Jennifer Rowland, Ph.D.

Children with cerebral palsy (CP) have lower endurance and greater muscular weakness than their non-disabled peers, which can be exacerbated by sedentary behaviors and lack of physical activity. A recent in-press article that will appear in the journal Physical Therapy and is authored by members of the American Physical Therapy Association’s Pediatric Research Summit, includes a review of evidence that children with CP often develop secondary conditions such as chronic pain, fatigue, and osteoporosis as a result of low physical activity levels.

There have been several articles published within recent years on the effects of exercise on the health of children with CP, including an article by Schlough et al. (2005) that is a pilot study testing the effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy. This study looked at three adolescents ages 17, 18, and 20 over two phases lasting 10 and 15 weeks, respectively. During phase one, researchers examined the effects of exercising three times per week using the elliptical machine, treadmill, or recumbent stepper, which were used in random order throughout the sessions. Exercise sessions began with two to five minutes of aerobic exercise and progressed as tolerated, with the goal being that participants were to reach and maintain their target heart rate for 20 minutes. During the second phase participants were able to customize their workout routine to their interests using three types of aerobic exercise equipment: treadmill, elliptical trainer, and recumbent stepper, in addition to one participant who elected to swim. Participants showed improvement in gross motor function, strength of the lower extremity muscles, decreased energy required to ambulate, and improved self-perception. The authors suggested that customizing exercise programs to fit individual needs and interests is one way of motivating the initiation of exercise programs that are engaging and could also lend itself to longer-term maintenance of regular exercise for people who might not otherwise find exercise to be rewarding. While this study involved individual case reports for three participants, the positive results provide evidence that customized exercise programs can be beneficial for people with CP. It’s important to note, however, that the evidence for these programs would be strengthened by larger population-based studies involving random assignment.

Although researchers agree more evidence is needed to generalize exercise recommendations across people with different types of cerebral palsy, such as those with spastic diplegia and athetoid CP, there is evidence that exercise programs have been beneficial in improving function, self-perception, cardiovascular health, and strength. Children with CP and other types of disabilities need to have access to sports and community-based programs that allow them to be engaged in interactive and motivational exercise activities. Currently, the barriers to participation in these programs are significant, but more effort must be made on the part of community leaders and those responsible for youth sports to include children with disabilities in all forms of formal activity as a means toward reducing secondary conditions that impair their health and function.

For more information on youth sports programs, visit NCPAD’s searchable programs database at http://www.ncpad.org/programs/ or contact NCHPAD at 800-900-8086.

Other NCHPAD resources include:

The Rationale and Benefits of Sport Participation for Youth of All Abilities at http://www.ncpad.org/397/2171/The~Rationale~and~Benefits~of~Sport~Participation~for~Youth~ of~All~Abilities

Fun and Leisure: Program Considerations for Integrating Children with Disabilities into Community Sports and Recreation Programs at http://www.ncpad.org/86/642/Program~Considerations~for~Integrating~Children~ with~Disabilities~into~Community~Sports~and~Recreation~Programs

References:

Schlough, K., Nawoczenski, D., Case, L.E., Nolan, K., & Wigglesworth, J.K. (2005). The effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy: A report of three case studies. Pediatric Physical Therapy, 17, 234-250.

I encourage you to write to me with suggestions for future column topics or to comment on the information provided in this column. You can reach me by e-mail at jenrow@uic.edu.