J Autism Dev Disord (2007) 37:9971006

DOI 10.1007/s10803-006-0238-3

ORIGINAL PAPER

The Efficacy of a 9-Month Treadmill Walking Program

on the Exercise Capacity and Weight Reduction for Adolescents
with Severe Autism
Kenneth H. Pitetti Andrew D. Rendoff
Travis Grover Michael W. Beets

Published online: 6 December 2006

Springer Science+Business Media, LLC 2006

Abstract This study evaluated the efficacy of a

9-month treadmill walking (TW) program on exercise
capacity and body mass index (BMI) for adolescents
with severe autism. Ten youth residing in a residential/
school treatment facility were assigned to either a
supplemental treadmill walking (TW) or control group.
Both groups continued to participate in their regular
physical education curriculum. Monthly records were
maintained for the following: (a) TW progression in
frequency, duration, speed and elevation; (b) caloric
expenditure; and (c) BMI. The TW program resulted
in significant increases in mean monthly TW frequency,
speed, elevation, and calories expended coupled with a
reduction in BMI.
Keywords Autism Adolescents Exercise Capacity
Body Mass Index

K. H. Pitetti (&)
Department of Physical Therapy, College of Health
Professions, Wichita State University, Wichita, KS 672600043, USA
e-mail: ken.pitetti@wichita.edu
A. D. Rendoff
Department of Physician Assistant, College of Health
Professions, Wichita State University, Wichita, KS 672600043, USA
T. Grover
Heartspring, Wichita, KS, USA
M. W. Beets
Oregon State University, Corvallis, OR, USA

The health benefits (e.g., reducing the risk for heart disease and type 2 diabetes) of regular exercise/physical
activity are well established (Blair et al., 1989; Booth,
Gordon, Carlson, & Hamilton, 2000; Pate, Pratt, & Blair,
1995). It has been documented that children, adolescents,
and adults with developmental disabilities (e.g., mild to
moderate mental retardation) demonstrate physical fitness levels that are not only inferior to their non-disabled
peers but reflect a population exhibiting a sedentary
lifestyle (Fernhall & Pitetti, 2001; Pitetti & Campbell,
1991; Pitetti, Rimmer, & Fernhall, 1993; Pitetti, Jongmans, & Fernhall, 1999; Pitetti, Yarmer, Fernhall, 2001).
This is also true of youth with severe developmental
disabilities, including youth with autism, living in a residential/school treatment facility (Pitetti et al., 1999).
Thus, it is suggested that a sedentary lifestyle contributes
to an increased risk of early morbidity and mortality in
persons with developmental disabilities. This belief is
strengthened by data showing that adults with developmental disabilities may be at risk for preventable mobidity and motality because of insufficient healthpromoting behaviors, including physical inactivity
(Chanias, Reid, & Hoover, 1998; Hayden, 1998; Sutherland, Couch, & Iacono, 2002). Accordingly, it appears
that physical activity is an important contributor to
health in populations with developmental disabilities.
It has been shown that participation in exercise programs can improve the physical fitness and health profiles of persons with mild to moderate mental retardation
(Andrew, Reid, Beck, & McDonald, 1979; Beasley, 1982;
Bundschuh & Cureton, 1982; Fernhall, 1993; Frey,
McCubbin, Hannington-Downs, Kasser, & Skags, 1999;
Nordgren, 1971; Pitetti & Tan, 1991; Pitetti et al., 1993;
Rimmer, Heller, Wang, & Valerio, 2004; Schurrer,
Weltman, & Brannel, 1985) and persons with severe

