Abstract
Research on using technology to support students with intellectual and developmental disabilities in exercise, health, and wellness is not as abundant as using technology in academic areas. The purpose of this article is to provide educators with resources that will assist in filling this technology gap. This article provides examples of specific apps and wearable devices that are accessible for diverse learners and selected based on practical experience using them with this population. In this article, apps are categorized by exercise, health, and wellness, while also including helpful tools for both mobile and wearable devices. Some of these apps fall into multiple educational categories and therefore can be used for a diverse population of learners. Although these tools are not applicable to all students with intellectual and developmental disabilities, they do address the specific needs of some students.
Students who receive special education services are a diverse population of learners with many different abilities and needs, some of which can be supported with technology. There is a large existing body of research on using these technology devices to address academic educational needs. For example, Erdem (2017) conducted a literature review and results of the study demonstrated how assistive technology can support various school subjects (e.g., reading) for students in special education. Unfortunately, there is a smaller body of research on using technology to support the education of students with intellectual and developmental disabilities (IDD) in the areas of exercise, health, and wellness. In fact, there is a need to provide greater access and understanding of how assistive technology devices can support the health and well-being for individuals with IDD (Boot, Dinsmore, Khasnabis, & MacLachlan, 2017). With the continuous ongoing progress of technology, this will always be an area of need. In addition to mobile devices like smartphones and tablets, new technology like augmented reality (AR) and virtual reality (VR) are bringing new immersive options for exercise and engagement. Wearable devices like smartwatches connect the powerful capabilities of our smartphones to location and movement data. This Technology in Action piece provides some of the rationale and challenges related to this topic and presents practical examples of how mobile and wearable devices can support exercise, health, and wellness for students with IDD.
The digital fitness community anticipates that the business will continue its rapid growth for the foreseeable future (Marketwatch.com, April, 2021). The COVID-19 global pandemic has helped to fuel the growth of digital fitness tools as many gyms and other fitness group activities were limited. This broadly expanding collection of mobile devices, apps, and wearables is an aspect of digital inclusion in society that needs to be addressed for students with IDD. Issues such as ease of use, accessibility, and design features supporting the guidelines of Universal Design for Learning (UDL) all need to be considered when implementing these resources to support students with disabilities (Rose, 2000). Engaging adequate exercise and making healthy decisions are functional skills that benefit students of all academic skill levels. Using technology tools, such as mobile devices, smartwatches, virtual reality headsets, and other wearables may help students with disabilities make healthy physical activity and nutrition decisions. Exercise, health, and nutrition are critical factors for an integrated approach to supporting students with IDD and are important educational and functional topics for successful transition to independent living.
Unique Physical and Mental Well-being Challenges
The technology tools we discuss align to three broad areas of health and wellness challenges that individuals with IDD may experience. First, people with IDD have an increased risk of obesity due to inadequate nutrition and unhealthy eating habits (Centers for Disease Control and Prevention [CDC], 2019). Our second category of tools address exercise and physical activity. Students with IDD often have a more sedentary lifestyle than peers without disabilities because of barriers to being physically active, such as having a lack of resources, transportation, and social support (CDC, 2019). Our final category of technology tools addresses the increased prevalence of negative mental health outcomes, such as anxiety and depression, that students with IDD can experience (Reardon, Gray, & Melvin, 2015).
Health and Nutrition Needs
Recent studies demonstrate a high prevalence of overweight and obesity in students with IDD (Stewart et al., 2009). For example, findings from a cross-sectional study report that 26% of students with IDD were obese or overweight (Salaun & Berthouze-Aranda, 2011). In addition, a sample of 9678 of children and youth with IDD demonstrated that overweight ranged from 4.1% to 26.3% and obesity from 4.6% to 32.6% (Lloyd, Temple, & Foley, 2012). These higher overweight and obesity rates can lead to secondary health conditions that our students with IDD can experience, such as high blood pressure, high cholesterol, and diabetes (Rimmer, Yamaki, Lowry, Wang, & Vogel, 2010). It appears that our learners are not only more likely to be overweight and obese, but are more prone to secondary health risks, which could negatively impact their quality of life.
