Wednesday, May 8, 2013

Creating a Fitness Program for People with Autism

 by guest blogger, Michael Ramirez

Recently I received a call from a parent asking if I could fitness train an autistic child. I
had been a high school baseball coach for over 10 years. Much of my expertise in fitness
had come from various experiences in working with athletes in strength and conditioning
programs, working in fitness centers, through textbook study, and apprenticing other
fitness experts. I also had 10 years of experience working as a behaviorist with autistic
children. I had a sound understanding of both areas, but this was an opportunity to
combine the two. I quickly discovered that despite the fact that people with autism face
many physical challenges, there wasn’t much information out there or programs that
addressed this area. In order to work with this child, I would have to start from scratch
and develop a program tailored specifically for him.

When I began my research, I started to think about what was available to the autism
community. School programs, like Adaptive PE, really didn’t address the issues I was
going to try to work on. One problem I saw with APE, during my years as a behaviorist,
is that it focused too much on teaching how to play certain games or sports, which I
found to be too abstract, with not enough focus on getting the kids to move and use their
bodies. Instead of focusing on functional movements, these programs produced more
frustration because of the slow paced activities. I then questioned why people with autism
don’t go to their local gym or just hire a trainer. This was obvious. First, even if a parent
hired a personal trainer to work out their child, there was no guarantee that the trainer
would have any understanding of autism and the challenges that accompany people
living with this condition. Secondly, therapists like myself, don’t always have the fitness
background to be able to work on the fitness side in a safe and knowledgeable way.
Needless to say there weren’t many resources out there, so I was going to have to develop
a program through the combination of my two experiences in both the fitness world and
as a behaviorist.

I began to think about all of the different children I had worked with in the past and the
physical challenges they faced each day. Many of the kids I had seen shared many similar
physical characteristics like low muscle tone, poor coordination, lack of strength, lack
of flexibility, balance issues, and overall limitations in their movements. Then there was
the neurological aspect that impacted their physical functioning. Challenges with motor
planning and sensory integration (proprioception and vestibular) were the most evident.
Communication and behavioral challenges are also common among children with autism.
Taking this into consideration, it became clear why there weren’t many programs
out there for people with autism. There were so many issues that made it difficult to
produce such a program. Safety was the first thing came to my mind. Initially I was
uncertain how I was even going to get a child with autism to perform the basic functions
of fitness. Although I had a great deal of experience in working with kids with autism
on the behavioral side as well as many experiences working with neuro-typical people
on the fitness end, I had never combined the two. Many autistic people are very out-of-
shape and have significant gaps in their strength and mobility. With this in mind, I began
imagining the process of getting one of my clients to do a burpee, or a deadlift or to run
for an extended period of time, or to be willing to exert themselves in a way that would
get them the types of results that would be necessary for a physical transformation. This
is hard for anyone beginning a fitness program, but is particularly challenging for an
autistic child who may not be used to engaging in any kind of exercise. I knew that if I
was going to get anyone in shape, they would have to be exposed to “real fitness.” I had
worked alongside occupational therapists for many years. I had seen how they struggled
to get children to do some of the things they demanded. What I was going to require was
not like putting a child on a swing. I was going to demand real workouts with the goal of
fitness and progression.

A couple years back, I had been exposed to the concept of CrossFit through a family
member. I had trained in CrossFit for a couple years when I began to train my first
client with autism. When I started to think about all the experiences and knowledge I had
from the therapeutic and fitness side, CrossFit was a good match as a means to structure a
program specifically tailored for children with autism. CrossFit scales exercises to the
individual. This seemed to connect to the “I” in Stanley Greenspan’s DIR Floortime
Model which stands for “individual differences.” Since no two people are alike, no two
people with autism are alike either. Children that I would be working with needed a
specific program to fit their needs. CrossFit allowed people to progress based on their
current fitness level. CrossFit was developed by Coach Greg Glassman. CrossFit ,com
states that Glassman defined “ fitness in a meaningful, measurable way (increased work
capacity across broad time and modal domains). CrossFit itself is defined as that which
optimizes fitness (constantly varied functional movements performed at relatively high

Many children with autism struggle with flexibility and range of motion. Proprioceptive
Neuromuscular Facilitation (PNF) was a good answer to this. Of course I needed to
modify its application. PNF was a good way for me to facilitate stretching without having
the student do the work. The combination of this type of stretching routine and the
CrossFit structure, gave me the necessary components needed to design a good program
to fit the needs of people with autism. All I needed to do was test it.