123

998

mental retardation without autism (Tomporowski & Ellis, 1985; Tomporowski & Jameson, 1985). While exercise studies have been performed with youth diagnosed
with severe developmental disabilities including autism
(Bachman & Fugua, 1983; Bachman & Sluyter, 1988;
Baumeister & MacLean, 1984; Elliot, Dobbin, Rose, &
Soper, 1994; Kern, Koegel, Dyer, Blew, & Fenton, 1982;
Kern, Koegel, & Dunlap, 1984; McGimsey & Favell,
1988; Rosenthal-Malek & Mitchell, 1997), the main
interest was the reduction of maladaptive behaviors and
not specifically the ability to increase exercise capacity
or the reduction of body weight.
In a recent study, Lotan and colleagues (Lotan, Isakov, & Merrick, 2004) performed a 2-month treadmill
walking program with 4 children (8.511 years) with
Rett syndrome to determine the affect treadmill walking program on aerobic fitness. Although children with
Rett syndrome share behavior characteristics similar to
autism (Diagnostic and Statistical Manual of Mental
Disorders, 2000), they also demonstrate ataxic motor
anomalies (i.e., gait patterns are unsteady and initiating
motor movements can be difficult). Lotan et al. (2004)
reported improvements in physical fitness by changes in
resting and treadmill exercise heart rates. In addition,
the efficacy of the treadmill walking program to increase weekly activity levels was determine by the
amount of calories (kilo-calories) expended throughout
the study. However, the specific methodology used by
Lotan et al. (2004) to determine resting and treadmill
heart rates was not reported and the validity of the
method used to determine caloric expenditure for each
treadmill training session is problematic in that it did
not follow established guidelines (American College of
Sports Medicine, 2005).
Therefore, the purpose of this study was to determine
the efficacy of incorporating a 9-month treadmill walking
program into the weekly academic curriculum of youth
with severe developmental disabilities including autism.
For this study, efficacy was defined as a significant progression in treadmill walking frequency, speed, elevation
(i.e., exercise capacity), and monthly calories expended
coupled with a reduction in body mass index.

Methods
Participants
Ten adolescents/young adults (6 male and 4 female)
participating in this study were clients of a Midwestern
residential/school treatment facility for people with
severe developmental disabilities. Written informed
consent was obtained from parents/guardians of the

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J Autism Dev Disord (2007) 37:9971006

participants and the study protocol was approved by the

residential/school treatment facility ethical committee
and the University Institutional Review Board. Participants were selected from 42 clients residing in this
facility and assigned to either treadmill walking group
(TWG) or the control group (CG). The sampling design
was purposive (Henry, 1990; Sherrill & OConner,
1999) and followed a previously established selection
criteria (Pitetti et al., 1999): (a) a physician and a psychologist, both experienced in autism, confirmed that
diagnosis met the DSM-IV-Text Revised (American
Psychiatric Association, 2000); (b) manifested moderate to profound mental retardation as assessed by
standardized tests of intelligence, including the Leiter
International Performance Scale (Leiter, 1969), the
Slosson Intelligence Test (Slosson, 1963), and/or
Wechsler Adult Intelligence Scale (Wechsler, 1981); (c)
all had histories of lengthy and restrictive placement
resulting from their severe maladaptive behaviors; (d)
had no medical contraindications (i.e., cardiovascular/
respiratory anomalies) or significant primary sensory or
motor impairments that restricted them from treadmill
walking; and (e) identified by staff as able to follow
instructions to perform treadmill walking . Descriptive
statistics on the participants are found in Table 1 and
diagnosis and medications are found in Table 2.
Procedures
Control Group
For the control group (CG), their Student Support
Plan (SSP), as designed and implemented by the residential treatment facility staff members, allowed for
30 min of leisure activity, 3-times per week, at the
Table 1 Descriptive statistics of exercise and control groups
Subject Gender Age
(years)
Exercise group
1
Male
2
Male
3
Male
4
Female
5
Female
Mean SD
Control group
6
Male
7
Male
8
Female
9
Female
10
Male

18
18
18
15
14

Weight
(kg)
96.2
92.9
129.2
80.7
91.4

Height
(cm)
179.7
180.3
168.3
176.5
160.0

Body mass
(kg m2)
30.0
28.6
45.6
25.9
35.7

16.6 1.9 98.0 18.3 173.0 7.8 33.2 7.8

18
72.6
168.9
25.4
16
80.3
178.4
25.2
19
107.9
166.4
39.0
17
63.1
163.2
23.7
17
142.9
186.1
41.3
17.4 1.1* 93.4 32.4 172.6 8.4 30.9 8.5

* Significantly (P < .05) older

J Autism Dev Disord (2007) 37:9971006

Table 2 Clinical
diagnosis
and medications of exercise
and control groups

Participant

999

Diagnoses

Exercise group
1
Autism
Severe mental retardation
Obesity

Autism
Severe mental retardation
Visual impaired
Behavior disorder
Autism
Hypertension
Fibromyalgia
Chronic constipation
Hypercalcemia
Mild mental retardation
Autism
Chronic constipation
Severe mental retardation

Autism
Severe mental retardation
Reactive attachment Disorder
Oppositional defiant disorder
Post-traumatic stress disorder

Control group
6
Autism
Severe mental retardation
Mood disorder
IED
7

Autism
Visual impairment
Seizures
Mental retardation
Attention deficit hyperactivity
Disorder

