CRITICALLY APPRAISED PAPER (CAP)
FOCUSED QUESTION
Does antecedent exercise have an effect of maladaptive and stereotypic behaviors
for persons with autism spectrum disorders (ASDs) and profound mental
retardation?
Elliot, R. O., & Dobbin, A. R. (1994). Vigorous, aerobic exercise versus general motor
training activities: Effects on maladaptive and stereotypic behaviors of adults with both
autism and mental retardation. Journal of Autism and Developmental Disorders, 24(5),
565–576. http://dx.doi.org/10.1007/BF02172138
CLINICAL BOTTOM LINE:
With the increasing prevalence of ASDs, families and caregivers are trying a variety of
treatments to enhance their child’s quality of life. However, it is easy for families to be
overwhelmed by the vast amount of alternative and complimentary treatments available.
Many families are currently obtaining their information by word of mouth (Wong,
2008). While this strategy is useful in sharing ideas, it does not provide families with
important information such as possible side effects, effectiveness, and research
available.
This study evaluates “the effects of antecedent exercise conditions on maladaptive and
stereotypic behaviors [on participants] with both autism and moderate to profound
mental retardation” (p. 565). The subjects participated in 2 exercise (antecedent aerobic
and general motor training) and 1 non-exercise condition in a controlled environment,
and their behaviors were observed before and after. The results of this study show that
through this intervention strategy, there is evidence that autistic behaviors decrease in
occurrence after vigorous exercise despite some lack of success for some participants in
the study.
Occupational therapists can use this study as a tool for to reference when choosing if
exercise techniques are beneficial for their consumers. This study indicates that further
research is needed for this topic with a larger sample size in order to improve its
generalization for any one population. This study is one source of evidence indicating
that antecedent vigorous aerobic exercise can result in positive changes in behaviors and
functional performance in the adults with lower functioning ASD.
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RESEARCH OBJECTIVE(S)
List study objectives.
1. To “compare the behavioral effects of general motor training activities to those of
vigorous, aerobic exercise” for people with developmental disabilities (p. 568).
2. To examine the effects on “adults with autism who reside in an institutional setting
and the potential impact of exercise on their daily lives and long-term options” (p.
568).
3. To evaluate vigorous aerobic exercise and its effects on “maladaptive and
stereotypic behaviors as separate behavioral entities” (p. 568).
DESIGN TYPE AND LEVEL OF EVIDENCE:
Design: 3 groups, randomized, pre–post testing, with one factor of repeated measures
Level: I
Limitations (appropriateness of study design):
Was the study design type appropriate for the knowledge level about this topic?
YES/NO This study authors reviewed previous research about this topic in
order to enhance and develop method, aims, and data collection.
SAMPLE SELECTION
How were subjects selected to participate? Please describe.
All participants were “clients of a residential treatment program for people with autism”
(p. 568).
Inclusion Criteria
All participants met the DSM–III–R criteria for ASD and mental retardation.
Exclusion Criteria
This study reports that “medical contraindications or significant primary sensory or
motor impairments” are exclusion criteria for participants in this study (p. 568).
SAMPLE CHARACTERISTICS
N=6
# Dropouts 0
# Male
3
Ethnicity
NR
Disease/disability diagnosis
# Female
ASD
Mental retardation
2
3
Check appropriate group:
<20/study
group

20–50/study
group
51–100/study
group
101–149/study
group
150–200/study
group
INTERVENTION(S) AND CONTROL GROUPS
Add groups if necessary.
Group 1
Brief
Description
General motor training activities were defined as “elevating heart
rates to levels between 90–120 beats per minute (bpm) after 20
minutes” (p. 570). Activities that achieved this targeted heart rate
included riding an exercise bike, using a stair-stepper machine, lifting
weights, or walking on a treadmill at 2.0 miles per hour (mph).
Setting
Controlled environment.
Who Delivered?
Designated staff.
Frequency?
5 trials.
Duration?
20 minutes.
