Abstract
Objectives
Individuals with autism spectrum disorder (ASD) report experiencing stress, which increases with age. Few studies have included the biological stress response for measuring stress. While aerobic exercise can lower stress and repetitive behaviors, motivating adults with disabilities to exercise can be challenging. This study examined whether virtual reality (VR) exercise would improve behavior and stress physiology.
Methods
Seven males with ASD participated. This study employed a single subject withdrawal design, using a baseline phase, followed by alternating intervention (i.e., VR biking) and withdrawal (i.e., no exercise) conditions. Frequency and/or duration of repetitive behaviors were assessed. Pre-post intervention hair cortisol and salivary cortisol for each phase were collected.
Results
Overall, repetitive behaviors were lower in the final phase (M = 24.28, SD = 2.42) compared to baseline (M = 36.68, SD = 5.33). There was no significant difference in basal T1 cortisol levels across phases (χ2(6) = 2.571, p < .276); however, four participants showed cortisol levels that decreased markedly following the first intervention and remained low for the duration of the study. There was a significant difference in the cortisol levels of participants by pre and post intervention status (first intervention phase, B) as measured by AUCg (χ2(1) = 7.00, p < .008).
Conclusions
This study demonstrates that exercise can have acute and cumulative effects on basal cortisol levels and repetitive behaviors for adults with ASD, particularly those with higher cortisol levels and rates of behaviors.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Data is available upon request.
References
Albantakis, L., Brandi, M. L., Bruckl, T., Gebert, D., Auer, M. K., Kopczak, A., Stalla, G. K., Neumann, I. D., & Schilbach, L. (2021). Oxytocin and cortisol concentrations in adults with and without autism spectrum disorder in response to physical exercise. Comprehensive Psychoneuroendocrinology, 5, 100027. https://doi.org/10.1016/j.cpnec.2021.100027
Allison, D. B., Basile, V. C., & MacDonald, R. B. (1991). Brief report: Comparative effects of antecedent exercise and lorazepam on the aggressive behavior of an autistic man. Journal of Autism and Developmental Disorders, 21(1), 89–94. https://doi.org/10.1007/bf02207001
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
Anderson-Hanley, C., Tureck, K., & Schneiderman, R. L. (2011). Autism and exergaming: Effects of repetitive behaviors and cognition. Psychology Research and Behavior Management, 4, 129–137. https://doi.org/10.2147/PRBM.S24016
Bahrami, F., Movahedi, A., Marandi, S. M., & Abedi, A. (2012). Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder. Research in Developmental Disabilities, 33(4), 1183–1193. https://doi.org/10.1016/j.ridd.2012.01.018
Beserra, A., Kameda, P., Deslandes, A. C., Schuch, F. B., Laks, J., & Moraes, H. S. (2018). Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends in Psychiatry and Psychotherapy, 40(4), 360–368. https://doi.org/10.1590/2237-6089-2017-0155
Bozovic, D., Racic, M., & Ivkovic, N. (2013). Salivary cortisol levels as a biological marker of stress reaction. Medical Archives, 67(5), 374–377. https://doi.org/10.5455/medarh.2013.67.374-377
Bremer, E., Crozier, M., & Lloyd, M. (2016). A systematic review of the behavioral outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism, 20(8), 899–915. https://doi.org/10.1177/1362361315616002
Carraro, A., & Gobbi, E. (2012). Effects of an exercise programme on anxiety in adults with intellectual disabilities. Research in Developmental Disabilities, 33, 1221–1226. https://doi.org/10.1016/j.ridd.2012.02.014
Carter, S. L. (2010). The social validity manual: A guide to subjective evaluation of behavior interventions. Academic Press. https://doi.org/10.1016/C2009-0-01897-2
Chang, L. C., Wang, C. Y., & Yu, P. (2014). Virtual reality improves sleep quality amongst older adults with disabilities. International Journal of Geriatric Psychiatry, 29, 1312–1317. https://doi.org/10.1002/gps.4172
Cheak-Zamora, N., & Odunleye, O. (2022). Stress and coping in autistic young adults. Autism in Adulthood, 4(3), 193–202. https://doi.org/10.1089/aut.2021.0043
Cohen, S., Conduit, R., Lockley, S. W., Rajaratnam, S. M., & Cornish, K. M. (2014). The relationship between sleep and behavior in autism spectrum disorder (ASD): A review. Neurodevelopmental Disorders, 6, 44. https://doi.org/10.1186/1866-1955-6-44
D’Anna-Hernandez, K. L., Ross, R. G., Natvig, C. L., & Laudenslager, M. L. (2011). Hair cortisol levels as a retrospective marker of hypothalamic-pituitary axis activity throughout pregnancy: Comparison to salivary cortisol. Physiology & Behavior, 104(2), 348–353. https://doi.org/10.1016/j.physbeh.2011.02.041
Elliot, R. O., Jr., Dobbin, A. R., Rose, G. D., & Soper, H. V. (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. https://doi.org/10.1007/bf02172138
Gerber, M., Brand, S., Lindwall, M., Elliot, C., Kalak, N., Herrmann, C., Pühse, U., & Jonsdottir, I. H. (2012). Concerns regarding hair cortisol as a biomarker of chronic stress in exercise and sport science. Journal of Sports Science & Medicine, 11(4), 571–581.
