Let’s get moving: physical activity can be challenging but highly beneficial for individuals with developmental disabilities, a few modifications may help

Playing at Waisman Whirl
Participants at the Waisman Whirl


By Charlene N. Rivera-Bonet | Waisman Science Writer

The researchers interviewed for this story use identity-first language in alignment with the preferences of many of those in the autistic community. This story reflects that preference.

A non-exhaustive list of accessible options for physical activities in the Madison area are provided at the end.

They say movement is medicine and while physical activity has so many benefits for everyone, what do you do when moving is a challenge? For some the challenge is time, for others motivation, but for individuals with intellectual and developmental disabilities (IDD) there are many barriers that can make physical activity a little harder to achieve.

Individuals with IDD often have more sedentary lifestyles compared to individuals without an IDD, research has shown. There are many factors that could contribute to this from musculoskeletal problems and difficulties with balance and coordination, to the lack of accessible programs and spaces for people with disabilities. Physical activity, although challenging, can be highly beneficial for individuals with IDD offering improved physical, mental and social health or well-being.

Barriers, benefits, and facilitators of physical activity in IDD

Sigan Hartley, PhD
Sigan Hartley, PhD

People with IDD often have co-occurring health conditions or motor challenges that can make it more difficult to be physically active. For example, children and adults with Down syndrome can struggle with balance and coordination and often have poor muscle tone and musculoskeletal problems. “These challenges can mean that certain physical activities need to be adapted to be inclusive of individuals with Down syndrome. For example, exercise classes may need to demonstrate multiple ways of doing squats so that individuals with varying ability levels can participate in the class,” says Sigan Hartley, PhD, professor, 100 Women Distinguished Chair in Human Ecology and Waisman Center investigator.

Hartley researches lifestyle factors that promote healthy aging in individuals with Down syndrome, including physical activity. One of her studies found that for individuals with Down syndrome, engaging in more physical activity of moderate-intensity (activities that get your heart rate up) was related to maintaining healthy brain function for longer. Although the benefits of physical activity for brain health are not unique to individuals with Down syndrome, understanding these benefits is particularly important because individuals with Down syndrome have a high risk for developing Alzheimer’s disease. In part the benefit of more physical activity was through reducing co-occurring health conditions such as apnea and endocrine/metabolic conditions, and anxiety disorders, another of her studies showed.

Hartley’s research uses a seven-day diary along with a research version of a Fitbit to track physical activity in adults with Down syndrome. They have found a few things that make exercise more attainable for this population. The first one is routine. “For individuals with Down syndrome who were engaged in more physical activity, the thing that seemed to differentiate that group is they established an exercise routine,” Hartley explains. They carved these activities into their weekly routines. Moreover, they often did physical activity with other people, such as going for a walk with a roommate or attending a group exercise class for adults with Down syndrome at Gigi’s Playhouse.

Occupational therapist at the Waisman Center Jaclyn Bender, MS, OTR/L, says that a routine helps individuals know what to expect. Children can also benefit from having a visual schedule to help them understand the repetitions, and length or sequence of activities.

“…finding activities that are meaningful and enjoyable for the individual and likely their family would be a way to just improve participation,”  Bender says

Jaclyn Bender
Jaclyn Bender, MS, OTR/L

Making physical activity a social task and doing it with other people is also a motivator for individuals with Down syndrome, Hartley’s research found.

“The enjoyment piece is absolutely a huge part of this because nobody really wants to exercise all the time,” Bender says. “We all need some sort of motivating factor. So, finding activities that are meaningful and enjoyable for the individual and likely their family would be a way to just improve participation.”

To make physical activity more enjoyable, Brittany Travers, PhD, associate professor of kinesiology and Waisman Center investigator, developed an intensive balance training for autistic children and adolescents using video games.

Through her research, Travers found differences in balance and joint movement between autistic and non-autistic children. “And we did this balance training in a video game to try to make it motivating and fun,” Travers says. The video game consisted of standing on a Nintendo Wii balance board while mimicking tai chi and yoga poses in an on-screen game. For autistic kids, difficulties with motor control are highly predictive of more severe autism symptoms and poorer execution of daily living skills. “And we found that six weeks of very intensive balance training had led to changes in the brain and changes in the prominence of some autistic behaviors,” Travers says. At the end of the training, the participating youth had improved balance and posture and a reduction in severity of autism symptoms.

