education

•Acceptance of the menu

•Improved weight control was a secondary goal but not expected to change greatly due to length of the program and the Center’s already relatively low rates of obesity.

General Population (CDC 2007/ 2008)

General Disabled Population (Yamaki 2005)

The Center for Discovery (2009)

NCPAD Participants

(2011)

33.8% 47.5%/37.5% 6% 35.7%

Each Week:

•RD to houses for nutrition lesson/ game (Think your Drink; Vegetable Color Cards)

•Focus on healthy eating and identification of vegetables

•Highlight connection to farm: Seed to Belly Initiative

Nutrition Component


Findings:•Remarkable weight loss

12/14 participants lost weight (1 outlier)

Participants lost a total of 63 pounds (avg 4.5 lbs/person)

3% drop in overall body weight; average BMI drop from 28.6 to 27.8

Obesity rate of group now at 14% (3 individuals no longer BMI>30)

•Increased water consumption

•Individual goals attained

Eat breakfast regularly

Increased intake of vegetables

Healthy choices when dining out

Discussions/activities voluntarily focused around nutrition

Implications for future nutrition projects/ goals:

• Targeted intervention for residents for weight control

• Agency wide wellness programming

• Attitude changes toward menu (counter cultural)

• Currently online to target ASD kids and families

• Food and Farm based learning for improved health

Nutrition Component


Other Program Components


• Team names/tee-shirts• Varied music and cardio routines• Personal celebrations/group

celebrations throughout the 14 weeks

Midpoint celebration and awards

Midpoint outing to community restaurant

• Staff training and involvement• Collaboration with Nursing and

participants specific therapists.• Final celebration and presentation

of certificates

Pre, Midpoint, and Post Study Measurements


NCPAD VITAL STATISTIC COMPARISON

Initiation of program Week of 2/ 25/ 2011

Midpoint Week of 4/ 12/ 2011

End of program Week of 5/ 24/ 2011

OTIS ARMSTRONG BP Resting/End/Recovery WT BP Resting/End/Recovery WT BP Resting/End/Recovery WT MA 106/66 ~ N/A ~ N/A ~ N/A WT ~ 131.2 116/60 ~ N/A ~ N/A ~ N/A WT~ 130 100/60 ~ N/A ~ N/A ~ N/A WT ~ 125 SC 126/66 ~ N/A ~ N/A ~ N/A WT ~ 92.8 110/54 ~ N/A ~ N/A ~ N/A WT~ 88.5 98/54 ~ N/A ~ N/A ~ N/A WT~ 95.5 BC 110/70 ~ 97 ~ N/A ~ 113 WT ~ 185.4 100/54 ~ 96 ~ 128 ~ 104 WT~185.2 118/64 ~ 81 ~ 129 ~ 90 WT~ 184 LC 94/60 ~ 94 ~ 108 ~ 93 WT ~ 140.2 110/70 ~ 86 ~ 106 ~ 93 WT~ 136.5 106/60 ~ 88 ~ 105 ~ 95 WT~ 137 DD 104/62 ~ 98 ~ N/A ~ 128 WT ~ 146.8 114/70 ~ 96 ~ 106 ~ 128 WT~ 142.6 108/70 ~ 91 ~ 109 ~ 80 WT ~ 141.8 GK 126/84 ~ 75 ~ 76 ~ 74 WT ~ 141.5 106/64 ~ 100 ~ 120 ~ 110 WT~ 140.5 110/68 ~ 80 ~ 91 ~ 89 WT ~ 135.9 HM 126/64 ~ 66 ~ 72 ~ 71 WT ~ 143 116/60 ~ 73 ~ 79 ~ 70 WT~ 139.5 116/70 ~ 65 ~ 64 ~ 66 WT~ 138 MH 96/50 ~ 86 ~ 89 ~ 86 WT ~ 246 96/50 ~ 89 ~ 85 ~ 80 WT~ 227.5 100/68 ~ 72 ~ 79 ~ 78 WT ~ 230.5 SPRUCE FA 115/83 ~ 73 ~ N/A ~ 100 WT~125.9 123/82 ~ 89 ~ 88 ~ 90 WT~131.8 100/69 ~ 102 ~ 113 ~ 96 WT ~ 125.2 FB 116/90 ~ 94~ N/A ~ 83 WT~129.7 130/88 ~ 86 ~ 104 ~ 103 WT~137.6 126/74 ~ 97 ~ 109 ~ 92 WT~ 134.2 KE 117/75 ~ 73 ~ N/A ~ 83 WT~154.1 114/70 ~ 77 ~ 95 ~ 91 WT~143.4 119/71 ~ 78 ~ 105 ~ 75 WT~ 143 MN 96/64 ~ N/A ~ 77 ~ 56 WT~110.0 90/59 ~ 64 ~ 70 ~ 68 WT~106.3 97/64 ~ 64 ~ 83 ~ 70 WT~ 104.6 KH 112/84 ~ 119 ~ N/A ~ 125 WT~108.9 125/99 ~ 89 ~ 88 ~ 90 WT~108.5 113/84 ~ 93 ~ 103 ~ 96 WT ~106.7 NS 114/69 ~ 101 ~ N/A ~ 105 WT~222.8 141/93 ~ 92 ~ 90 ~ 86 WT~223.6 119/77 ~ 91 ~ 106 ~ 91 WT ~ 222.1