10

Autism
Aspergers syndrome
Attention deficit hyperactivity
Disorder
PDD
Anxiety disorder
Autism
Seizure disorder
Disruptive behavior disorder
Severe mental retardation
Scoliosis

Autism
Mental retardation
Obesity

Medications
Risperdal 1 mg tab (1 tab BID)
Docusate Sodium (200 mg SID)
Certavite (1 tab SID)
Diphenhydramine (25 mg BID)
Benzac gel 10% (Apply to skin BID)
Clonidine 0.1 mg tab (1/2 tab am, 2 tabs pm)
Risperdal 1 mg tab (1 tab am, 2 tabs pm)

Protonix (40 mg SID)

Diovan (160 mg SID)
Zyrtec (10 mg SID)
Neurontin (300 mg SID)

Nordette (1 tab SID for menses)

Metamucil Apple Wafer (1 wafer 5/wk)
Acetominophen (650 mg every 4 h
as needed for pain/fever)
Aleve (220 mg BID as needed
for dysmenorrhea)
Ziprasidone (40 mg SID @8 pm)
Topiramate (50 mg BID)
Ziprasidone (20 mg BID @8 am and 2 pm)

Ambien (2.5 mg SID)

Propanolol 80 mg tablets
(1 tab am, tab pm)
Seroquel 200 mg (1 tab QID)
Topamax 100 mg tab ( 1 tab BID)
Trileptal 600 mg tab (1 tab 3x/day)
Depakote 250 tab(3 tabs BID)
Docusate Sodium 100 mg
caps (1 cap 3x/week)
Geodon 60 mg (1 cap BID)
Lamictal 25 mg (2 tab BID)
Loratadine 10 mg (1 tab SID)
Ativan 2 mg/ml (2 mg rectally
as needed for seizures)
Clonazepam 1 mg tab
(1/2 tab am, 1 tab pm)
Fiber-latex (1 tab every other morning)
Lamictal 100 mg tabs (1 tab BID)
Seroquel 100 mg tabs (2 tabs BID)

Allegra 60 mg tabs (1 tab SID)

Carnitor 330 mg tabs (1 tab BID)
Certagen Multivitamin (1 tab SID)
Citrucel (1 tablespoon 5x per week)
Depakote 250 mg tabs (1 tab SID)
Depakote ER 500 mg tabs (2 tabs BID)
Geodon 40 mg cap (1 cap SID)
Lamictal 100 mg tabs (1 tab BID)
Necon 1/50 tabs (1 tab SID)
Ativan 2 mg/ml (1 ml as needed for seizures)
Glycolax Powder (1 tablespoon SID in 8oz juice)
Seroquel 100 mg tabs (1 tab SID)
Seroquel 25 mg tabs (2 tabs SID)

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J Autism Dev Disord (2007) 37:9971006

Table 3 Initial and 9-month weight and BMI for treadmill
walking and control groups

campus gymnasium. These activities took place under

the guidance of a staff member with a masters degree
in adapted physical activity. Classes permitted participants to engage in the following activities; basketball
(shooting, dribbling, passing), jumping rope, roller
skating, Scooter-Board activities, object control skills
(i.e., throwing and catching the ball), striking a ball
(i.e., tennis or nerf) with a tennis racket or plastic bat,
and cycling skills (e.g., two or three wheeled adult
bicycle).

Weight
98.0 18.3 93.0 32.3 92.9 15.5 91.2 30.9
(kg)
33 7.82 30.9 8.49 30.2 6.33 30.0 7.35*
BMI
(kg m2)

Treadmill Walking Group

* 9-Month treadmill walking group BMI significantly (P < .05)