Brittany Travers observes girl as she plays a video game using the balance board.
Brittany Travers, PhD observes a participant mimicking tai chi and yoga poses on a balance board.

Family involvement can go a long way, parents can benefit from training

Luis Columna, PhD
Luis Columna, PhD

There are not very many facilities for families with children with disabilities to go and play that are directed by professionals. Because of this, making physical activity fun and engaging, especially for children, can rely heavily on parents. This can be by advocating for them at school, communicating their child’s needs to their physical education teacher, or spending time being active with their kids. The latter can be a challenging task, so Luis Columna, PhD, professor of kinesiology, focuses on training parents of kids with disabilities on physical activity in order to make it more attainable.

“These children, or these individuals, most of the time, they’re going to spend time with their parents and their family,” Columna says. Because of this, parents can be an important motivator and facilitator of their children’s physical activity. “The parents need to be motivated first, and they need to have set rules,” Columna says. “Sometimes we need to go out of our ways to do that.”

Columna’s main line of research began when staff didn’t show up for a sports camp for kids with disabilities. Being short-staffed led him to ask parents to help out. At the end of the event, a dad approached Columna with tears in his eyes saying “I didn’t know I was holding my kid back.” Helping his child do sports led him to realize his unexplored potential. “Sometimes [parents] don’t know what to do, they tend to over protect them. And that’s a problem,” Columna says. He then adapted this training for parents of autistic children, and is now working on adapting it for individuals with Down syndrome.

Columna’s research focuses on identifying ways to increase participation of families of children with disabilities in physical activity. In collaboration with parents, he created the Fit Families Program, through which he provides training and adaptive equipment for parents, as well as an app that shows how to use the equipment and different types of adaptations to tailor the activity to different abilities. The app is currently for research purposes only, but he hopes to be able to make it available for the public in the near future.

Start with being less sedentary, find movement opportunities everywhere

The World Health Organization (WHO) just recently updated their guidelines and recommendations on physical activity to include individuals with intellectual disabilities in 2020. According to their guidelines, some potential benefits of physical activity on health outcomes for individuals with disabilities include improved cognition for those with a disorder that impairs cognitive function, and improvement in physical function in children with intellectual disability.

Lindsey Stanek
Lindsey Stanek, PT, DPT

Although their recommendation is that children and adolescents with a disability should do an average of at least 60 minutes a day of moderate to vigorous intensity, they state that doing some physical activity is better than doing none. “They don’t set out additional specific guidelines for children with developmental disabilities,” says Lindsey Stanek, PT, DPT, a physical therapist at the Waisman Center Clinics. “That amount might need to be adapted or changed, or just what that might look like might need to be different.”

When we think about staying physically active our minds might go to a gym, a running trail, or a Zumba class, but there are ways to increase physical activity even in the most mundane of tasks. Columna’s children get annoyed when he drives by dozens of close by, open parking spots just to park farther away at the mall. But it gets them walking just a little further. Sometimes it’s not about increasing physical activity, but also decreasing sedentary activities, Bender says. “It seems very obvious, but even just implementing small bursts of regular daily activities into kids’ days can be a great way just to get started into this trend toward trying to get to those daily recommendations, but it might feel very lofty, and unattainable for kids with IDD or physical disabilities or both,” Bender says.

Children help prepare cookie dough
Children at the Waisman Early Childhood Program help with making cookies

There are daily activities, Bender says, that a parent can step back from if they feel their child is safe and they have the time to commit to letting the kids try. For example, helping them gather items in the kitchen to make a simple meal, or having them do chores that are within their developmental level. “It could even be emptying the waste baskets in the house, so that’s going from room to room to room. That’s increasing their mobility. And they’re doing something functional,” she adds. “It’s really challenging from a logistical standpoint, because families are busy. And we just live in this life of needing to get to the next thing,” Bender says. “This may not work all the time, and families can’t do it every day, every time. But I do think making small changes can help change just expectations of both the parent and the individual.”