Groden, J., Baron, G., & Groden, G. (2006). Assessment and coping strategies. In G. Baron, J. Groden, G. Groden, & L. Lipsitt (Eds.), Stress and coping in autism (pp. 15–41). Oxford University Press.
Groden, J., Diller, A., Bausman, M., Velicer, W., Norman, G., & Cautela, J. (2001). The development of a stress survey schedule for persons with autism and other developmental disabilities. Journal of Autism and Developmental Disorders, 31(2), 207–217. https://doi.org/10.1023/a:1010755300436
Hillier, A., Murphy, D., & Ferrara, C. (2011). A pilot study: Short-term reduction in salivary cortisol following low level physical exercise and relaxation among adolescents and young adults on the Autism Spectrum. Stress and Health, 27, 395–402. https://doi.org/10.1002/smi.1391
Hong, J., Bishop-Fitzpatrick, L., & Smith, L. E. (2016). Factors associated with subjective quality of life of adults with autism spectrum disorder: Self-report versus maternal reports. Journal of Autism and Developmental Disorders, 46, 1368–1378. https://doi.org/10.1007/s10803-015-2678-0
Iadarola, S., Oakes, L. A., Shih, W., Dean, M., Smoth, T., & Orlich, F. (2018). Relationship among anxiety, depression, and family impact in adolescents with autism spectrum disorders and average-range IQ. Focus on Autism and Other Developmental Disabilities, 33(3), 171–181. https://doi.org/10.1177/1088357616672416
Kern, L., Koegel, R. L., & Dunlap, G. (1984). The influence of vigorous versus mild exercise on autistic stereotyped behaviors. Journal of Autism and Developmental Disorders, 14(1), 57–67. https://doi.org/10.1007/bf02408555
LaLonde, K. B., MacNeill, B. R., Eversole, L. W., Ragotzy, S. P., & Poling, A. (2014). Increasing physical activity in young adults with autism spectrum disorders. Research in Autism Spectrum Disorders, 8, 1679–1684. https://doi.org/10.1016/j.rasd.2014.09.001
LeBeau, M. A., Montgomery, M. A., & Brewer, J. D. (2011). The role of variations in growth rate and sample collection on interpreting results of segmental analyses of hair. Forensic Science International, 210, 110–116. https://doi.org/10.1016/j.forsciint.2011.02.015
Levinson, L. J., & Reid, G. (1993). The effects of exercise intensity on the stereotypic behaviors of individuals with autism. Adapted Physical Activity Quarterly, 10(1), 255–268. https://doi.org/10.1123/apaq.10.3.255
Lotan, M., Yalon-Chamovitz, S., & Weiss, P. L. (2009). Improving physical fitness of individuals with intellectual and developmental disability through a virtual reality intervention program. Research in Developmental Disabilities, 30, 229–239. https://doi.org/10.1016/j.ridd.2008.03.005
Lotan, M., Yalon-Chamovitz, S., & Weiss, P. L. (2010). Virtual reality as means to improve physical fitness of individuals at a severe level of intellectual and developmental disability. Research in Developmental Disabilities, 31, 869–874. https://doi.org/10.1016/j.ridd.2010.01.010
Manente, C. J., Maraventano, J. C., LaRue, R. H., Delmolino, L., & Sloan, D. (2010). Effective behavioral intervention for adults on the autism spectrum: Best practices in functional assessment and treatment development. The Behavior Analyst Today, 11(1), 36–48. https://doi.org/10.1037/HO100687
Martens, B. K., Witt, J. C., Elliott, S. N., & Darveaux, D. X. (1985). Teacher judgments concerning the acceptability of school-based interventions. Professional Psychology: Research and Practice, 16(2), 191–198. https://doi.org/10.1037/0735-7028.16.2.191
McGillivray, J. A., & Evert, H. T. (2018). Exploring the effect of gender and age stress and emotional distress in adults with autism spectrum disorder. Focus on Autism and Other Developmental Disabilities, 33(1), 55–64. https://doi.org/10.1177/1088357614549317
McMahon, D. D., Barrio, B., McMahon, A. K., Tutt, K., & Firestone, J. (2020). Virtual reality exercise games for high school students with intellectual and developmental disabilities. Journal of Special Education Technology, 35(2), 87–96. https://doi.org/10.1177/0162643419836416
McMahon, A. K., & McMahon, D. D. (2016). Exercise technology interventions and individuals with IDD. DADD Online Journal: Research to Practice, 3(1), 42–53.