Nutritional issues associated with IDD may further promote the risk of becoming overweight and obese. Students with IDD can have atypical eating behaviors, such as only consuming certain colored foods or foods with a certain smell or texture (Rimmer, Rowland, & Yamaki, 2007). Additionally, some students with IDD are more prone to overeating, which can lead to becoming overweight and/or obese (Rimmer et al., 2007). Another issue is food intake. Food can be used as a reinforcement for the learner to accomplish or complete a task (American Dietetic Association [ADA], 2004). Frequently the food for reinforcement is not nutritious or healthy and could lead the learner to associate unhealthy food as a reward (ADA, 2004). In addition, a lack of knowledge or awareness of healthy lifestyle behaviors may encourage students with IDD to become overweight or obese (Rimmer et al., 2007). Those with IDD may not understand the concept of excess body weight and the detrimental health consequences that can arise from an unhealthy lifestyle (Rimmer et al., 2007). Overall, these nutritional risk factors that students with IDD can experience may make it more challenging to adopt and practice healthy behaviors.
Physical Activity
According to the Physical Activity Guidelines (2018), children and adolescents should engage in at least 60 minutes of physical activity daily, which should be either moderate-or vigorous-intensity aerobic physical activity. However, students with IDD are typically sedentary and do not participate in the recommended physical activity levels (Esposito, MacDonald, Hornyak, & Ulrich, 2012). What’s more, physical activity levels often decline as the severity of the IDD increases (Hinckson & Curtis, 2013). There are also stark differences of physical activity levels between students with and without IDD. Einarsson and colleagues (2014) conducted a study to investigate physical activity patterns in students with IDD and those without IDD. Results of the study demonstrated that students with IDD were 40% less physically active and spent 9% more time sedentary than students without IDD (Einarsson et al., 2015). Another interesting finding from the study was how no students with IDD met the physical activity guidelines, however, 40% of students without IDD met them (Einarsson et al., 2015). This may be due to physical activity barriers that students with IDD can experience, such as a lack of accessible facilities and equipment and inappropriately trained teachers and staff (Rimmer et al., 2007). As a result, those with IDD generally do not engage in activities or sports that require higher energy expenditure that can help maintain a healthy body weight (Rimmer et al., 2007). New technology platforms such as virtual reality show some promise for increasing exercise for people with IDD (McMahon, Barrio, McMahon, Tutt, & Firestone, 2019).
Mental Well-Being
Students with IDD can have an increased risk of developing mental health disorders. Specific examples of these mental health disorders include anxiety, depression, conduct (e.g., aggressive behavior), and others as listed by the Diagnostic and Statistical Manual of Mental Disorder (American Psychiatric Association, 2013). Studies report a high prevalence of mental health disorders in students with IDD (Dekker & Koot, 2003). Einfeld and colleagues (2011) conducted a systematic review and identified nine studies that investigated the mental health in children and adolescents with IDD. Results of the study found that 30–50% of the individuals experienced psychiatric symptoms, such as anxiety (Einfeld, Ellis, & Emerson, 2011). Other studies exhibit stark differences in mental health disorders when comparing those with IDD to the general population. For example, Emerson (2003) compared those with IDD to those without IDD and found that 39% had some type of mental health disorder versus 8.1% of the typical sample. A recent review and meta-analysis study identified 19 articles investigating the prevalence of mental health disorders in youth and adolescents with IDD (Buckley et al., 2020). The prevalence of psychiatric symptoms in those with IDD were 38%–49%, which is much higher compared to the 14% prevalence estimate in those without IDD experiencing psychiatric symptoms (Buckley et al., 2020). It is also important to note that students with IDD are often underdiagnosed for their mental health issues, due to inadequate screening and detection (Kauffman, Mock, & Simpson, 2007). Another issue is this population is likely to experience a lack of access to appropriate clinical care (Whittle, Fisher, Reppermund, Lenroot, & Trollor, 2018). As a result, it is imperative to not only support the physical, but also the emotional needs of our students with IDD.