lower than initial month exercise group

The treadmill walking groups (TWG) weekly activity

differed from the CG in the following manner, (a) the
majority of time within the regular activity classes (i.e.,
1530 min, MondayWednesdayFriday) consisted of
treadmill walking, (b) during the weekdays when regular activity classes activity classes were not planned
(i.e., Tuesday and Thursday), they were taken to the
gymnasium and given the opportunity to walk on the
treadmill (i.e., taken to the gymnasium), and (c) they
were given the opportunity to walk on the treadmill at
their residence in the evening (i.e., 3:15 pm8 pm).
Treadmill Protocol
Prior to initiating the study, all 10 participants had
been trained to walk unassisted (i.e., not holding on to
railing) on the treadmill during their regular class time
(e.g., 13 times per week, duration of 510 min) and,
therefore, were acclimated to the use of the treadmill.
For the TWG, the treadmill protocol consisted of (a)
an initial frequency of 2 times per week, with a progression of 1 day every 2 weeks to a peak frequency of
5 times per week, (b) an initial duration of 8 min per
session, with a progression of 12 min every 23 weeks
to a peak duration of 20 min per session, (c) an initial
treadmill speed (individualized based on ability) ranged from 2.4 mph to 3.5 mph, with a progression
of .1 mph to .3 mph every 23 weeks to a peak speed
ranging from 3.7 mph to 4.1 mph, and (d) an initial
grade of 0%, with progressive increases of .5%. Due to
the fact that the participants in this study were particularly schedule oriented (i.e., abrupt changes potentiated negative behaviors), frequency and duration was
slowly increased by an average of 1 day every
35 weeks and 1 min every 23 weeks, respectively.
Increases in speed and grade were also behavior
dependent. During residential (3:158 pm) or weekend
hours, participants were allowed to walk on the
treadmill at intensities, durations, and speeds consistent with the treadmill protocol, under the direction of

123

Initial
Treadmill
walking
group

Month 9
Control
group

Treadmill
walking
group

Control
group

their residential staff. All treadmill information (i.e.,

frequency, speed, grade, duration) was recorded by
residential staff members into daily logbooks for each
of the participants. This information was used to track
the progression of the participants over the duration of
the program (Table 3).
Caloric Expenditure
Caloric expenditure specific to treadmill walking was
determined from equations established by the American College of Sports Medicine (ACSM, 2005) and
calculated in the following manner, (a) for each day,
VO2 was expressed in net terms (ml kg1 min1)
from the formula: VO2 = 0.1 (speed of treadmill) + 1.8 (speed of treadmill) (fractional grade of
treadmill) + 3.5, (b) net VO2, as calculated from the
last equation, was then converted to METS (i.e., metabolic equivalent) by dividing net VO2 by 3.5 ml kg1
min1; and (c) caloric expenditure per minute was then
calculated
from
the
formula:
kcal min1 =
(METs 3.5 body weight in kg)/(200).
Daily logs of caloric expenditure were added to
obtain the sum of each weeks caloric expenditure.
Mean monthly caloric expenditures were determined
by dividing the total sum of weekly caloric expenditure
by the number of weeks per month.
Body weight was measured weekly and used for
weekly caloric expenditure calculations. The treadmill
was calibrated monthly.
Body Mass Index (BMI)
Body mass index is defined as body weight (kg) divided
by height (m) squared (kg m2). Height (to the nearest
0.64 cm of inch) and weight (to the nearest .11 kg or
lb) were measured on a standard physicians scale
(Detecto). Body mass index is shown to strongly
correlate with total fat content (ACSM, 2005). For
descriptive purposes we used the following BMI cutoff

J Autism Dev Disord (2007) 37:9971006

1001

points to classify the participants: overweight

(BMI 25.0 and < 29.9); and obese (BMI 30.0)
(Centers for Disease Control and Prevention, 2005).
Statistical Analysis
Means and standard deviations () were computed for
all variables. Initial body weight and BMI between
groups were compared using an independent sample
t-test. For the TWG, comparison between month 1
(baseline) and month 9 was made using one-tailed
paired sample t-tests for the following parameters:
BMI, weight (kg), treadmill speed (mph), duration on
treadmill (min), elevation of treadmill (%), METS,
and caloric expenditure (kcal min1). For all analyses,
statistical significance was adjusted to control for Type
I errors using Holms sequential Bonferroni test
(Holm, 1979). Clinical significance for the main outcome of interest, body mass index, was determined by
calculating effect sizes and the reliable change index.
Effect sizes were calculated using the following formula: baseline minus month 9 divided by the standard
deviation of baseline. Effect sizes were interpreted
according to previously established standards: small
( < .41); moderate (.41.70); and large (>.70) (Cohen,
1969). The reliable change index (RC) (Jacobson &
Traux, 1991) was calculated for each participant by the
following formula: RC = x2 x1/Sdiff, where x2 and x1
represent a participants pre- and post-test scores,
respectively, and Sdiff represents the standard error of
difference
between
two test scores. The Sdiff is equal to
q

2
the: 2SE : The SE (standard
error of measurement)
p
was calculated by: SE s1 1
rxx ; where s1 is the
standard deviation of the control and experimental
group pre-test measure and rxx is the testretest
Fig. 1 Exercise group versus
control group BMI and body
weight

reliability coefficient of the measure. For our analysis, we used the Spearman Rank Order coefficient
(q) between baseline and month 1 measures. An RC
equal to or greater than 1.96 indicates significant
changes occurred in the measure, in this case BMI.
Given the limitations with the small sample size,
changes were graphically illustrated in outcome
variables for the TWG and CG over the 9-month
study.

