03 Dec Exercising with Cerebral Palsy
Cerebral palsy occurs when there is an injury to the developing brain either during pregnancy or shortly after birth. Cerebral palsy results in a physical disability that affects movement and posture and is a permanent life-long condition, which does not worsen over time.
1 in 700 children are born with cerebral palsy and it is considered to be the most common physical disability in childhood.
Cerebral Palsy is classified via a system called the Gross Motor Function Classification System, commonly referred to as the GMFCS.
THE BENEFITS OF EXERCISE
People with cerebral palsy of all ages and all GMFCS levels can improve their function and gross motor skills through increasing their fitness levels and reducing sedentary behaviours. Improved function will then allow them to enhance their health and well-being and prevent them from entering a cycle of deconditioning.
The wide range of benefits elicited by regular physical activity include:
- improved health and well-being (including decreased anxiety, depression and stress)
- maintained mobility and range of motion
- decreased sedentary behaviours
- decreased risk of mortality due to cardiovascular and circulatory complications
- improved sleep patterns and quality
- increased circulation and movement of the bowels and therefore decreased likelihood of bowel obstructions and constipation
Exercise programs can be tailored to focus on specific, meaningful life goals and increasing capacity and independence, such as confidence to walk across the road, go swimming, or go grocery shopping.
In one study, participants who were young people with cerebral palsy discussed the psychological benefits of participating in a strength training programme, of having more energy, of having a feeling of well-being, and the benefits of taking personal responsibility.
The social opportunities during exercise therapy are also important as it can result in increased opportunities for people living with cerebral palsy to engage in the community.
TYPES OF EXERCISE RECOMMENDED
Every individual with cerebral palsy is unique, as the type and presentation of their movement disorder depends on the area of the brain affected and therefore impacts the recommended type of exercise.
For example, exercise for a person with spastic cerebral palsy following botulinum toxin therapy would include targeted strength training in the antagonist muscles of the target limb, whereas exercise for the prevention of long-term chronic health conditions and metabolic dysregulation should focus on reducing sedentary behaviours through regular low to moderate physical activity.
Overall, a mixture of aerobic and strength training is recommended:
- 150 minutes of moderate intensity exercise per week
- 2-3 sessions of strength training per week
According to existing research, exercise prescription for people with cerebral palsy should include:
- a minimum frequency of 2-3 times per week;
- an intensity between 60-95% of peak heart rate, or between 40–80% of the heart rate reservice (HRR), or between 50–65% of VO2peak; and
- a minimum time of 20 minutes per session, for at least 8 consecutive weeks, when training three times a week, or for 16 consecutive weeks when training two times a week.
Overall, greater gains are made with longer training programs (in terms of duration: 3 months plus of adherence to program) and participating in higher dosages of training.
Aerobic exercise is important for people with cerebral palsy as it enables them to complete activities such as walking or propelling a wheelchair without being inhibited by fatigue. A range of research reported that fitness training increased aerobic capacity in this population.
Maintaining strength through strength exercise is important to keep muscles healthy and reducing cardiometabolic risk factor profiles and lowering all-cause mortality. Strong muscles are helpful for daily activities like getting up and down from the couch, getting dressed, or leaning forward to put a sling on for hoist transfers.
As cerebral palsy results from an injury to motor regions of the developing brain, muscle weakness is a primary impairment and there is strong evidence showing that children with cerebral palsy are significantly weaker than typically developing children. Resistance training promotes an increase in muscle mass and can be done in a variety of ways such as body weight training, resistance training machines found within a gym setting or free weights.
Some types of strength training are safer than others for different individuals. For example, individuals with ataxia with uncoordinated movements may not be recommended to use free weights due to the risk of dropping them or over-extending their joints. Fixed range resistance training machines are safer in these aspects. Similarly, an increase in energy expenditure due to decreased efficiency of movements in individuals with dystonia can lead to increased fatigue, and therefore adequate rest breaks need to be considered when commencing strength training programs.
People with cerebral palsy are recommended to utilise both functional and progressive strength training. This technique involves using exercises that are made progressively more difficult through an increase in the amount of weight or the resistance over time. Functional strength training involves doing everyday functional activities while the amount of resistance increases. Examples of this method include repetitively throwing and catching weighted balls or moving around in a self-propelling wheelchair to help increase arm strength.
Due to decreased lower limb strength, co-ordination and poor muscle control, and increased fatiguability of the muscles, falls risk can be high in individuals with cerebral palsy. Balance exercises are therefore important. Practicing both static and dynamic balance, in a range of different foot positions and environments, are great ways to maintain and improve balance.
Hydrotherapy involves training in a heated pool (32-34 degrees), completing exercise tailored to the individual’s unique needs. Along with improving strength and mobility, including gross motor function and walking endurance, hydrotherapy is also frequently used as part of rehabilitation programs following surgery. For someone with severely limited mobility, hydrotherapy can be liberating – enabling much greater movement and range of motion than on land. Hydrotherapy programs can integrate aerobic, strength and balance training in a safe environment.
SPEAK TO THE EXERCISE PROFESSIONALS
There are many kinds of exercises and the ‘best’ type will depend on the person’s age, family situation, health and mobility. The decision to undertake fitness training involves understanding the evidence, cost, time and resources required and putting plans and preparations in place to overcome any potential barriers.
For example, these associated impairments experienced by people with cerebral palsy may significantly impact upon opportunities to participate in physical activities:
- 3 in 4 people with cerebral palsy experience pain
- 1 in 4 has a behaviour disorder
- 1 in 2 has an intellectual impairment
- 1 in 5 has a sleep disorder
However, none of these should be a barrier to participation.
There are a multitude of exercise and activity options for all individuals with cerebral palsy regardless of level of severity and physical disability. The important thing is finding the right approach for the individual.
The best way to do this is to consult with an Accredited Exercise Physiologist or other suitably qualified health professional such as an Accredited Exercise Scientist. These exercise professionals can also work with local community groups and sports clubs to provide education and training for increasing participation opportunities within local groups and programs for people living with cerebral palsy.
Click here to find an accredited exercise professional near you.
Expert Contributor: Lauren Dadd, Accredited Exercise Physiologist and Clinical Educator at Cerebral Palsy Alliance