Tools for Health and Nutrition
It is important to note that health and nutrition, physical activity, and mental well-being are highly interrelated with each other. These three facets of health are fundamentally linked and one without the other will significantly impact an individual’s quality of life. Understanding how mobile and wearable devices can support the physical and mental well-being of learners with IDD can help them be successful in many aspects of life, such as education and workplace settings.
List of Technology Tools and Apps.
In this piece, our examples are focused on IDD populations. This does not mean these tools are only applicable to these populations. The following sections will provide an overview of several applications and tools that can be used to meet this specific purpose.
Story
Kayla is a twenty-one-year-old girl who has Autism. She lives on her own, takes community college classes, and has a job at the local coffee shop. Kayla is a very good barista and can make a plethora of hot and cold beverages. One area that Kayla struggles with is cooking at home. She can make microwave meals and heat frozen meals in her convection oven. Kayla is slightly concerned about her weight due to her apron from work continuing to tighten around her waist. In order to stay healthy and agile on her feet at work, Kayla decides she needs to eat healthy and count her calories. Kayla is not currently making time to exercise due to her busy work and school schedule. She decides to take control of her diet. Kayla downloads Fooducate. With this app Kayla can count her calories and learn recipes. She is able to create a grocery list based on the recipes from the list. She can follow the recipes on the app and track her calories based on the measurements from each recipe. With this app Kayla is able to stay independent and take control of her health and nutrition.
Mobile Apps for Health and Nutrition
Grow Garden. ($3.99/$5.99, iOS/Android). This is a great tool for young students to understand sustainability and learn how to grow healthy foods. This app is very interactive which helps to keep students engaged and excited to learn about gardening. Parents might also enjoy using this app with their children. Step by step instructions are provided to demonstrate the most effective ways to grow vegetables, including how to care for them and when to plant them. This app helps students learn how to be both sustainable and healthy.
My Food—Nutrition for Kids. ($2.99, iOS). This app provides interesting facts about food and how it fuels the body. Nutrition information is explained so that it is useful for all ages. By connecting the understanding of nutritional contents in fruits and vegetables to how food is grown, this app provides young students with overall knowledge of crucial food groups that are essential to their health.
Fooducate—Eat Better Coach. (Free, iOS/Android). With this app, users can scan food barcodes, track calories, and search a recipe bank. After scanning an item, the app provides users with a grade based on the health of the food item. The community and diet tips options on the app are also beneficial. This app is convenient for use at the grocery store or at home while cooking. The simple to use scanning feature and clean display of information help users determine the differences between healthy and unhealthy food options. For individuals who may struggle with cooking independently, this app can provide a better understanding of the ingredients used in pre-packaged meals.
MyFitnessPal. (Free, iOS/Android). This app is an excellent tool for tracking food, calories, water, and physical activity. The barcode scanner feature includes a large database of foods allowing the user to easily track meals and calories. The app experience is also completely personalized to the user. Other services include logging menu items from restaurants and uploading nutritional information from recipes. MyFitnessPal is easy to use and great for users wanting to learn how to easily track food and choose healthier food options.
Start Simple with MyPlate. (Free, iOS/Android). Explore each food group and choose daily food goals with this app. Following the USDA Dietary Guidelines, the Start Simple with MyPlate app encourages the user to learn more about each food group and make daily goals. All goals are listed for each food group, allowing for autonomy and choice in goal-making compared to the user needing to create goals. There are also opportunities to win badges by participating in challenges and taking quizzes. The simplicity and usability of this app makes it an excellent resource for diverse learners.
Wearables for Health and Nutrition
Health. (Free, Apple Watch Feature). The Apple Watch health app and its companion app on the iPhone both provide a wealth of health tracking features including heart rate, weight tracking, and many others. The 2019 update to this app allows users to track menstrual cycles. Health has a simple and clear interface supported with representative icons which could be useful for users with disabilities.
Calorie Counter Pro MyNetDiary. ($3.99, iOS/Android). This app can be used with a smart watch to scan barcodes on food and add them to a daily food log. The user receives personalized feedback on their daily caloric intake to help them reach their goals. The app suggests healthy recipes and tracks the amounts of fats, carbohydrates, and proteins in each food that is logged. Users can also share their weight loss stories with others using the application by posting before and after photos.