Updated as of 5/25//11

Sample Goniometric Comparison


Shoulder 2/24 Left 4/13 Left 5/31 Left Shoulder 2/24 Right 4/13 Right

5/31 Right

Flexion 0-180

0-135 0-140 0-150 Flexion 0-180

0-130 0-135 0-140

Extension 0-60

0-20 0-20 0-20 Extension 0-60

0-5 0-10 0-5

Abduction 0-180

0-165 0-170 0-170 Abduction 0-180

0-150 0-155 0-155

Horizontal Abd. 0-90

0-80 0-80 0-80 Horizontal Abd.

0-90

0-55 0-55 0-59

Horizontal Add. 0-45

0-35 0-40 with discomfort noted

0-45 no discomfort reported

Horizontal Add.

0-45

0-40 0-40 0-45

Elbow and Forearm

Elbow and Forearm

Extension/Flexion0-150

15-125 10-130 8-148 Extension/Flexion0-150

0-135 0-135 15-135



Shoulder 2/24 Left 4/13 Left 5/31 Left Shoulder 2/24 Right 4/13 Right 5/31Right

Flexion 0-180

0-98 0-100 0-138 Flexion 0-180

0-135 0-140 0-135

Extension 0-60

0-30 0-30 0-32 Extension 0-60

0-35 0-35 0-35

Abduction 0-180

0-120 0-125 0-130 Abduction 0-180

0-138 0-140 0-160

Horizontal Abd. 0-90

0-90 0-90 0-80 Horizontal Abd. 0-90

0-90 0-90 0-80

Horizontal Add. 0-45

0-10 0-15 0-15 Horizontal Add. 0-45

0-18 0-20 0-20

Elbow and Forearm Elbow and Forearm

Extension/Flexion 0-150

62-140 60-140 50-150 Extension/Flexion 0-150

50-135 45-135 40-142



Shoulder2/24 Left 4/13 Left 5/31 Left

Shoulder2/24 Right 4/13 Right 5/31Right

Flexion

0-180

0-90 0-90 0-110 Flexion

0-180

0-70 0-75 0-110

Extension

0-60

Limited by wheelchair mold Extension

0-60

Limited by wheelchair mold

Abduction

0-180

0-95 NT 0-100 Abduction

0-180

0-110 NT 0-115

Horizontal Abd.

0-90

0-60 0-70 0-60 Horizontal Abd.

0-90

0-45 0-45 0-45

Horizontal Add.

0-45

0-8 0-10 0-15 Horizontal Add.

0-45

0-10 0-12 0-15

Elbow and Forearm Elbow and Forearm

Extension/Flexion

0-150

55-125 50-130 48-145 Extension/Flexion

0-150

60-138 60-140 56-150

Summary of Findings- Objective


•All Spruce group participants demonstrated an ability to exercise at an increased intensity at the conclusion of the 14 week program, as evidenced by pre and post-exercise HR measures

•Trend toward increased ability to actively flex shoulders as well as flex and extend elbows in individuals presenting with significant AROM impairment

•Documented weight loss in 12 of the 14 participants

Summary of Findings- Subjective


• 13/14 participants demonstrated overall positive response and active participation in all components of the program.

• Many participants verbally indicated positive attitude changes and satisfaction with the program (pride, self-confidence, motivation)

• Participants described impact of the program on their daily lives (improved sleeping, more range of motion)

• Participants expressed desire to continue with the program.

• Active participation by staff in the program.

Future Directions


• Continue with present groups incorporating participants and staff as coaches.

• Look at longer term health benefits for present participants.

• Expansion of program to additional residences at the Center.

• Development of training component for staff.

• Application of program to other aging populations.

References


• Heller,T., McCubbin, J.A., Drum, C., & Peterson, J. (2011). Physical activity and nutrition health promotion interventions: what is working for people with intellectual disabilities? Intellectual and Developmental Disabilities, 49, 26-36.

• Podgorski, C.A., Kessler, K., Cacia, B., Peterson, D.R., & Henderson, C.M. (2004). A fitness intervention for older adults with developmental disabilities: report on a pilot project. Mental Retardation, 42, 272-283.

• Rimmer, J. Aging, mental retardation, and physical fitness. Strenghthforcaring.com - Caring for Others, 2-9.

• Rimmer, J. Introduction to achieving a beneficial fitness for persons with developmental disabilities. The National Center on Physical Activity and Disability/Condition, 1-17.

• Stanish, H., Temple, V.A., & Frey, G. (2006). Health-promoting physical activity of adults with mental retardation. Mental Retardation and Developmental disabilities Research Review, 12, 13-21.

• Yamaki, K. (2005). Body weight status among adults with intellectual disability in the community. Mental Retardation, 43, 1-10.

Documents

The Carrus Institute for Families The Center for Discovery The Janet and Gerald Carrus Institute for Families Physical Activity and Nutrition for Adults