Short version
A cognitively limited adult with early metabolic syndrome (hyperlipidemia, elevated glucose, elevated blood pressure, obesity) has halted weight gain over 9 months with a 300 calorie a day exercise program and some compliance with dietary guidelines.
Ingredients
- Schwinn IC-4 trainer ($900 to $1000 depending on demand and supply chain). This is one of the few quality cycle trainers on the market that doesn't require a subscription. (Review)
- Zwift exercise service on iPad ($15/month - we could put this on his ABLE account but I hate his ABLE account)
- Zwift Companion on iPhone to monitor activity (free)
- iMessage to send screenshot of activity and praise (free)
- The ability to disable WiFi service to a specific iPad (free with most routers)
How it works
To receive free afternoon WiFi service to his iPad #1 must do one of:
- Complete 300 calories on the IC-4 trainers as measured by Zwift (bluetooth connection to the IC-4). This takes him about an hour at a fairly easy pace.
- Go for a bike ride -- his usual ride is about 10 miles and takes about an hour but sometimes he goes longer
- Go for a CrossFit workout. He does this infrequently now -- that's a challenging social environment. He'll go most often if the son of a close friend of our family is there. (He's pretty strong by the way!)
- Participate in a family exercise outing -- typically bicycling or Nordic skiing
There are no days off -- it's 300 calories daily.
I check his workouts after 5pm using the Zwift Companion app on my iPhone. I take a screenshot and send him (and my wife) an iMessage praising his work. The iMessage is very important; if I forget he's likely to stop doing the workout.
Background - including health challenges of adults with cognitive disabilities
Obesity varies by education -- which is also a proxy for cognitive ability:
Adults who didn't finish high school had the highest level of obesity at 35.5 percent, followed by high school graduates (32.3 percent), those who attended college (31 percent) and college graduates (22.2 percent).
Adults with cognitive disabilities have the greatest risk of all. When #1 was younger he was pretty active -- participating in many sports from wrestling to inline skating to bicycling to hockey to mountain biking and more. As an adult in a socially challenging world his activities are much more limited.
His diet hasn't helped. It was never healthy, but with income from his two part-time jobs it's gone from bad to worse (switching from Coke to Coke Zero helped). His BMI steadily increased over the past two years to 30, at the low end of obesity. That's bad by itself, but his obesity is abdominal. The worst kind.
Emily and I arm twisted him into a basic evaluation and he's classic metabolic syndrome. Everything is at the high end of normal or worse: BMI, blood pressure, glucose (HgbA1c), and LDL. He had "diabetes in 5 years with MI at 45" all over him. [1]
So we decided to exercise the "guardian of a dependent adult" role and came up with a 300 calorie a day goal and the Zwift/IC-4 scheme. Given his diet and screen habits that's not enough to lose weight but we hoped it would hold him for a while.
The incentive was WiFi restriction of his iPad. I framed as "earning" the WiFi. If he didn't do the cals, he didn't earn afternoon WiFi for his iPad (I can disable that from my wifi router).
It's #1's nature to 'just say no'. He says 'no' to most everything, then often 'yes' after he's given it some time. In this case his objections were, by his standards, pro forma. He didn't get upset when he lost WiFi for a day and then he just started doing the cals. He likes the Zwift app and rides with this videos, podcasts, and music. He takes his time -- anywhere from 50 to 70 minutes for about 10-11 miles and 300 calories.
Every day I check Zwift Companion on my iPhone, screenshot his work for the day, and iMessage it with a comment. That's important. If I forget he stops riding.
He's done it daily for 9 months, 3 seasons and a pandemic. It's a routine, and he's good at routine. He gets bored with it, but then he can do road biking or hockey or CrossFit or something else. So I'd call it successful.
PS. More posts on exercise in special needs children and adults. Incidentally, #2 is classic autism spectrum and very different from #1. He's "overweight" but not remarkably and, with fewer complaints over time, routinely does 3 exercise outings a week -- mountain biking/inline skating, home CrossFit with Emily and me, and a family bike ride or equivalent.
- fn -
[1] Or, if he was willing, he'd be on metformin, a glutide, and atorvastatin. I'm a convert to the Church of Lipitor. That sh*t is amazing.
Update 10/26/20221
I wrote their were "no days off" but he insisted he did an adequate amount of exercise running food at the local NHL arena and shouldn't have to do the trainer those days. I didn't believe it, but he wore his Apple Watch and showed me an estimate of 600-800 calories per shift (over many flights of stairs). So he won that one.