Group 2
Brief
Description
A non-exercise condition was used to control attention. This group
carried out activities with little potential for increasing the heart rate
of participants. Activities included board games, puzzles, and arts
and crafts.
Setting
Controlled environment.
Who Delivered?
Designated staff.
Frequency?
5 trials.
Duration?
20 minutes.
Group 3
Brief
Description
Vigorous, aerobic exercise was defined in this study as “elevating
heart rates to levels above 130 bmp after 20 minutes” (p. 570). This
group only used a motorized treadmill moving at 4.0 mph.
Setting
Controlled environment.
Who Delivered?
Designated staff.
Frequency?
5 trials.
Duration?
20 minutes.
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Intervention Biases: Circle yes or no and explain, if needed.
Contamination
YES/NO
Co-intervention
YES/NO Other interventions were continued during the time of services.
Timing
YES/NO Timing of intervention was not consistent daily.
Site
YES/NO The setting where intervention was completed was in an institution
that individuals were used to.
Use of different therapists to provide intervention
YES/NO
MEASURES AND OUTCOMES
Complete for each relevant measure when answering the evidence-based question:
Name of measure, what outcome was measured, whether the measure is reliable and valid
(as reported in article–yes/no/NR [not reported]), and how frequently the measure was
used.
Heart rate: Overall heart rate was measured pre- and post-intervention.
a. Reliability, NR
b. Validity, NR
c. Frequency of measure used = every session.
Name of measure, what outcome was measured, whether the measure is reliable and valid
(as reported in article–yes/no/NR [not reported]), and how frequently the measure was
used.
Observation was used to measure maladaptive behaviors.
a. Reliability. high degree (r = .97)
b. Validity, NR
c. Frequency of measure used = every session.
Measurement Biases
Were the evaluators blind to treatment status? Circle yes or no, and if no, explain.
YES/NO Evaluators were aware of diagnosis and aims of study.
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Recall or memory bias. Circle yes or no, and if yes, explain.
YES/NO Data was collected during and analyzed after treatment.
RESULTS
List results of outcomes relevant to answering the focused question.
Include statistical significance where appropriate (p < 0.05).
Include effect size, if reported.
Improved behavior during sessions following vigorous and aerobic exercise was
significantly greater than those results yielded from the non-exercise control
group (p < 0.001).
There was no significance of effects following general motor training (p < 0.03)
when compared to the control group that did not receive the experimental
intervention.
“Following aerobic exercise, over 57% of the maladaptive and 65% of the
stereotypic behaviors showed improvement” (p. 572).
Was this study adequately powered (large enough to show a difference)? Circle yes or
no, and if no, explain.
YES/NO Only 6 participants were evaluated, and all were adults from the same
facility; therefore, this study cannot be generalized to all with the
diagnosis of ASD.
Were appropriate analytic methods used? Circle yes or no, and if no, explain.
YES/NO
Were statistics appropriately reported (in written or table format)? Circle yes or no, and if
no, explain.
YES/NO Tables were used appropriately and accurately depict results.
CONCLUSIONS
State the authors’ conclusions that are applicable to answering the evidence-based
question.
Vigorous exercise is beneficial for reducing undesirable behaviors associated with ASD
for many with the diagnosis. Occupational therapists can use this data to assist in
designing treatment programs for clients with an ASD diagnosis. Although this study
yields promising results, the population and sample size used are not large enough to be
generalized to the entire autism population. Further research is needed to provide
conclusive results with a larger sample size.
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This work is based on the evidence-based literature review completed by Hannah Doody, OTS, and Carmela Battaglia,
PhD, OTR/L, Faculty Advisor, Keuka College.
CAP Worksheet adapted from “Critical Review Form–Quantitative Studies,” copyright  1998, M. Law, D. Stewart,
N. Pollack, L. Letts, J. Bosch, & M. Westmorland, McMaster University. Used with permission.
For personal or educational use only. All other uses require permission from AOTA. Contact: www.copyright.com
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