Exercise training increases physical fitness for children with cerebral palsy
Article Outline
- Verschuren O, Ketelaar M, Gorter JW, Helders PJ, Uiterwaal CS, Takken T. Exercise training program in children and adolescents with cerebral palsy: a randomized controlled trial. Arch Pediatr Adolesc Med 2007;161:1075–81
- References
- Copyright
Verschuren O, Ketelaar M, Gorter JW, Helders PJ, Uiterwaal CS, Takken T. Exercise training program in children and adolescents with cerebral palsy: a randomized controlled trial. Arch Pediatr Adolesc Med 2007;161:1075–81
Question
Among children and adolescents with cerebral palsy, does an 8-month training program with standardized exercises improve aerobic and anaerobic capacity compared with no additional intervention?
Design
Randomized controlled trial.
Setting
Four schools for special education in the Netherlands.
Participants
86 children with cerebral palsy, aged 7 to 18 years, classified at Gross Motor Function Classification System level I or II.
Intervention
The training group met twice per week for 45 minutes to circuit train in a group format that focused on aerobic and anaerobic exercises.
Outcomes
Aerobic capacity was assessed by the 10-m shuttle run test, and anaerobic capacity was assessed by the muscle power sprint test. Secondary outcome measures included agility, muscle strength, self-competence, gross motor function, participation level, and health-related quality of life.
Main results
A significant training effect was found for aerobic (P < .001) and anaerobic capacity (P = .004). A significant effect was also found for agility (P < .001), muscle strength (P < .001), and athletic competence (P = .005). The intensity of participation showed a similar effect for formal (P < .001), overall (P = .002), physical (P = .005), and skilled-based activities (P = .001). On the health-related quality of life measure, a significant improvement was found for the motor (P = .001), autonomy (P = .02), and cognition (P = .04) domains.
Conclusions
An exercise training program improves physical fitness, participation level, and quality of life in children with cerebral palsy when added to standard care.
Comment
Studies have suggested that individuals with cerebral palsy are less active1 and have lower aerobic capacity2, 3 than their able-bodied peers and can have significant rates of risk of overweight.4 In addition, adults with cerebral palsy are at risk of losing ambulatory skills and other functional independence as they age. In response to these concerns, there have been a number of recent studies that have examined the benefits of exercise for individuals with cerebral palsy.5 The training programs have focused on strengthening and aerobic training and have generally shown positive results. This study by Verschuren et al used a circuit training program that contained functional tasks designed to elicit both aerobic and anaerobic training responses. As in other studies, participants in this trial had significant improvement in aerobic and anaerobic capacity, as well as agility and muscle strength, on the basis of functional testing. There was also significant improvement in participation and health-related quality of life. At 4 months after intervention, the subjects had decreased in most measures, although not to baseline. The authors used functional measures for their outcomes, which may lack some of the precision of laboratory measures, but are much more practical for a clinical setting. This study is important in that it describes a functional exercise program requiring no special equipment that can be easily adapted to the child's skill level and the increased physical fitness that results. Although long-term effects are not known, one can only assume that an early introduction to a lifestyle that includes fitness would be beneficial for future health and function for children with cerebral palsy.
References
- . Physical and sedentary activity in adolescents with cerebral palsy. Dev Med Child Neurol. 2007;49:450–457
- . Longitudinal study of physical working capacity of young people with spastic cerebral palsy. Dev Med Child Neurol. 1984;26:328–334
- . Maximal aerobic capacity of young people with spastic cerebral palsy. Dev Med Child Neurol. 1978;20:205–210
- Hurvitz EA, Green LB, Hornyak JE, Khurana SR, Koch LG. Body mass index measures in children with cerebral palsy related to gross motor function classification: A clinic-based study. Am J Phys Med Rehabil (in press).
- Verschuren O, Ketelaar M, Takken T, Helders PJ, Gorter JW. Exercise programs for children with cerebral palsy: A systematic review of the literature. Am J Phys Med Rehabil (in press).
PII: S0022-3476(08)00128-5
doi:10.1016/j.jpeds.2008.02.022
© 2008 Mosby, Inc. All rights reserved.