National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Addressing the need for evidence-based practice guidelines for Autism Spectrum Disorder. National Autism Center.
Putnam, S. K., Lopata, C., Thomeer, M. L., Volker, M. A., & Rodgers, J. D. (2015). Salivary cortisol levels and diurnal patterns in children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 27, 453–465. https://doi.org/10.1007/s10882-015-9428-2
Rosenberg, R. E., Kaufmann, W. E., Law, J. K., & Law, P. A. (2011). Parent report of community psychiatric comorbid diagnoses in autism spectrum disorders. Autism Research & Treatment, 2011, 1–10. https://doi.org/10.1155/2011/405849
Sowa, M., & Meulenbroek, R. (2012). Effects of physical exercise on autism spectrum disorders: A meta-analysis. Research in Autism Spectrum Disorders, 6, 46–57. https://doi.org/10.1016/j.rasd.2011.09.001
Tarr, C. W., Rineer-Hershey, A., & Larwin, K. (2020). The effects of physical exercise on stereotypic behaviors in autism: Small-n meta-analyses. Focus on Autism and Other Developmental Disabilities, 35(1), 26–35. https://doi.org/10.1177/1088357619881220
Taylor, J. L., & Corbett, B. A. (2014). A review of rhythm and responsiveness of cortisol in individuals with autism spectrum disorders. Psychoneuroendocrinology, 49, 207–228. https://doi.org/10.1016/j.psyneuen.2014.07.015
Todd, T., & Reid, G. (2006). Increasing physical activity in individuals with autism. Focus on Autism and Other Developmental Disabilities, 23(3), 167–176. https://doi.org/10.1177/10883576060210030501
van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychological Review, 14, 302–317. https://doi.org/10.1007/s10567-011-0097-0
de Vaan, G., Beijers, R., Vervloed, M. P. J., Knoors, H., Bloeming-Wolbrink, K. A., de Weerth, C., & Verhoeven, L. (2020). Associations between cortisol stress levels and autism symptoms in people with sensory and intellectual disabilities. Frontiers in Education, 30(5), 1–8. https://doi.org/10.3389/feduc.2020.540387
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. https://doi.org/10.1016/j.cpr.2009.01.003
Witt, J. C., Elliott, S. N., & Martens, B. K. (1984). Acceptability of behavioral interventions used in classrooms: The influence of amount of teacher time, severity of behavior problem, and type of intervention. Behavioral Disorders, 9(2), 95–104.
Wright, K. D., Hickman, R., & Laudenslager, M. L. (2015). Hair cortisol analysis: A promising biomarker of HPA activation in older adults. The Gerontologist, 55(Suppl 1), S140–S145. https://doi.org/10.1093/geront/gnu174
Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI Journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480
Yui, K., & Ohnishi, M. (2013). Plasma cortisol response to asked questions on recent events during videogame play in individuals with autism spectrum disorders. American Journal of Clinical Medicine Research., 1, 65–70. https://doi.org/10.12691/ajcmr-1-4-5
Zimmerman, D., Ownsworth, T., O’Donovan, A., Roberts, J., & Gullo, M. J. (2017). Associations between executive functions and mental health outcomes for adults with autism spectrum disorder. Psychiatry Research, 253, 360–363.
Acknowledgements
This research was partially funded by a Morris Grant from Saint Joseph’s University, which was awarded to Cheryl George. We would like to thank Gabrielle Droste, Ashley Russell, Erin Fahey, and Mary Katherine Sheplock for their assistance in data collection and analysis. We would also like to thank the staff at the adult educational day program, as well as the participants and their families.
Author information
Authors and Affiliations
Contributions
Cheryl L. George: conceptualization, methodology, investigation, resources, writing—original draft, writing—review and editing, supervision, project administration, funding acquisition. Amber Valentino: formal analysis, writing—original draft, investigation. Kimberly D’Anna-Hernandez: formal analysis, resources, writing—review and editing, visualization. Elizabeth A. Becker: conceptualization, methodology, validation, formal analysis, investigation, resources, data curation, writing-original draft, writing—review and editing, visualization, supervision.
Corresponding author
Ethics declarations
Ethics Approval
The treatment of human subjects was in accordance with ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments, and was approved by the Institutional Research Board at Saint Joseph's University.
Consent to Participate
Written informed consent was obtained from the parents. Participants then provided assent.
Conflict of Interest
The authors declare no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
George, C.L., Valentino, A., D’Anna-Hernandez, K. et al. Virtual Reality Biking Reduces Cortisol Levels and Repetitive Behaviors in Adults with Autism Spectrum Disorder. Adv Neurodev Disord 7, 616–628 (2023). https://doi.org/10.1007/s41252-023-00326-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41252-023-00326-5