Phillip Conatser

Respiratory Exercises Changing Lives              Phillip Conatser, University of Texas Brownsville; Contributing Author: Chris Ledingham, University of Texas Brownsville Many years ago when I was pursuing a master’s degree, a series of events happened that forever changed my life and the life of a young boy with Cerebral Palsy (CP). I’m not a novelist so bear with me while I try to organize this story in a most meaningful way. One of my master adapted physical education (APE) classes had a volunteer/community service component as a requirement, which by the way, I would encourage all college professors to integrate community service into their classes. One of the sites that I elected to volunteer at was an elementary school where I taught three children with disabilities. Two of the children were mobile with mild intellectual disabilities (ID) and the third, intellectually normal, used a wheelchair and had severe CP. Some of you may remember in the early years of APE, most school systems did not have any full-time APE. You taught class in the hallway or cafeteria, and you had to bring your own equipment. This was my situation. Nobody knew or had heard of APE, and I was not welcome to utilize the gym. I worked 45 minutes three days a week with these children in an empty portable classroom that was use as a storage room. I was young with little experience working with children who had disabilities, but I did know that if I could improve their overall fitness this would carry over into all aspects of life. I knew plenty about fitness because of my years as a collegiate athlete, so I began teaching a simple stretching and strengthening program. For many weeks these 4th grade boys did a typical exercise program and I was very pleased with their progress. One day, I was expressing my excitement to their speech therapist when she informed me during our conversation that these boys were having problems pronouncing words clearly. After listening to her concerns, and wanting to help her objectives, I thought respiratory exercises may benefit pronunciation. The next day I purchased a bag of party blowout toys. These toys roll out when you blow, make noise, and then roll back up. The two boys with ID learned quickly how to make the toy work; however, the child with CP at first could not close his lips tight enough and blow hard enough to make the blowout toy work. He worked for a month to just make the paper roll out half way. After three more months of effort he learned how to blow the toy where it would roll out all the way and make noise 20 times. To make the respiratory exercise more challenge, I started to time how long he could continuously blow and keep the toy’s paper from rolling back up.

Chris Ledingham

This went on for another month and was part of our warm-up. One day while we were going to our classroom, he turned to me and said he wanted to thank me. I asked what for, and he told me “for the first time in my life at my birthday party at the Pizza Palace, I could blow the toys like the other children and blow out my Birthday candles.” I was speechless and all I could do was give him a big hug. At that point I decided, for me, this is the field I wanted to work, and have ever sense. Even today as I’m writing this story, it still brings tears to my eyes, puts a lump in my throat, and reconfirms my commitment to APE. I worked with him and the other boys for one year and continued to be amazed and proud of their success.

I thought the story was over, however, ten years later I was teaching a college class in Adapted PE and to my surprise, this young man in a wheelchair strolled/rolled into my life again. He’s first words to me were, “I knew it was you. I could hear you down the hallway. I could never forget your voice pushing me to do better.”

For the next two years before he went to seminary school, we had many long talks. He helped me in my adapted aquatics class where we taught children with disabilities, as well as being a regular guest speaker for my APE class. Before he left town to attend seminary school he called me to say good bye, and that his decision to become a teacher was because of me. He also told me he hoped he would have the same passion to motivate people like I motivated him. I shared with him, like I had many time before, he changed my life and I knew he would change other lives. I was then, and even still pleased he became such a great person.

The rest of this article will present the prevalence, fun activities, danger signs, helpful suggestions and evidence of effective school polices that relate to teaching PE students with respiratory problems. I hope these activities make as big of a difference in your life and someone else’s as they did for me and a 4th grade boy.

Prevalence:
Respiratory problems such as asthma are among the fastest growing disabilities in the United States. From 1980 to 1996, asthma prevalence among children increased by an average of 4.3% per year, from 3.6% to 6.2%. Low-income populations, minorities, and children living in inner cities experience disproportionately higher morbidity and mortality due to asthma. Asthma has many effects on children and adolescents include the following:

• Asthma accounts for 14 million lost days of school missed annually.
• Asthma is the third-ranking cause of hospitalization among those younger than 15 years of age.
• The number of children dying from asthma increased almost threefold from 93 in 1979 to 266 in 1996.
• The estimated cost of treating asthma in those younger than 18 years of age is $3.2 billion per year.

Currently, children and adolescents who have asthma can still lead quality, productive lives if they control their asthma, as there are no preventive measures or a cure for asthma. Asthma can be controlled by taking medication and by avoiding contact with environmental and physical "triggers" for asthma. Environmental triggers include cockroaches, dust mites, furry pets, mold, tobacco smoke, and certain chemicals. Physical triggers include stress, anxiety, aggressive exercise, common cold, and sudden injury.

Respiratory Activities:
There are a number of activities that children can take part in that both improve their respiratory capacity and physical ability. Remember to modify and change these activities (amount of equipment, group size, distances, time for exertion) based on your students ability and make the activity fun. The following activities are offered as suggestions:

Problem Signs:
Asthma attacks and other respiratory conditions can occur without warning in those afflicted with asthma or an associated disease. These symptoms can be relatively minor, but without proper care can lead to more serious situations. Typically as a child ages, they become more aware of the early warning signs of an attack and will ask for their medication if they are not allowed to carry it on their person. However, younger children and people with disabilities may not be aware of the minor symptoms, and can easily develop more severe attacks if the teacher is not paying attention. The following are the typically warning signs associated with asthma attacks.

• Coughing
• Wheezing
• Shortness of breath
• Decreased work capacity
• Chest discomfort
• Avoiding activities

Helpful Suggestions:
While it is hard to tell exactly what triggers will set off an asthma attack in a child, 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, and using the following suggestions, 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
• Exercising before noon 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 excessive pollen, dust, and mold benefits all students)
• Have the child temporarily avoid daily exercise if they have a severe cold or allergy problems
• Use appropriate medications 30 minutes before activity or as advised by the student’s physician
• Ensure the child has taken their daily medication as advised
• Have medication available and ensure proper use when needed
• Know your student (condition, triggers, medication, last attack, what activities are best, etc.)

School Policies:
Numerous policies have been put in place, at both the state and school district levels, to train and inform teachers on the risks associated with chronic disease in the physical education classroom setting - such as asthma. These policies are designed to protect students, and allow for a comprehensive approach to illness management. According to the 2006 School Health Policies and Programs Study (SHPPS) the following statistics represent the state and district level polices in place throughout the country.

44.9% of states and 59.3% of districts provided funding for staff development, or offered staff development to those who teach physical education on chronic health conditions (e.g., asthma or diabetes), including recognizing and responding to severe symptoms or reducing triggers.

43.6% of elementary school classes, and required middle school and high school physical education courses, had a teacher who received staff development on chronic health conditions.

The percentage of states that allowed some students to carry and self-administer a prescription quick-relief inhaler increased from 45.8% in 2000 to 88.0% in 2006.

The percentage of elementary schools that permitted students to carry and self-administer a prescription quick-relief inhaler increased from 59.3% in 2000 to 76.9% in 2006.

83.3% of middle schools and 92.0% of high schools permitted students to carry and self-administer a prescription quick-relief inhaler.

Respiratory conditions are nowadays a common occurrence among children of all ages, and the well informed and trained educator can play a key role in condition management. Care should be taken by the educator to ensure they have prior knowledge of the child’s condition, and have an appropriate response plan on file for how to deal with each individual child. While many view asthma and other conditions as limiting (which for some children they are), proper management and a knowledgeable educator can be two key factors which allow a child to actively participate in almost any activity.

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