Physical fitness and physical strain in adults with CP

Abstract

REVIEW Background: Physical fitness is important in promoting health and preventing disease. To remain physically fit a certain amount of physical activity/exercise is necessary. Adults with Cerebral Palsy (CP) are at risk to be less active and this might result in reduced physical fitness, increased risk of diseases, dependency and functional limitations. A training program could be a solution to battle the effects of the inactivity. However, the level of physical fitness in adults with CP is unknown. Research is needed to investigate the level of physical fitness of this group enabling the development of a training program. Therefore, the aim of this review is to describe the level of physical fitness of adults with cerebral palsy compared to healthy adults. Methods: A computer-aided literature search was performed in MEDLINE, CINAHL, Embase, Cochrane en Pedro. Data extraction and methodological assessment was performed. Results: A total of nine studies were included, three investigated bodycomposition, five cardiorespiratory endurance, three muscular strength and one investigated muscular endurance. No studies on flexibility were found. Muscular strength, muscular endurance and cardiorespiratory endurance showed significantly lower values in adults with CP compared to their healthy controls. Body composition did not show significant differences between the CP and control groups. Conclusion: This review demonstrates reduced level of physical fitness of three components in adults with CP: muscular strength, muscular endurance and cardiorespiratory endurance. Especially muscle strength and endurance showed large reduction compared to healthy controls. The development of a training program is recommended, aiming to stop the cycle of deconditioning.

COMPARATIVE STUDY Objective: To determine the physical strain (expressed as percentage heart rate reserve, %HRR) during daily life in adults with cerebral palsy (CP), compared to able-bodied peers. Secondary the level of physical activity in daily life in adults with CP was assessed. Design: Non-experimental comparative study Methods: Twelve adults with bilateral spastic CP, with mainly high level gross motor functioning, and twelve able-bodied peers participated. They were 1:1 matched on age and sex. With an accelerometry based Activity Monitor (AM) both stationary and dynamic activity and ECG were recorded during two consecutive weekdays. From the ECG recordings the HRduring activity and the HRrest were derived. The HRpeak was assessed by a maximal cycle ergometer test. From the accelero-signals we calculated the duration of activities. Main outcome measures: From the HR data and accelero-data we calculated the mean %HRR during 48 hours, mean %HRR during waking hours, and mean %HRR during separate stationary and dynamic activities. From the AM the mean duration in 48 hours (expressed as percentage) of both stationary and dynamic activities was derived. Results: Adults with CP had a significantly higher %HRR during 48 hours than able-bodied peers (15.1% ± 7.2 versus 11.2% ± 2.1, respectively: p≤0.01). Strain was higher (p≤0.01) in both stationary activities (sitting, standing) and dynamic activities (walking). No significant difference in duration of stationary and dynamic activities was found between both groups. Conclusion: Despite the fact that we found no significant difference in physical activity level, the adults with CP endure a significant higher physical strain in daily life compared to able-bodied peers.