Differences in cardiovascular health in ambulatory persons with cerebral palsy

Abstract

Physical activity has many health benefits, one of which is the health of the heart and blood vessels. People with cerebral palsy are at risk of developing unhealthy heart and blood vessels due to limitations in mobility reducing the amount of physical activity they can perform. We studied the differences in blood vessel health between people with cerebral palsy who walk without limitations compared with those who walk with limitations. The group who walk without limitations had better measures of vessel health, such as lower blood pressure, and engaged in more physical activity than those who walk with limitations. We recommend that healthcare providers measure blood pressure and discuss physical activity with people with cerebral palsy in order to help them maintain heart and blood vessel health. Objective: To compare cardiovascular health vari ables and physical activity levels of adolescents and adults with cerebral palsy who are Gross Motor Func tion Classification System (GMFCS) levels I and II. Methods: Eleven adolescents (mean age 13.1 (stan dard deviation (SD) 2.1) years) and 14 adults (mean age 31.7 (SD 10.4) years)) with cerebral palsy were included, grouped by their GMFCS level (level I (n = 12); level II (n = 13)). Assessments of cardio vascular health, body composition and physical acti vity levels were performed. Cardiovascular variables included resting blood pressure and carotid artery intima media thickness. Body composition included height, weight, body mass index, and waist circum ference. Physical activity was measured using acce lerometry. Results: Adjusting for age between GMFCS levels (GMFCS I mean 17.3 (SD 5.2); GMFCS II mean 29.3 (SD 14.1) years, p = 0.011), significant differences were evident for moderate-to-vigorous physical activity per day (GMFCS I median 45.8 (interquar tile range (IQR) 32.4-75.1); GMFCS II median 16.4 (IQR 13.0, 25.0) min/day, p = 0.011), height (GM FCS I mean 1.63 (SD 0.14); GMFCS II mean 1.56 (SD 0.12) m, p = 0.010), mean arterial pressure (GMFCS I mean 84.6 (SD 7.8); GMFCS II mean 89.4 (SD 8.5) mmHg, p = 0.030), and carotid artery intima media thickness (GMFCS I mean 0.431 (SD 0.06); GMFCS II mean 0.489 (SD 0.04), p = 0.026). Conclusion: Individuals with cerebral palsy who were GMFCS level I had lower mean arterial pres sure, thinner carotid artery intima media thickness, and engaged in a greater amount of moderate-tovigorous physical activity per day than those who were GMFCS level II. Clinicians should acknowled ge that ambulatory individuals with cerebral palsy could have differing cardiovascular health profiles and should monitor these cardiovascular variables and discuss physical activity during healthcare vi sits, regardless of age.

Diet quality in adults with cerebral palsy: a modifiable risk factor for cardiovascular disease prevention

“…3 Although a variety of factors influence risk, body composition and a sedentary lifestyle are likely contributors. 1,2,4,5 The observation that functional mobility in adults with CP worsens as early as young adulthood, much earlier than in neuro-typical adults, is consistent with the pattern of reduced activity playing a role in the development of cardiovascular disease (CVD) among individuals with CP. 6 Implementation of an active lifestyle can be difficult, as the disability itself impacts participation in many community-based physical activities.…”

“…Our population had a lower prevalence of obese individuals compared to the general population for our state (Illinois) 33 . We also found lower levels of obesity than several prior studies of adults with CP 1,2 . Comparing our cohort to other studies of CMS in those with CP, our population may have fewer persons with elevated BMIs as our group included non‐ambulatory adults who, in turn, could have less independent access to food or greater overall deficits including swallowing 1,34 .…”

Prevalence of metabolic syndrome and cardiovascular disease risk factors in adults with cerebral palsy

“…Future research on this topic should focus on developing best practices for CVD biomarker monitoring and risk factor cut‐offs specifically for individuals with CP. Since current literature has reported a high prevalence of obesity in adults with CP, creating CVD‐specific guidelines for this population could have important public health implications . Researchers in this area should develop screening tools better suited to individuals with CP, to more accurately identify risk factors early, before CVD development, and effectively intervene with diet, exercise, and lifestyle modification to reduce the likelihood of developing CVD and metabolic syndrome over their lifetime.…”

Adults with Cerebral Palsy Require Ongoing Neurologic Care: A Systematic Review

“…For instance, outcomes for adults undergoing selective dorsal rhizotomy, injection of botulinum A toxin, and orthopedic surgery have been reported 81–83 . Improving access to and acceptance of exercise by adults with CP has been the subject of several studies and clinical projects 84,85 . As highlighted throughout this article, the rigorous tracking of neurologic outcomes is an area of significant need.…”

“…[81][82][83] Improving access to and acceptance of exercise by adults with CP has been the subject of several studies and clinical projects. 84,85 As highlighted throughout this article, the rigorous tracking of neurologic outcomes is an area of significant need.…”