The Carrus Institute for Families

1. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities The Center for Discovery The Janet and Gerald Carrus Institute for Families   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. The Carrus Institute for Families

2. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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. National Center on Physical Activity and Disability (NCPAD)

3. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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) Current Research

4. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities There are four main parts to physical fitness: Muscle strength and endurance Flexibility Body composition (body fat- amount of activity you get, type and amount of food you eat) 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) Components of Physical Fitness

5. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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.

6. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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

7. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities Physical Activity Component

8. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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.

9. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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. • 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

10. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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

11. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities Nutrition Component • 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

12. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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

13. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities Pre, Midpoint, and Post Study Measurements

14. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities Sample Goniometric Comparison

15. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities Sample Goniometric Comparison

16. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities Sample Goniometric Comparison

17. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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

18. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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.

19. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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.

20. Physical Activity and Nutrition for Adults Aging with Multiple Disabilities 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.