Results
The primary outcomes of interest, body weight and
body mass index (BMI), for month 1 (i.e., baseline)
and month 8 for the TG and CG are presented in
Table 1. Monthly body weight and BMI for both
groups are shown in Fig. 1. At baseline, there were no
significant differences between groups for body weight
or BMI. Comparisons between baseline and month 8
for the TG and CG, separately, demonstrated the
following, (a) a significant decrease in BMI for the
TWG, t (4) = 3.23, P = .016, whereas no significant
changes in BMI for the CG, t (4) = 1.149, P = .315; and
(b) a non-significant reduction in weight for the TWG,
t (4) = 1.904, P = .065 and the CG, t (4) = 0.879,
P = .215 (see Table 2).
The effect size (ES) for change in BMI over the
duration of the study indicated a modest effect for the
TG (ES = .38) and a minimal effect for the CG
(ES = .03). The reliable change index (RC) indicated
that three of the five TG participants reliably reduced
their BMI (RC range 2.453.65) over the duration of
the study (see Table 1). Interestingly, one of the CG
participants also reduced their BMI during this same
34

220

33

32
210
31
205
30

200

Body Mass Index (kg/m2)

Body Weight (lbs)

215

29

195

28
1

Month
Exp Wht

Cont Wht

Exp BMI

Cont BMI

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J Autism Dev Disord (2007) 37:9971006

Fig. 2 Mean body mass index

(BMI) versus mean average
caloric expenditure
per month

1400

35

1200

1000
30
800
27.5
600
25
400
22.5

200
Exp BMI

20

time (RC = 2.82). The relative percent change in BMI

from baseline indicated that a minimum of 2.8%, up to
a 17.2% reduction in BMI occurred with the TG. For
the CG, three participants reduced their BMI (percent
change range 3.09.6%); while two participants increased their BMI (percent change 1.73.8%). The
percent changes are graphically illustrated in Fig. 2.
Discussion
The primary purpose of this study was to determine the
efficacy of a supplemental treadmill walking program
on the exercise capacity and BMI reduction of youth
with severe developmental disabilities including autism. For this study, efficacy was defined as a significant
progression in treadmill walking frequency, speed,
elevation (i.e., exercise capacity), monthly calories
expended and a reduction in BMI. For the participants
in the TWG, the treadmill walking program used in
this study resulted in a significant increase in exercise
capacity and monthly caloric expenditure coupled with
a decrease in BMI.
In a similar study, Lotan et al. (2004) perform a
2-month treadmill walking program with 4 children
(8.511 years) with Rett syndrome. Although the
present study and that by Lotan et al. (2004) substantiate the efficacy of incorporating a treadmill walking
program into the daily activities of two different groups
of individuals with developmental disabilities, significant differences existed in methodology and, therefore,
outcomes. Obvious differences were seen in participants mean age (10 years vs. 16.6 years), disability
(Rett syndrome versus Autism with mild to severe
mental retardation), and duration of the studies (i.e.,
2 months vs. 9 months). In addition, Lotan et al. (2004)

123

5
Month

Average caloric expenditure per week

Body Mass Index (kg/m2)

32.5

Exp CE
9

did not report (a) specific clinical diagnosis, or medication, and (b) individual or group mean weekly or
monthly initial and incremental increases in treadmill
speed, grade or walking duration. However, the major
methodological difference between studies concerned
determination of caloric expenditure. In the present
study, caloric expenditure was determined from equations established by the American College of Sports
Medicine (ACSM, 2005) and calculated accordingly.
The validity of the formula used by Lotan et al. (2004)
to determine caloric expenditure was not established
(i.e., no reference(s) were given). That is, according to
ACSM (2005) equations, and using Lotan et al. (2004)
highest reported treadmill speed (1.5 k h1) and grade
(1%), average weekly duration (19.9 min), and an
estimated weight of 45 kg (although body weight was
not reported), the total caloric expenditure would be
24.1 calories for that session. Lotan et al. (2004)
reported an average of 213.5 calories per session, an
885% difference. Even if one increased or decreased
the estimated body weight of 45 kg by 50%, this would
not account for the significant differences in estimating
caloric expenditure.
The U.S. Surgeon General (U.S. Department of
Health and Human Services, 1996) along with the
Centers for Disease Control and Prevention and the
American College of Sports Medicine recommend a
minimum duration of 30 min of moderate intensity,
physical activity for 57 days of the week (Pate et al.,
1995). Brisk walking (i.e., 34 mph) has been recognized as a type of moderate activity and has been
shown to substantially reduce the risks for heart disease, stroke, and type 2 diabetes (Gregg, Gerzoff,
Caspersen, Williamson, & Narayan, 2003; Hakim et al.,
1999; Hu et al., 1999; Lee, Rexrode, Cook, Manson,

