Physical inactivity is an increasing health concern for the autistic community. A growing body of research suggests that autistic people of all age groups are less physically fit (Borremans et al., 2010), less physically active (Jones et al., 2017), and engage in fewer sports/recreational activities as compared to their non-autistic peers (Brewster & Coleyshaw, 2011). Guidelines from the Canadian Society for Exercise Physiology (CSEP, 2011) and Public Health Agency of Canada (as reported in Tremblay et al., 2011) recommend that young adults engage in a weekly minimum of 150 minutes of moderate to vigorous physical activity (MVPA) to improve health and reduce susceptibility to disease and illness. However, many studies (e.g., Eaves & Ho, 2008; Lang et al., 2010; Pan & Frey, 2006) report that large portions of the autistic population are more likely to engage in sedentary behaviours for significant amounts (i.e., an average of 13 hours) of the day.
Low engagement in physical activity (PA) is a troubling trend as many studies examining health outcomes for this population report that low PA is associated with an increased risk of many physical health and psychiatric conditions (Croen et al., 2015; LaLonde et al., 2014; Lang et al., 2010). The Centers for Disease Control and Prevention (CDC, 2020) report that low PA can lead to increased risk factors, including increased susceptibility to certain cancers (e.g., colon, breast, uterine), obesity, type 2 diabetes, cardiovascular disease, high blood pressure, and stroke. In addition, growing evidence suggests many of these conditions are more common in autistic adults than among the general population (Croen et al., 2015; Sedgewick et al., 2020; Wright, 2015).
Autism is a pervasive neurodevelopmental disorder characterized by differences in social interactions, communication impairments, sensory issues, and the presence of unusual patterns of restricted, repetitive behaviours (American Psychiatric Association [APA], 2013). Additional obstacles that autistic people may face, specific to engaging in PA, include coordination and balance challenges, disordered sleep, atypical (selective) eating behaviours, metabolic abnormalities, and social anxiety (Nichols et al., 2019; Obrusnikova & Cavalier, 2011; Wright, 2015).
Promoting PA engagement and sustaining a healthy lifestyle can be particularly challenging for autistic young adults. As adolescents, many experience setbacks related to their diagnosis (e.g., lack of engagement due to differences in social, behavioural, and motor skill development) and environmental barriers (e.g., lack of appropriate PA programs, lack of trainers/coaches with knowledge of best practices to support this population) which can negatively affect their motivation to engage in PA (Nichols et al., 2019). Research by Arnell et al. (2018) notes that PA patterns (i.e., regularity, intensity, duration of activity) tend to decline with age. To develop effective PA interventions for autistic people, it is crucial to develop insights into how attitudes and motivations towards PA change with age.
A potential intervention that has been proven successful in clinical applications is behaviour change techniques (BCTs). Research by Michie and colleagues (2009) identifies the BCT of self-monitoring as the most strongly associated with success in behaviour change when combined with other self-regulatory (e.g., feedback on behaviour, goal setting, shaping knowledge) techniques in the Behaviour Change Technique Taxonomy (BCTT). The BCTT is the most comprehensive and reliable coding tool used in current behaviour change research consisting of 93 hierarchically clustered BCTs. In addition, the BCTT provides a standardized method for specifying, implementing, and evaluating the active mechanisms (i.e., the “what” rather than the “how”) that influence successful behaviour change within interventions (Michie et al., 2013).
The use of wearable activity trackers (WATs) to deliver BCTs that encourage PA and promote healthy lifestyle change has gained tremendous traction. WATs are electronic monitoring devices that support users to monitor and measure personal health-related metrics, including calories burned, distance travelled (e.g., steps taken), heart rate, daily level of PA achieved, and sleep patterns (Shin et al., 2019). In the last decade, WATs have been recognized as a top trend for promoting PA engagement (Bunn et al., 2018). In addition, a growing body of research suggests that BCTs embedded in newer WATs have utility in encouraging behaviour change to improve PA, sleep hygiene, and diet (Lyons & Swartz, 2017; Maher et al., 2017).