I began to work with the family who was in search for a personal trainer. It was my first
opportunity to test my concepts and ideas. There were many bumps in the road, but the
road to success is not always straight, as they say. It took a while to figure out how to
elicit certain movements, capture attention, and promote motivation. I relied heavily
on my experiences working with Dr. Arnold Miller, who created The Miller Method; a
cognitive systems approach to working with kids on the spectrum. The basic philosophy
that I took from his teachings, in the application to this program, was the use of children’s
aberrant systems and transforming them into functional, relevant activities. For example,
one of my athletes likes to take string like objects and twirl them around. It is a self-
stimulatory behavior. I used his motivation to stim on these objects, to introduce a heavy
rope and create a system of functional movements that can be repeated. It turns “rituals
into repertoire”, also a title of one of Dr. Miller’s books. His philosophy in working with
people with autism shifted my view about how to use certain behaviors that are common
to people with autism. I was fortunate enough to have worked closely with Dr. Miller
for several years before his passing. His techniques worked well in combination with
CrossFit methodologies. They simply complimented each other.

The philosophy of this workout program is based on three principles: Neurological/
Physical/Individual Based (NPI). Neurological Skills, as it refers to fitness, describes
functions like agility, accuracy of movements, coordination, and balance, as well as body
awareness. Physical Skills include characteristics like strength, flexibility, endurance,
stamina, power, etc. The last part takes into consideration the differences between each
individual. Everyone has their own set of skills and abilities. With children and teens with
autism, I needed to consider many different things, primarily communication (receptive
and expressive), cognitive ability, socio-emotional skills, sensory processing, behavioral
challenges, and learning styles. Scaling and modifying exercises, using the CrossFit
methods allowed us to tailor a program specifically for each individual, while helping
them progress through each movement at their own pace.

The physical components of exercise in relation to people with autism needed to address
the student’s areas of weakness as well as their strengths. My research emphasized the
five basic fundamental movements of fitness: pushing, pulling, bending, rotation, and
locomotion. These foundational movements allow us to work on basic movements, and
build up to more complex and compound movements, through the use of scaling and
prompting. Many autistic kids have difficulties with these movements. For example, one
of my clients has a big frame and was fearful of certain movements. In our assessment, he
was fearful of bending his elbows to lower his upper body because he thought he would
not be able to support his own weight and might flop down and smash his face into the
ground. As a result, he was unable to do a push-up, so for weeks and months we worked
incrementally toward this goal, first by getting him vertical and pushing off a wall, and
then by progressively lowering him horizontally towards the ground. Today he can push
off the ground, and with a little assistance, he can get his hips up. I know it will be no
time before he is doing a full push-up on his own. He has also made big strides in his
ability to bend and squat. Initially he would bend his knees only very minimally. This
impacted on his ability to perform daily functions like picking up an object from the floor
or even sitting down at a desk. A few weeks ago he got his rear end below his knees for
the first time, when doing an air squat, with some support to maintain balance (holding
his hands out in front of his chest). This was a great accomplishment for him.

When I began to work with some of my first clients I noticed many common
characteristics. Many of the children had bodies that had low muscle tone, very weak
posterior chain and core muscles, tightness in the lower half, and very soft upper
bodies (Physical). Some of the kids I met had difficulties with balance, coordination,
motor planning, agility, the ability to perform compound movements, and be accurate
in movements (Neuro). There were also deficits in communication, attention, and
behavioral issues, which made it difficult to motivate them to perform for an extended
period of time. Let’s face it; exercise can sometimes be painful and hard, especially in
the beginning. To get the best results in each workout I focused on strength, compound
movements, strengthening a specific muscle groups, and work on the constant varying
functional movements at a high intensity.

It takes time to get the kids accustomed to the workload, the pacing, and to gain
confidence in the movements. There are times when I need to be more of a motivational
coach, than a fitness coach. It is definitely a process. All of my students are making gains
in one way or another. Working on physical fitness has its obvious advantages when
you consider the health benefits but when it comes to people with autism, the benefits
are even greater. I have received feedback that fitness training has impacted things like:
sleep patterns, energy levels, mood, attention, communication and behavior. One of
my students expressed that exercising helps him to feel his body better. He also feels
it has been helpful with his pointing (typing). Exercise gives kids with autism added
satisfaction and increased self-esteem when they connect their brain and their body and
even strategies to deal with excess energy. Recently, the mother of a client told me that
her son requested to do some pull-ups in the middle of a behavioral therapy session.
He then proceeded to continue to perform his own routine of sit-ups and push-ups in
combination until he relaxed.

Fitness is an area that has far too long been under utilized in the lives of people with
autism. My mission is to change that, through my company, Special-Fit. I want to thank
all of my students for inspiring me and helping me develop this program. It was because
of the relationship I’ve created with them and their families, that forever changed the way
I view people with autism. They have taught me more about breaking through limitations
than any other individuals I have met in my lifetime.

Michael Ramirez
Owner and Head Trainer

For more information about Special-Fit, visit our website at

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