J Autism Dev Disord (2007) 37:9971006

1003

& Buring, 2001; Manson et al., 1999, 2002; Sesso,

Paffenbarger, & Lee, 2000; Tanasescu et al., 2002). For
this study, the treadmill walking program did not attain
the minimum recommendations for duration or frequency (Table 4, month 9), but did achieve recommended speed (3.86 0.12 mph, Table 4, month 9) to
be classified as moderate intensity.
Although the causative variables that contribute to
overweight/obesity can be intricate (i.e., neuroendocrine, genetic, etc.), diet and physical inactivity are still
considered the primary causes for overweight/obesity
(National Institutes of Health and National Heart,
Lung, and Blood Institute, 1998). Given the clinical
needs of their disability, daily (i.e., 24 h) activity levels
and dietary intake for the participants in this study
were closely monitored and controlled. While holiday
breaks did occur (e.g., Thanksgiving and Christmas
Holidays), the participants spent approximately 95%
of the study time within the campus of the residential/
school treatment facility. The fact that the CG demonstrated a slight reduction in body weight and BMI,
although not statistically significant, substantiates that
care was taken by the staff of the facility to ensure
caloric balance for their clientele. For the TWG, the

gradual drop in monthly BMI was seen in conjunction

with a gradual increase in monthly caloric expenditure
(Fig. 2). This suggests that the treadmill walking program was a contributor to the significant reduction in
BMI for the TWG. Further support for the treadmill
walking program is the reduction of baseline BMI, with
initial levels well above the obesity criteria (i.e., >30),
to borderline obesity status (mean BMI = 30.2) by
month 9.
Obesity, in and of itself, is a primary risk factor for
heart disease (National Institutes of Health and National Heart, Lung, and Blood Institute, 1998). Because
excessive weight gain is easier to prevent than to reverse
(Institute of Medicine, 2004), practitioners have called
for modest reductions (510%) in BMI and weight for
individuals who find substantial weight loss difficult to
achieve (De Levia, 1998). The percent reduction in
BMI for the TWG averaged 8.4% while weight reduction an average of 4.8%. The sustained and gradual
weight loss experienced by the participants would likely
have contributed to a reduction in the risk associated
with the complications due to diabetes, hypertension,
hyperlipidemia, and cardiovascular disease (Pasanisi,
Contaldo, de Simone, & Mancini, 2001). However,

Table 4 Average treadmill walking speed, time, elevation and METS per exercise group participant per month
Participant

