Health and Adapted Physical Activity

written by Phillip Conatser & Chris Ledingham, University of Texas Brownsville

Phillip Conatser

Chris Ledingham

This article is a modified version of a presentation Chris and I made at a national heath conference last year. The purpose of the presentation was to explore the adaptations a teacher should make in both the physical education and health education classrooms with regard to students with special needs. A variety of physical, mental, social, and behavioral conditions will be reviewed.

Objectives
List and describe six common health conditions typically seen in today's schools.
List and describe specific adaptations related to a variety of health conditions.
Discuss the role of Section 504 of the Rehabilitation Act of 1973 in student health.

The Conditions
What is a Seizure?

A recurring central nervous system problem, whereby there is an upset in the electrical activity of neurons within the cerebral cortex of the brain. When a person has a seizure, the cells in the brain are unable to maintain normal balance and depolarization (change in electrical activity) occurs too easily and frequently. One must also realize that seizures can affect only one part of the brain or the whole brain. In general, the person is not aware of their surroundings and is unable to control the movements.

The Adapted PE & Health Education View

• Educators needs to have a few basic skills and an understanding of the health needs of their students. More specifically, the basic understanding of first aid and the skills associated with treating seizures.
• Teachers need to know what type of seizure the students has, and have protocols in place for treatment.
• Have the student wear appropriate head protection for contact sports or activities that risk head injuries or falling.
• During swimming activities (a) use the "buddy" system, (b) use a smaller group setting, (c) use one-on-one instructor to student ratio, and (d) use personal flotation device (PFD). Use of a PFD, small group setting, and constant supervision can make swimming activities fun and safe. However, if the students is experiencing more frequent and violent seizures, and is currently not feeling well, instructors should choose alterative activities that are not in the pool. Even at home during bathing, careful supervision is needed because of the danger of drowning.
• During gymnastics activities or climbing a rope use experienced spotters and extra mats.
• If the student will be doing some form of rock climbing activity, the educator needs to ensure the person properly uses a safety rope to prevent falling. Free rock climbing is not recommenced.
• Exercises, games, and sport activities should be on soft surfaces such as grass, mats, or sand vs. hard wood floors, tile, or concrete.
• When hiking, go with a buddy or use a guide rope.
• When riding a ski lift use a safety strap.
• If downhill skiing, use the buddy system or use a guide rope.
• When bike riding, use a bicycle-built-for-two or choose trails with less hazards.
• If scuba diving or snorkeling, always have an experienced partner.
• If needed, have a change of clothes.
• It is worth repeating; if seizures are out of control, recent changes in medication, and/or the person is not feeling well, choose alternative activities that are lower risk.

What is Asthma?
Asthma is a disorder that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing. Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass.
In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

The Adapted PE & Health Education View

• Teachers need to know who has asthma in their classroom, and what the standard course of treatment is for the student experiencing an asthma attack.
• Students with asthma should have quick access to their personal inhaler.
• Teachers should monitor the student when using the inhaler.
• Care should be taken to prevent exposure to both environmental and physical triggers associated with attacks. By paying attention to those students with respiratory conditions, a severe attack may be avoided.
• Use longer warm-up (15-30 minutes) and cool-down (5- 10 minutes) periods.
• Have the child drink appropriate amounts of water before, during, and after activity.
• Avoid high body temperature.
• Exercise intermittent (5-10 minutes), interval training, or sports activities requiring short bursts of energy.
• Endurance activities should start slow, and then gradually increase to 65 - 85% THRZ.
• Avoid activity in extreme weather conditions (high temperature, high humidity, etc.).
• Have alternative indoor activities if outside weather is not suitable (excessive pollen, windy, high humidity).
• Exercising in mild weather conditions is best.
• Avoid cold dry air.
• Use a "Peak Flow" meter pre- to post- exercise to measure airflow (if there is more than 15% drop in airflow from baseline stop activity).
• Keep the gym clean (an environment free of dust and mold).
• Respiratory activities such as blowing party toys, bubbles, ping-pong balls, small feathers, or making loud noises in the gym, singing during play, laughing, swimming, and yoga are all good.

What are Allergies?
An allergy is an immune response or reaction to substances that are usually not harmful. The immune system normally protects the body against harmful substances such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless in most people. But for some people with allergies, the immune response is oversensitive. When it recognizes an allergen, the immune system launches an overwhelming response. Chemicals such as histamines are released. These chemicals cause allergy symptoms. Both genes and environment play a role.