Human Anatomy VR Complete Edition. ($19.99, Oculus/STEAM). Using the Oculus Go VR headset, this app takes learning about anatomy to the next level. Users can dissect the human body into skeletal, nervous, cardiovascular, digestive, reproduction, or respiratory system planes. Both male and female bodies are represented in the VR headset. The controllers will allow users to choose parts of the body and separate them from their original placement. During this activity, information about each body part appears to provide more detail on its importance and function within the body.
Tools for Exercise and Fitness
Story
George is a 17-year-old student with Down Syndrome whose body mass index (BMI) of 28.0 places him in the overweight range, according to CDC (2021). He wants to be more fit and his parents are concerned that his unhealthy BMI could lead to health problems. George loves to play video games of any kind, especially multiplayer games. He frequently goes online after school and plays video games with his friends. This video game play results in a highly sedentary day for George. It is recommended that children and adolescents get at least 60 minutes of physical activity per day (Physical Activity Guidelines, 2018). George decides to combine his love for video games, gaming with friends, and exercise by using Beatsaber VR. The average caloric burn per minute is between “6.55 and 7.45 kcal” (Virtual Reality Institute of Health and Exercise, 2018). George can play this with his friends by using multi-player mode. He can enjoy his video games and exercise all at the same time.
Mobile Apps for Fitness and Exercise
Go Noodle. (Free, iOS/Android). This app is designed for teachers and parents, combining both content and movement as a learning tool. Some of the curricular categories that are featured within this platform are math, science, English/language arts, social studies, health education, reading, and Spanish. There are also other categories that cater to movement, including social and emotional learning and mindfulness, sensory and motor skills, school life, as well as options to choose a specific movement type. All these categories have ample amounts of videos that include very engaging, fun, and interactive ways for students to both learn and play simultaneously.
NFL Play 60. (Free, iOS/Android). The goal of this app is to get users to move. The app connects to the apple health app on iPhones to track activity. As users hit specific move milestones, they can modify gear that their self-created avatar wears in the app. This app could be beneficial for users with IDD as the app is based on walking, not strength training or tasks that include compound movements. As users build endurance and can walk for longer periods, they will increase the amount of gear for their avatar.
Sworkit Fitness and Workout. (Subscription, iOS/Android). This app connects users through iOS, Android, or the web to personal trainers. The personal trainers develop specific workout plans for individuals based on their specific workout goals and needs. This app also allows users to browse through pre-made workouts created by the personal trainers. The individualized personal training programs allows users to focus on a specific health need, for example, muscle toning, weight loss, or overall general health.
Super Stretch Yoga. (Free, iOS/Android). This app is geared towards grades K-5; however, it is so fun that the whole family can enjoy it. Some of the features include demonstrating yoga poses through storytelling, flashcards and music. After goals are achieved, students can take a group photo to document their success. This app demonstrates all the benefits that yoga has regarding health and mindfulness.
Eat and Move-O-Matic. (Free, iOS). Users can compare the number of calories in a certain food to the amount of physical activity it would take to burn off the calories. The app uses a fun spinner to randomly choose foods and exercises. Users can also select their favorite exercises and compare them to different foods and workout times. If users like a specific workout, they can continue that activity to determine how many minutes of that exercise they need to burn off a certain food item, like a milkshake. The wacky and engaging examples pique students’ interest for long periods of time. For example, eating an eight-ounce bag of chips and drinking a 12-ounce soda would take 4 hours and 28 minutes of roller skating to burn off! Tips on healthy eating and physical activity are also included.
Pokémon Go or Harry Potter Wizards Unite. (Free, iOS/Android). Augmented reality meets exercise in this app. Users walk to novel locations and catch Pokémon or solve Magical problems depending on the game. The more users walk, the more new locations they find to get rewards. These apps not only promote walking (a low impact activity), but users can also explore their community. Depending on their location, they can earn “Pokeballs” for visiting parks, historical sights, and other recreational areas. This app tracks walking distance, and it is engaging for users who are already partial to video games.