1
2
3
4
5
Mean
SD

Month 1

Month 2

Freq

Speed

Time

ElVN

METS

Freq

Speed

Time

ElVN

METS

Freq

Speed

Time

ElVN

METS

1.8
3.0
1.8
2.3
3.5
2.5
.8

2.35
3.02
3.00
3.50
2.78
2.93
.42

8.50
16.55
17.63
20.21
20.00
16.57
4.78

.00
.00
.00
.17
.06
.05
.07

28.25
114.61
68.19
146.04
151.31
101.68
52.71

4.8
3.8
3.0
2.3
4.5
3.7
1.0

2.91
3.10
3.07
3.44
2.94
3.09
.21

16.29
17.50
19.50
20.96
18.85
18.62
1.80

.07
.00
.08
.00
.10
.05
.05

184.46
154.49
147.54
163.81
210.73
172.21
25.63

2.8
6.0
2.3
3.0
4.0
3.6
1.5

3.23
3.17
3.22
3.54
3.14
3.26
.16

14.03
15.10
20.08
22.38
18.83
18.08
3.48

.34
.10
.88
.31
.46
.42
.29

139.39
236.95
198.25
213.85
237.53
205.19
40.33

17.13
18.60
21.27
15.50
20.12
18.52
2.30

.19
1.08
3.47
2.44
1.48
1.73
1.26

111.75
394.04
928.83
299.19
386.36
424.03
304.24

18.61
19.94
15.36
17.38
18.43
17.94
1.71

1.68
2.00
1.75
1.83
1.26
1.70
.28

584.70
747.06
511.11
444.20
436.66
544.75
127.92

Month 4
1
2
3
4
5
Mean
SD

4.8
3.3
2.0
1.5
5.3
3.4
1.7

3.46
3.24
3.36
3.55
3.20
3.36
.15

Month 5
18.59
19.44
21.61
19.46
20.30
19.88
1.14

.96
.76
1.25
1.46
.44
.97
.40

484.04
272.67
231.19
278.08
375.93
328.38
101.94

Month 7
1
2
3
4
5
Mean
SD

Month 3

4.0
6.0
4.0
2.8
5.3
4.4
1.2

3.40
3.19
3.38
3.54
3.25
3.35
.14

4.3
4.0
3.3
2.3
4.3
3.6
.9

3.47
3.13
3.33
2.66
3.27
3.17
.31

Month 6
20.19
19.21
21.51
17.33
20.49
19.75
1.58

1.34
1.57
2.60
2.29
1.58
1.87
.54

528.86
464.68
628.14
411.20
564.33
519.44
84.61

Month 8
19.84
18.75
20.25
18.48
19.25
19.31
.74

2.03
1.14
2.21
2.10
1.28
1.75
.50

600.08
603.73
660.37
464.09
517.29
569.11
77.78

6.5
5.5
4.0
3.3
4.5
4.8
1.3

3.58
3.50
3.54
3.68
3.53
3.57
.07

1.8
4.3
3.8
1.0
2.8
2.7
1.4

3.29
3.08
3.46
2.80
3.28
3.18
.25

Month 9
18.89
19.21
20.17
19.53
20.60
19.68
.70

1.75
1.85
2.00
1.75
1.80
1.83
.10

861.99
784.39
639.32
559.10
680.92
705.14
119.51

4.0
4.3
4.3
3.5
4.5
4.1
.4

3.90
3.93
3.79
4.00
3.70
3.86
.12

ElVN, Percent (%) elevation of treadmill

123

1004

J Autism Dev Disord (2007) 37:9971006

bio-markers (e.g., fasting blood glucose) indicating reduced risk for these diseases were not collected in the
current study. Nevertheless, the overall percent reduction in BMI and weight suggests the health profiles of
the participants were positively impacted.
The significant decrease in BMI by the TWG becomes
even more noteworthy when considering that two participants in the TWG (#1 and #2) were taking daily doses
of 1 mg of risperdal (risperidone, Table 2). Resperidone
has been shown to have efficacy for treating aggression,
self-injury, and property destruction for persons with
developmental disabilities, including adolescents and
young adults with autism (APA, 2000). However, it was
found that significant weight gain was a limiting side
effect when using daily dosages of reperidone, similar to
the daily dosages used by participants #1 and #2 (i.e.,
1 mg/day) (Hellings, Zarcone, Crandall, Wallace, &
Schroeder, 2001). As stated by Hellings et al. (2001),
...the drug treatment (resperidone) may be stopped
prematurely because of weight gain in spite of good
efficacy (on behavior), without any trials of nutritional
consultation and exercise intervention. Participant #1
demonstrated a reduction in body weight (212188 lbs)
and BMI (3025.6), while the body weight and BMI for

participant #2 remained constant (body weight of

204 lbs, and BMI of 28.6). These results suggest that the
treadmill walking program, if implemented for persons
with autism taking resperidone, could be beneficial as an
exercise intervention in controlling body weight and
BMI.
In this study, intensity of exercise was determined by
treadmill walking speed. However, the American
College of Sports Medicine (ACSM, 2005) has established 6090% of heart rate (HR) maximum (220age = HR maximum), based upon a minimum of
20 min of exercise in one session, as the appropriate
intensity for developing and maintaining cardiorespiratory fitness. Heart rate monitors were offered to each
participant but they did not cooperate in its placement
(e.g., immediately removed the device or moved away
when offered). Therefore, no further attempt was
made to teach the participants to wear the monitors.
In addition to their regular activity classes (i.e.,
1530 min, MondayWednesdayFriday), the TWG
was also given time to voluntarily walk on the treadmill
during the other weekdays (i.e., Tuesday and Thursday),
in the evenings, and on weekends. Monthly mean caloric
expenditure at these locations is found in Table 5.