WATs are considered “persuasive technologies” that are instrumental in providing users with helpful health information (e.g., current physical health data, feedback, and support tips for engaging in PA), which encourages users to engage in PA (Fritz et al., 2014). Moreover, to motivate users to maintain engagement with PA, some WATs adapt motivational techniques, such as gamification and social engagement, through friendly competition (Bunn et al., 2018; Savage et al., 2018). Currently, strong evidence from randomized controlled trials (e.g., Cadmus-Bertram et al., 2015; Hartman et al., 2018) and additional studies (e.g., Eisenhauer et al., 2016; Valbuena et al., 2015) suggest that participants using WATs and adhering to evidence-based BCTs often experience better health outcomes. However, low motivation, avoidance, or abandonment of PA may be higher for sedentary autistic young adults due to a perceived lack of immediate health benefits (Sullivan & Lachman, 2017).
O’Donoghue and Rabin (2015) define this issue as “present bias” when individuals perceive high value for immediate rewards (i.e., receiving benefits now) and place less emphasis on beneficial long-term outcomes (e.g., avoidance of a myriad of chronic health complications) of the health behaviour. Advancements in WATs have made it possible to provide users with instant health information to evaluate and provide immediate feedback on user progress. A common theme among studies using WATs (e.g., see Cadmus-Bertram et al., 2015; Hartman et al., 2018) was that most participants who received the WAT intervention reported increased awareness/interest in monitoring PA and other health outcomes (e.g., energy output, active heart rate, distance travelled) because the devices provided access to this information in real-time.
While WATs are often promoted for use “out of the box,” research indicates that users who have a system of support (SOS) to operationalize the WATs achieve improved results. A systematic review found that participants in studies that leveraged an SOS achieved higher PA outcomes (e.g., see Cadmus-Bertram et al., 2015; Hartman et al., 2018; Valbuena et al., 2015) over participant control groups. Researchers incorporated various support techniques in an SOS, including providing opportunities for learning through guided observation, ‘hands-on’ practice using the device, provision of intermittent feedback to enhance understanding and skill development, and consultation guidance for considering the next steps in improving PA behaviours.
The application of an SOS may improve the behaviour intention of autistic young adults to engage in PA. The Theory of Planned Behaviour (TPB) posits that an individual’s intention is the precursor (i.e., motivational factors that influence the level of effort put towards performing a behaviour), which determines their engagement in a target action/behaviour (Ajzen, 1991). Behavioural intention is the decision or firm intention to conduct an action or behaviour in the immediate or near future (Ajzen & Fishbein, 1980). Ajzen (1991) found that when an individual’s intention to participate in a target behaviour is high, the likelihood increases that they will engage in the specific behaviour.
According to the TPB, three psychosocial antecedent constructs influence behavioural intention:
Ajzen (2020) notes that it is possible to improve behavioural intention by manipulating the three constructs.
Considering the potential negative consequences of low PA engagement, interventions are needed to increase the behavioural intention of autistic young adults to engage in PA. Low PA engagement places autistic young adults at a higher risk of health concerns and reduced life expectancy than non-autistic people (Hirvikoski et al., 2016). Thus, identifying interventions with utility in increasing PA engagement that autistic young adults can achieve independently or with minimal supervision is essential for improving health outcomes and alleviating pressure on health care systems.
Currently, there is a dearth of research exploring whether WATs have utility in improving behavioural intention to engage in PA for autistic young adults. Prior research has often relied on consultation with family members (e.g., parents/care providers) rather than directly with the autistic young adult (Eaves & Ho, 2008; Nichols et al., 2019) to develop specialized fitness (Todd & Reid, 2006) and sports programming (Barak et al., 2019; Yu & Jee, 2020). Input from autistic young adults in health promotion and PA research is essential for understanding their needs and preferences. Gotham et al. (2015) note that “given their unique first-hand experience, adults with autism…are de facto experts on their needs, problems, and priorities” (p. 794).
The proposed research aims to explore the behavioural intention of autistic young adults to engage in PA and understand what supports would be helpful to leverage WATs.