Therapy can help with new physical activity goals

To make tasks more attainable for children with disabilities, occupational therapy and physical therapy can come in handy. As a physical therapist, Stanek helps provide meaningful recommendations for kids to be able to access their environment and participate in activities based on their personal characteristics, environment, and daily routines. “I want physical activity to be meaningful and engaging. And then to provide appropriate supports to allow that participation, whatever that might look like for each individual,” Stanek says.

Occupational therapists like Bender assist individuals in completing activities that they need or want to do in their daily life. “We’re either going to work on a skill behind a task, or we’re going to adapt a task, or modify something to make the task a little bit more attainable to an individual, or we’re going to adjust their environment to promote as much independence as possible for that individual,” Bender explains.

Accessing these types of therapies can help an individual gain a skill they need in order to achieve their physical activity goals. However, therapy appointments, Stanek and Bender emphasize, do not need to become a family commitment or extracurricular activity, but a supplement to the family and the individual’s life goals. “So, moving away from this idea that my child has a disability, and therefore we need to be in therapy, physical or occupational therapy, to really identifying what the goal is, and then seeking out the assistance that might be needed,” Bender says. They call this episodic care. This then encourages the family or individual to carry those goals at home in their everyday life. “I think physical therapy can be so helpful to address this topic, but I don’t want it to just be in the closed setting. How could it be a part of a lifestyle?” Stanek says. “Unstructured play and physical activity are just as important.”

Start incorporating physical activity early on

Bender and Stanek encourage an early jump start on working on motor skills and implementing physical activity for kids. As early as day one.

“Movement might not look exactly how it’s listed on a motor milestone chart, but we are moving and that is so important,” Stanek says

Babies learn through movement. “The baby brain is making so many connections, and the experiences that are provided to the baby brain can really enrich those connections,” Stanek says. This can help with intrinsic motivation, spatial awareness, and cognition. “Movement might not look exactly how it’s listed on a motor milestone chart, but we are moving and that is so important,” she adds.

Early intervention can also set kids up for success, so providing as much support as possible early on can be highly beneficial.

Accessible recreation in the Madison area

Playground with ramp at Elver Park
Playground at Elver Park with ramp, making it wheelchair accessible

Accessibility and lack of exercise or sports programs and spaces for individuals with disabilities are a barrier for staying physically active. Gyms can be loud and crowded, and are not always inclusive of adapted equipment or instructors that are trained on how to adapt exercises to fit diverse ability levels.

“Transportation can also be a struggle,” Hartley says. While some individuals with disabilities are able to drive, many others rely on public transportation or transportation services, which presents another accessibility barrier.

Dane County Parks has a list of adapted options in their park system, grouped by activity. Some of these options include but are not limited to free all-terrain wheelchair rentals, a list of five accessible campgrounds, and a list of hard surface trails.

Visit Madison also has a list of six accessible destinations to enjoy the outdoors, with playgrounds that are accessible to wheelchair users.

Madison Parks Foundation has funded several initiatives to make parks in Madison more welcoming for people of all ages and abilities. Currently, the four playgrounds adapted to all abilities are the Jeff Erlanger Accessible Playground at Rennebohm Park, The Frautschi Family Accessible Playground in Warner Park, which has 50 unique features for different levels of speaking and mobility including a board with signs for kids who are non-verbal to communicate with, Elver Park, and the Jenni and Kyle Foundation Playground at Brittingham Park. Just nearby in Fitchburg, McKee Farm Parks, which includes a splash pad, features accessible ramps, swing sets and paths.

At the Waisman Center, the Discovery Garden was created with accessibility in mind. The 1.5-acre outdoor learning and play space is inclusively designed to welcome developmentally diverse children.

Non-profit organizations such as Special Olympics Wisconsin, Arts for All, and Madison School and Community Recreation also provide adapted opportunities for physical activities for individuals with disabilities. These include opportunities for sports and dance.

The Bakke Recreation and Wellbeing Center at the University of Wisconsin-Madison also houses the Adapted Fitness and Personal Training Program from the Department of Kinesiology, which offers classes designed to accommodate participants with permanent or temporary disabilities. Some participants also work on improving activities of daily living. The center also has adapted equipment, including adaptive climbing.

This list is not exhaustive. More programs and spaces may be available to help individuals with IDD be physically active.


Adapted swings at Elver Park
Adapted swings at Elver Park