The Adapted PE & Health Education View

• Allergies and asthma often go hand-in-hand. However, many students today have a host of allergies which can run from simple seasonal allergies requiring minimal treatment to severe allergic reactions caused by bee/wasp stings, food, or other contact allergies.
• In the event a teacher suspects a student is having an allergic reaction, the school nurse or EMS should be contacted depending - on the severity of the attack.
• Causes, incidence, and risk factors need to be documented for students with allergies.
• Allergies are common and typically non-threatening. However, teachers should be alert and take action if symptoms get worse.
• EpiPen should be available for students with severe allergic reactions.
• Individuals with Spinal Bifida may be highly allergic to latex. Therefore, avoid equipment made with this product.
• Wear gloves to avoid contact with allergenic substances such as latex balls or horse hair during equestrian activities.
• Keep hands from touching eyes, nose, mouth, and face.
• Wash hands well after contact with allergenic substances.
• Have alternative indoor activities if outside weather is not suitable (excessive pollen, very windy, high humidity).
• Keep the gym clean (dust, mold, etc.).

What is Obesity?
Childhood obesity has both immediate and long-term effects on the health and well-being students. In the United States, 55% of adults and 25% of school-age children are overweight. Further, 17% of the children and adolescents are considered obese. Overweight is 10 to 20% above ideal body fat for sex and age; Obese is 20% above ideal body fat; and Morbid Obese is 50% above ideal body fat.

Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5 - 17 year olds, 70% of obese youth had at least one risk factor for cardiovascular disease. Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes. Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem. (source)

The Adapted PE & Health Education View

• The classroom teacher should be sensitive to the needs of obese students, needs such as modified furniture and the threat of bullying.
• Prior to engaging in any type of strenuous activity the student should have a complete physical assessment completed by a physician. This is very important for students who may have hypertension or other cardiovascular conditions.
• The student should engage in non-weight-bearing activities, exercise daily 30 or more minutes (split workout for best results), and maintain an intensity of 40% to 60% of VO2 max (must be able to carry on a conversation while exercising).
• Help the student to vary the workout routine daily. It may be helpful to assign, or have the student select, a partner/buddy when exercising, and make activities fun (music, stimulating equipment, cooperative games, friendly supportive atmosphere).
• Extra hydration may be warranted because of excessive sweating and becoming hot more quickly than nonobese. When exercising, allow for more water hydration, breaks, and/or preform activities intermittent.
• Increase warm-up and cool-down time (slowly change body temperature). Activities such as Qigong, Yoga, and Pilates are great activities to start or end a workout session. These activities are also much needed for people who are obese because they are often lacking in strength, flexibility, and balance.
• Help the student to set goals, develop a written contract, keep records of performance, and manage time to allow for physical activity.
• Have the student avoid activities that require lifting ones' body weight, and high-impact activities such a pull-ups, gymnastics activities (rigs, uneven bars, high bar, etc), rope climbing, and pyramid building.
• Thermoregulation may be another problem when exercising for overweight or obese students, so try to maintain a cool or neutral temperature and humidity in the classroom environment. If outside weather is too hot, have the student take frequent breaks and use cool water or wet towels to help with overheating. For cold weather, layer clothes to help regulate body temperature. When weather is extreme an alternative activity could be considered in the gym and/or choose a different time of day.
• Chafing of the skin between the thighs, underarms, and around the abdominal area can be painful for students and may be slow to heal. Areas of the skin that rub together could be wiped with baby powder or a non gelling lubricant before exercising. Areas of contact between the thighs could be covered with pantyhose, athletic sleeves, or stretch-pants. Athletic sleeves can also be used on the arms. Additionally, excessive sweating can also promote chafing. Therefore, provide ample ventilation (fans) and clothing that allows the body to cool.
• Fear of falling can be a concern with knock-knees, pronated/flat feet, and a awkward shoulder width gait, creating mobility and balance problems. To help overcome fear, have the students participate in slower moving activities, use softer equipment, play on a level playing surface, use extra mats, and have proper spotters (2 or more). Spotters, buddies, and classmates can also be used to encourage and motivate performance.
• Cycling, arm ergometry, and rowing are great cardiovascular activities with little impact to joints and bones.
• Swimming is another great activity for people who are obese. Water properties allow for movement and floatation opportunities not afforded on land. With the ability to float well, they could be seen as equals or even leaders of water activities. Remember to let them keep their shirt on if they choose, non-traditional clothing may be needed, and privacy in the dressing room is a must.
• Vary workout routine daily, have a partner/buddy when exercising, and make activities fun (music, stimulating equipment, cooperative games, friendly supportive atmosphere).
• Cooperative recreational games encourage everyone to work together for success. Activities should be designed to allow for choices in equipment (big/small balls, light/heavy bats), choices in distance (close/faraway, low/high), and choices to modify rules (two bounces in tennis, no double-dribble in basketball).
• To increase understanding for teachers, coaches, parents, and other students role playing may be used. Role playing is one way to "walk a mile" is someone else's shoes. Have those not faced with being obese put on a 40% of the body weight back-pack an try to run, climb, or do a cartwheel. The extra weight can really make a difference in energy out-put and balance. Use this as a talking point, and an opportunity for the realization of the effort obese individuals make to perform the simplest of tasks.