Geocaching. (Free, iOS/Android). Join the largest treasure hunt with the Geocaching application! Users walk around outdoors to discover geocaches in their local neighborhood and parks. To play, choose the geocache you wish to find and navigate to its location with an interactive GPS map. Once you are at the geocache look for the hidden geocache boxes. The geocache boxes come in varied sizes, and some are more difficult to find than others. When the user finds the geocache, they can sign the logbook physically and virtually, as well as trade personal items with others. There are millions of geocaches worldwide which create endless opportunities for outdoor exploration. There are fun adventures surrounding you, everywhere, with this app.
Wearables for Fitness and Exercise
Fitness App. (Free, Apple Watch Feature). This app is a built-in feature of the Apple Watch operating system. It allows users to track their daily movement, exercise, and standing. The move feature tracks the users non-exercise related activities. The exercise feature tracks their specific workouts. The stand feature tracks how many hours per day the individual stands up. The activity app also allows users to share their information with friends and challenge friends to movement competitions. This app promotes self-awareness of activity level throughout the day.
Beat Saber VR Game. ($29.99, Oculus/HTC/STEAM/PlayStation). Beat Saber is one of the most popular VR games in the world. It is available on Oculus, HTC VIVE, STEAM, and PlayStation. This game allows users to pick a song and difficulty level before entering the game. Once the song begins, the user slashes through boxes to the beat of the music. As the boxes approach the user, a small arrow appears on each box. The user must slash through each box following the correct direction of the arrow, avoiding bombs and walls to earn more points. This game is so fun and entertaining that users will not notice they are exercising. The interface is also very user friendly and easy to navigate. A brief audio preview of the song plays before each selection to assist users that may have difficulty reading the song titles.
Holoball. ($14.99, Oculus/HTC/STEAM/PlayStation). Available for the Oculus, HTC VIVE, STEAM, and PlayStation. This app is like racquetball but in virtual reality. Users compete against the computer to hit a bouncing ball at a moving target on a wall. Users select a difficulty level that matches or challenges their ability level. The upbeat background music keeps them moving to the beat as they hit the ball. Points are achieved when the moving target on the wall is hit. Like Beat Saber, this game would be beneficial for students who typically do not like exercising.
Tools for Wellness and Mental Health
Story
Kelley is a 15-year-old female student who has a history of behavioral outbursts including physical aggression in situations when she feels overwhelmed. Her school is providing support for her through an individualized educational plan (IEP), because of an emotional disturbance. Her family has also used an outside service provider who has identified that Kelley has a disruptive mood dysregulation disorder. She has a behavior intervention plan in place that has helped her to successfully reduce disruptive and violent incidents at school. Outside of school and at home, Kelley continues to have regular outbursts (multiple times a week). Kelley, her parents, and her teachers met to discuss her IEP and Transition plan and her continued emotional challenges at home with her siblings. Kelley explained that at school she primarily uses just one of the strategies on her behavior intervention plans (BIP). Rather than taking a walk with a staff person to calm down or other strategies that involve leaving class, she prefers the ones that allow her to remain in class. She requests help from a teacher or paraprofessional who coaches her in a deep breathing de-escalation strategy. Her teacher points out that they could look for some technology resources to help self-coach Kelley to engage in her preferred calm down strategy. Her teacher points out that as Kelley prepares for the Transition from school to adulthood, being able to manage her emotional needs independently is going to be an important skill to develop. Kelley, her parents, and her IEP team decide to amend her BIP to include some mobile device options including using mobile apps and her personal smartwatch to support her in managing deep breathing strategies with increased independence.
Mobile Apps for Wellness and Mental Health
Calm. (Free, iOS/Android). This app allows users to choose between four categories: meditate, sleep, body, and music. Each choice serves a different function. Guided meditation allows users to choose over 100 different meditations to reduce anxiety or decrease stress. The sleep setting reads sleep stories to users, encouraging a restful night’s sleep. The body setting guides users through ten-minute videos aimed to stretch the body and complete mindful movements. The music setting is filled with hundreds of hours of music for relaxation, focus, or sleep. This app can be used as a de-escalation technique for users who have outbursts or get upset easily.
