Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial

Abstract

AIM To evaluate the effectiveness of functional progressive resistance exercise (PRE) strength training on muscle strength and mobility in children with cerebral palsy (CP).METHOD Fifty-one children with spastic uni-and bilateral CP; (29 males, 22 females; mean age 10y 5mo, SD 1y 10mo, range 6y 0mo-13y 10mo; Gross Motor Function Classification System levels I-III) were randomized to the intervention group (n=26) or the control group (n=25, receiving usual care). The intervention group trained for 12 weeks, three times a week, on a five-exercise circuit, which included a leg-press and functional exercises. The training load progressively increased based on the child's maximum level of strength, determined by the eight-repetition maximum. Muscle strength (measured with hand-held dynamometry and a six-repetition maximum leg-press test), mobility (measured with the Gross Motor Function Measure, two functional tests, and a mobility questionnaire), and spasticity (measured by the appearance of a catch) were evaluated before, during, directly after, and 6 weeks after the end of training by two blinded research assistants.RESULTS Directly after training, there was a statistically significant effect (p<0.05) on muscle strength (knee extensors +12% [0.56N ⁄ kg; 95% confidence interval {CI} 0.13-0.99]; hip abductors +11% [0.27N ⁄ kg; 95% CI 0.00-0.54]; total +8% [1.30N ⁄ kg; 95% CI 0.56-2.54]; six-repetition maximum +14% [14%; 95% CI 1.99-26.35]), but not on mobility or spasticity. A detraining effect was seen after 6 weeks.INTERPRETATION Twelve weeks of functional PRE strength training increases muscle strength up to 14%. This strength gain did not lead to improved mobility.Cerebral palsy (CP) describes a group of disorders in the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing brain. 1 It is the most common cause of movement disability in childhood. Children with CP may experience a variety of impaired muscle functions, such as spasticity, muscle weakness, and loss of selective motor control. Although all impaired muscle functions limit the performance of daily life activities and participation in a child with CP, a recent study has shown that muscle weakness showed a stronger association with mobility limitations in children with CP than spasticity. 2 Strength training for these children is, therefore, expected to improve or maintain their mobility.Until recently, strength training in children with CP was discouraged as it was assumed that it would increase spasticity. However, this was not supported by the results of earlier uncontrolled studies which showed that strength training can improve lower-limb muscle strength in children with CP without increasing spasticity. 3,4 Although studies have shown there to be sufficient evidence for its effectiveness on muscle strength, these effects are probably overestimated because of the low methodological quality of the studies. 5,6 The few uncontrolled studies that have evalua...

Progressive resistance training and mobility‐related function in young people with cerebral palsy: a randomized controlled trial

“…[6][7][8] Previous reports not based on randomized controlled designs may have overestimated the effect that resistance training can have on improving mobility. 1,5 The progressive resistance training programme that led to strength increases in our trial fulfilled key requirements of resistance training including training intensity, frequency, and duration 10,22 and was effective in its intended purpose of increasing muscle strength.…”

“…1,5 Although these studies have provided important preliminary evidence to suggest that progressive resistance training could improve mobility, the lack of randomization reduces confidence in the findings. Recent randomized controlled trials that have addressed this limitation have not identified changes in mobility after progressive resistance training in young children 6,7 or in middle-aged adults with CP. 8 However, in these trials, all participants underwent the same exercise programme regardless of their individual presentation.…”

Physical activity as a prescription for the children with cerebral palsy

“…Given that the effect sizes in this metaanalysis obtained 59/0, we can say that the effect of exercise therapy for CP spastic symptoms in children with spastic cerebral palsy is moderate. Based on the findings of this meta-analysis therapists can choose appropriate treatment to decrease CP symptoms to obtain better and more reliable results [11,21,22]. It is proposed that treatment method of nerve development and sensory-motor integration therapy be included in daily programs of these children from practitioners because of being pioneer in serve and treatment of children [11,23,24].…”

Goal Oriented Activity Towards Life Skill Training: Preliminary Indications of a Task-intensive Approach to Manage Cerebral Palsy

“…The target movement must be repeated 120-150 times. The authors suggest 75 % of 8 Repetition Maximum (RM) (Scholtes VA et al, 2010) as loading for strengthening movements.…”

“…8 RM must be calculated for progressive resistance training (Scholtes VA et al, 2010). This may be done by means of a weighted jacket.…”