The Adapted PE & Health Education View

• Because the severity of cerebral palsy varies greatly from student to student afflicted with CP, the teachers need to be well informed of all health needs.
• Teachers should ensure that all appropriate accommodations are made in accordance with the students Individual Education Plan.
• For student that uses a wheelchair, they should be repositioned every 30 minutes and every hour taken out of the wheelchair for 30 minutes (30-30 rule). Students could lay on a mat, be put in a stander, or be placed in a vestibular swing for 30 minutes.
• The physical educator should have a sports wheelchair and/or a standing wheelchair available to substitute with a traditional wheelchair during physical activity.
• If a student can use a walker, encourage its use around the classroom, in the hallway, and in physical education. Further more, if a student can "push" his/her wheelchair, encourage this behavior and do not allow peers to push for them.
• Muscular endurance, muscular strength, and stretching are all great activities for students with CP.
• Students with CP should be included in all activities, and inclusion should be in a meaningful way (not the scorekeeper).
• Student will succeed best if teachers are creative, flexibly, adaptable, and open to new ideas.
• Students with CP may experience fatigue easer, so a healthy snack could be provided throughout the day. Note, this is especially true for students that use a walker.

What is Diabetes?
Diabetes is a disease in which there are high levels of sugar in the persons blood. There are two major types of diabetes.
Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Type 2 diabetes makes up most diabetes cases. It most often occurs in adulthood. However, because of high obesity rates, teens and young adults are now being diagnosed with diabetes.

The Adapted PE & Health Education View

• Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (which often comes before type 2 diabetes).
• Diabetes is, unfortunately, becoming more common among children of all ages.
• If a student is diagnosed as a diabetic, all teachers should be made aware of the condition and receive special training on how to monitor and treat the needs that may arise.
• Teachers should be involved in monitoring the student, and have a good relationship with the child, the school nurse, medical provider (doctor), and the parents.
• If at any time the teacher suspects the child may be ill, they should not hesitate to call the nurse or an emergency medical service.
• Physical activity is highly recommenced for people with diabetes.
• Endurance (aerobic) activities are best.
• Check glucose levels before, during, and after physical education.
• Glucose levels should be between 75 to 130 milligrams per deciliter percent.
• Eat meals or snacks 30 minutes before physical activity.
• Do physical activity in the morning, and if student is insulin dependent do not take short term medication. Only long lasting medication.
• For best results, have students glucose levels as high as safely possible before physical activity.
• Have sugar (candy, juice), glucose pills, or glucose injector available.
• Stop workout if glucose level gets too low (e.g., 55 m/dc), then have student ingest something that will increase glucose levels. Continue to monitor.
• Encourage student to have a high fiber and protein diet.
• Document daily glucose levels during physical activity so adjustments can be made to maximize performance.

The Role of Section 504 of the Rehabilitation Act of 1973?
Section 504 is a national law that protects qualified individuals from discrimination based on their disability. Service and activities must be made readily accessible with reasonable accommodations. Individuals with disabilities are defined as "persons with a physical or mental impairment which substantially limits one or more major life activities. People who have a history of, or who are regarded as having a physical or mental impairment that substantially limits one or more major life activities, are also covered. Major life activities include caring for one's self, walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning."

The Adapted PE & Health Education View

• Individuals with seizures, asthma, allergies, obesity, cerebral palsy, and diabetes could all qualify for protection under this law and receive modifications as needed to be successful in school.
• School systems are required to have a annual meeting to discuss and draft a education plan for all qualified students.
• The educational plan could include all previously mentioned suggestions presented in this article and more.
• Modifications could also include the school cafeteria, whereby students with obesity, diabetes, and allergies may have special diets to follow, or students with CP may need food blended, feeding tubes, or specially designed fork/spoons.
• Remember, any reasonable modifications that could help the student be successful in the classroom, gym, sports, and/or cafeteria would be appropriate.

The Standards

• National Health Education Standards
• Adapted Physical Education National Standards
• American Association for Health Education 2008 NCATE Health Education Teacher Preparation Standards
• NASPE and APENS Standards

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