Insight Timer. (Free, iOS/Android). Free courses, guided meditation, and session tracking are just a few of the options that this app has to offer. Some of the other features include meditation meet-ups and meditation music. The tracking device on this app could allow users to increase self-awareness of their meditation or mindfulness-based habits.
Smiling Mind. (Free, iOS/Android). This app allows users to set reminders to meditate and has a multitude of other meditation programs for different users. Personalizing the different meditation programs allows users to choose the meditation that is right for them. The reminder setting could help users create healthy, mindful habits and establish a daily routine.
Headspace. (Free, iOS/Android). This app provides users with a 10-day free beginner meditation and mindfulness course. In addition to the course, the website has a plethora of reading material for users. This app teaches the importance of meditation to decrease anxiety and stress, and it also aims to help users sleep. The teaching portion of this app is great for beginners in meditation and mindfulness.
Mind Shift CBT—Anxiety Relief. (Free, iOS/Android). This app uses Cognitive Behavioral Therapy (CBT) to assist users in managing their anxiety. Users can move a slide on the homepage to track how anxious they are feeling at that moment. The app then provides coping cards to read to help users decrease their anxiety levels. There are lots of features in this app including expanding your comfort zone, check-ins, and healthy habits. This app would be beneficial for students to track and manage their anxiety, as well as self-monitor their emotions during the day.
iMoodJournal. ($2.99/$1.99, iOS/Android). This app is like a personal diary allowing users to chart their mood and emotions, track sleep, symptoms, and energy patterns. This organized, concise and esthetically pleasing format helps users want to use the app consistently. One of the benefits of tracking moods and life patterns is to gain a better understanding of overall emotional wellness.
Wearables for Wellness and Mental Health
Muse 2. ($211 for headset, application free for iOS/Android). The Muse or Muse 2 are wireless EEG Headsets that provide neurofeedback to support mindfulness. The Muse helps guide individuals through a meditated practice which in turn tracks the brain activity of the user. Users can pair their headset with the mobile application to track their brain activity.
Breathe Watch Face. (Free, Apple Watch Feature). This app reminds users to breathe. A timer can be set to remind the user to take a break and follow the breathing icon on the app. The goal is for the user to connect and become mindful of their breathing. The Breathe Watch Face teaches the user how to complete the breathing exercise, using an inhale/exhale icon. This would be beneficial for students to become more self-aware of themselves and when they might need to take a break to focus on breathing. This could be used as a de-escalation technique for students who are quick to anger.
Discussion
First, it should be fairly self-evident that our students with disabilities benefit from being healthy and having a level of fitness that supports them to live an independent and self-directed life. There is no guarantee any app or technology is going to work for all students with a diverse range of needs. Exercise technology tools are a rapidly growing field and keeping up to date with the available tools in any technology landscape is challenging. This article is designed to give individuals with IDD and those who support them a starting place to explore exercise and health related apps that may address their needs.
These selections are designed to help individuals with disabilities, their educators, and families get started exploring technology tools for exercise and health. The selections above all address identified needs of people with IDD and were selected for their ease of use and design features. The authors based these selections on their experiences using technology to support the health and wellness needs of their students.
Implications for Practice and Research
Practitioners can use this list of exercise tools and their features to make informed decisions about matching student needs to these capabilities. This list is not exhaustive and like any tool or intervention educators will need to decide what will work best for their student. We do recommend that educators, particularly transition teams, think about including teaching technology tools for healthy independent living in student transition plans. If students are able to be guided into an overall understanding of their health with the assistance of technology, they can find a well-balanced, healthy, and successful lifestyle.
This growing field of exercise technology tools also has implications for researchers. Smartwatches, virtual reality exercise games, and other mobile apps need to be examined critically to address issues of accessibility, determine effectiveness, and identify key features (e.g., audio or visual prompts).
As the exercise and health technology landscape grows and matures, we believe it is important that the capabilities and benefits of these tools include individuals with IDD. We also believe that the experiences and needs of people with IDD need to be represented in the design of these platforms. Increasing the use of exercise and health apps for people with IDD can provide opportunities to support their needs and eventually opportunities for people with IDD to be included in the design process of future wellness applications.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
