Promotion of Physical Fitness and Prevention of Secondary Conditions for Children with Cerebral Palsy - Part I

The American Physical Therapy Association’s Section on Pediatrics Research conducted a research summit a couple of years ago to examine the current literature on physical fitness and secondary condition prevention in children with cerebral palsy (CP). Results of this meeting will be published in the October issue of the journal, Physical Therapy. It will be one of the first reviews of fitness in children with CP published in this journal. This is part one of a two-part series on the report’s findings. Part Two will appear in the November issue of Physical Therapy.

The overall goal of the report was to examine the evidence that exercise can improve fitness and prevent secondary conditions for children with CP. The report uses the terms "physical fitness" and "secondary conditions," which are not often the focus of a multidisciplinary group such as was convened for this expert panel. This document represents an important first step in identifying current practice and the need for future research in determining optimum exercise programs customized for children with CP.

Findings of this report are somewhat alarming, given the enormous health disparities between children with and without disabilities. Children with CP have reduced physical activity levels and exhibit greater weakness and less endurance than children without disabilities. Weakness, poor balance, and muscle spasticity also make it difficult to participate in physical activity sufficient to develop and maintain fitness in this population. The group concluded that muscular strengthening exercises (using resistance such as weights) can have a beneficial impact on activity for children with spastic CP.

Some of the major findings regarding strength programs and barriers to physical activity include:

Strength

• Children with CP can benefit from progressive resistance (weight) training that has been shown to improve strength and function.
• Strengthening programs reviewed included use of free weights, strength training machines, and isokinetic exercise.
• The concern that performance of strengthening exercises would increase spasticity appears to be unfounded based on the literature.
• Children reported feeling better about their appearance following a community strengthening intervention.

Children with CP are often excluded from school and community-based sport and physical fitness opportunities because of lack of accessibility of these programs. Community fitness centers were found to have participation barriers such as lack of safety, inaccessible equipment, lack of resources, transportation and financial barriers, and lack of knowledge by facility personnel about accessible exercise.

Committee's Conclusion

The report concludes, "Given the importance of mobility to overall health, well-being and independence in the child with CP, it is vital to:

1. identify underlying causes of excessive energy use,
2. develop effective treatments to reduce energy-wasteful movements,
3. develop physical fitness interventions for children who are unable to walk, and
4. implement community exercise and sports programs to improve cardiorespiratory fitness."

This report provides a solid foundation upon which to draw upon evidence-based exercise programs for children with CP. It is a comprehensive examination of not only the physiological (i.e., strength, cardiovascular fitness) evidence, but also provides acknowledgement of the physical and societal barriers that exist for children with CP (and other disabilities) to be able to fully participate in exercise programs sufficient to raise their levels of fitness. These barriers must be removed in order for children with CP (and other disabilities) to be able to participate in activities and exercise with their peers in ways that are enjoyable and engaging, which is what all children deserve.

Next month’s column (Part II) will focus on the committee’s findings regarding cardiovascular health and secondary conditions for children with CP.

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.

This fact sheet was last updated on 10-08-2007.