An aerobic exercise program in specialist schools for young people with cerebral palsy, that may improve measures of cardiovascular performance, can be completed safely, with moderately high levels of adherence.

Aim To explore the barriers to and facilitators of physical activity for young people with cerebral palsy in specialist schools. Method Eleven focus groups involving 73 participants (10 young people with cerebral palsy, 13 parents of children with cerebral palsy, 27 teachers, 23 therapists) were held at two specialist schools. Focus groups were audio‐recorded and transcribed verbatim. Transcripts were analysed using inductive thematic analysis by two researchers, independently. Results Four main themes emerged from the focus groups: school priorities; student factors; staffing and environment; and roles and relationships. Physical activity was promoted when academic work and physical activity were seen as equally important school priorities. Student factors that reduced physical activity included fluctuating health, school absences, and protracted rehabilitation after surgery. The staffing and environment unique to specialist schools played a pivotal role in assisting students to be active, as was the importance of collaborative, relationship‐based care. Interpretation Physical activity programmes developed in specialist schools need to take into consideration complexities associated with the age, developmental stage, and academic requirements of young people with cerebral palsy. Particularly for adolescents, motivation was discussed as having a substantial influence on physical activity participation. These findings may assist school leadership teams, clinicians, and teachers in planning physical activity interventions. What this paper adds Specialist schools offer custom‐built environments that promote physical activity and inclusion for students with physical impairments. Therapists and teaching staff work creatively and collaboratively to incorporate an ‘all‐day’ approach to providing physical activity opportunities. Balancing time spent on physical activity versus academic work can cause tension.

These data converge with those from a randomized controlled trial and attribute physical and psychosocial benefits to a specialist school-based exercise program for young people with cerebral palsy.

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AimTo identify implementation strategies and safety outcomes (adverse events) of community‐based physical activity interventions for adolescents and adults with complex cerebral palsy (CP).MethodFive electronic databases were systematically searched to April 2022. Data were extracted on the implementation and safety of physical activity interventions for adolescents and adults with CP, classified in Gross Motor Function Classification System (GMFCS) levels IV and V, delivered in a community setting.ResultsSeventeen studies with 262 participants (160 participants classified in GMFCS levels IV or V) were included. Community settings included schools (n = 4), participants' homes (n = 3), gymnasia (n = 2), swimming pools (n = 2), and other settings (n = 4). Most studies specified medical or safety exclusion criteria. Implementation strategies included pre‐exercise screening, use of adapted equipment, familiarization sessions, supervision, physical assistance, and physiological monitoring. Attendance was high and attrition low. Nine studies reported non‐serious, expected, and related events. Four studies reported minor soreness and four studies reported minor fatigue post‐exercise. Serious adverse events related to exercise were infrequent (reported for 4 of 160 participants [<2%]: three participants withdrew from an exercise programme and one participant ceased exercise for a short period). Most frequently reported was pain, requiring temporary exercise cessation or programme change, or study withdrawal (three participants).InterpretationFor most adolescents and adults with CP classified in GMFCS levels IV and V, physical activity interventions can be safely performed in a community setting, without post‐exercise pain or fatigue, or serious adverse events.

Background: Fatigue is a common problem for people with cerebral palsy (CP), which adversely affects health-related outcomes. The emerging body of literature on fatigue in people with CP is characterised by substantial heterogeneity in assessment methods. To date, a systematic analysis of the measurement methods, and appraisal of the tools used to measure fatigue in people with CP has not been carried out. The aim of this review is to use The International Classification of Functioning, Disability and Health (ICF) as a framework to categorise and appraise current methods for measuring fatigue in people with CP. Methods and Design: Literature searches will be conducted in MEDLINE, PsycInfo, CINAHL, Web of Science and Cochrane databases. Studies will be included in this systematic review if they purport to measure any type of fatigue in people with CP of any age through original research, are written in English and are published in peer-reviewed literature since 1980. From included studies we will extract the assessment methods used to measure fatigue, and demographic and clinical characteristics of the sample of people with CP. We will then provide a narrative synthesis of the type and ICF domain of fatigue purportedly measured and critical appraisal of the assessment methods used. Discussion: This review will summarise current methods for measuring fatigue in people with CP. Critical appraisal and systematic categorisation of assessment methods will allow us to identify areas for further research on the domains in which fatigue occurs, and the role of fatigue in relation to clustering with other symptoms. Findings are expected to guide future assessment of fatigue in people with CP.

Purpose: We systematically reviewed the effectiveness of interventions to increase physical activity in older adults (aged ≥ 60 y), admitted for inpatient rehabilitation, without increasing the amount of therapy. Method: Five electronic databases were systematically searched to identify English-language articles reporting controlled trials of interventions to increase the physical activity (through participation or behavioural change) of older adults receiving inpatient rehabilitation. Trials were excluded if an intervention increased the intensity of usual care, either during the week or on the weekend. Two reviewers independently completed trial selection, quality assessment, and data extraction. Data were synthesized descriptively, and effect sizes with 95% CIs were calculated. Results: Of the 316 articles identified, 3 were included. Two were activity-based, and 1 was a behavioural change intervention. Physical activity was significantly improved in the behavioural change intervention trial that occurred during therapy ( d = 0.27; 95% CI: 0.02, 0.52) and non-therapy time ( d = 0.43; 95% CI: 0.19, 0.68). Participants in all trials were sedentary for the vast majority of the day. Conclusions: Older adults in inpatient rehabilitation have a high level of inactivity. Evidence is lacking that interventions increase physical activity in older adults admitted to inpatient rehabilitation without increasing the amount of time in therapy. Evidence from one trial indicates that behaviour-based strategies are effective for increasing physical activity levels in the inpatient rehabilitation setting.

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