Table 5 Average caloric expenditure per exercise group participant per week by month and location
Participant Month 1
Class
1
2
3
4
5

Resd Wkend Total

28.5
.0
169.0 19.0
155.3
.0
207.3
.0
209.8 33.0
Mean SD

20.0
0.0
.0
.0
.0

48.5
188.0
155.3
207.3
242.8
168.38 74.1

Month 4
1
2
3
4
5

741.8 55.0
417.8
.0
522.3
.0
209.3
.0
562.3
.0
Mean S.D.

Month 3

Class

Class

233.8 20.0
242.0
0.0
334.8
.0
175.5
.0
282.0 42.5
Mean SD

9.5
21.0
.0
.0
26.8

806.3
438.8
522.3
209.3
589.0
513.14 217.7

1089.5
.0
40.3
1015.5 45.0
84.8
1446.0
.0 111.3
820.8
.0
.0
796.3 92.5
43.5
Mean S.D.

783.5
657.8
1411.8
689.3
831.5
Mean

57.3
10.0
.0
.0
12.3

311.5
252.0
334.8
175.5
336.8
282.12 68.7

1129.3
1145.3
1557.3
820.8
932.0
1116.94 281.4

57.8
97.0
.0
.0
53.8
S.D.

28.5
6.8
.0
.0
.0

1005.8 247.0 40.0

1219.3
.0 127.3
1492.5
.0
.0
667.0
.0
.0
934.8 137.5
.0
Mean S.D.

Resd = Residential: 3:15 p.m.8 p.m. (MondayThursday)

Wkend = Weekend: 3:15 p.m.7:45 a.m. (FridayMonday)

Resd Wkend Total

222.8 0.0
267.0 82.3
449.3
.0
339.3
.0
335.3 16.5
Mean SD

13.0
37.3
.0
.0
24.3

235.8
386.5
449.3
339.3
376.0
357.38 78.7

Month 6

Month 8

Class = 8:00 a.m.3:00 p.m. (MondayFriday)

123

Resd Wkend Total

Month 5

Month 7
1
2
3
4
5

Month 2

869.8
761.5
1411.8
689.3
885.3
923.54 284.5

177.8
.0
.0
546.8 36.5 54.0
2082.0
.0
.0
403.5
.0
.0
574.8 38.0
.0
Mean S.D.

177.8
637.3
2082.0
403.5
612.8
782.68 749.5

Month 9
1292.3
858.5
.0 16.3
1346.8
1213.8
.0
.0
1492.5
1084.5
.0
.0
667.0
754.0
.0
.0
1072.3
585.3 31.3 22.8
1174.18 321.2 Mean S.D.

874.8
1213.8
1084.5
754.0
646.0
914.62 233.4

J Autism Dev Disord (2007) 37:9971006

The calories expended on Tuesdays and Thursdays were

combined with those expended on the other weekdays
and are part of the total calories found under the Class
column. Those expended during the weekdays after
3:15 pm were under Residential and those on the
weekends are listed under the Weekend column. For
all the participants in the TWG, the majority of calories
(>96%) were expended during the regular class hours.
For this study, therefore, participants were more willing/
able to engage in treadmill walking during their regular
class hours than at other times of the week.
A limitation of this study concerns number of participants. Of the 42 clients residing in the facility, only
10 (24%) were selected according to a selection criteria
based on the work by Pitetti et al. (1999). Of the 10
that met these criteria, only 5 participated in the TWG.
Given that it was not the scope of this study to determine whether on not those in the CG would have
demonstrated the same results of the TWG, only 5
(12%) of the clients residing in this facility actually
participated in the treadmill walking program. Future
studies should expand the selection criteria to determine if more individuals with severe developmental
disabilities can actively engage in an exercise program
of similar intensity.
Conclusion
Although prior research has established the positive
impact of antecedent exercise programs on behavioral
outcomes for adolescents with multiple disabilities,
including autism, none have established whether a longitudinal study with this population could be feasible
and result in increasing exercised capacity along with a
reduction in BMI. The treadmill walking program was
successful in achieving significant reductions in BMI in
combination with an increase in caloric expenditure.
The program also positively impacted the exercise
capacity (i.e. treadmill walking frequency, speed, and
grade) of the participants. The results of this study indicate that for persons with autism living in a community
residential/school treatment facility, a treadmill walking
program could improve or control their health profiles.

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