Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy II: Influencing the Trajectory

Abstract

Physical activity of at least moderate intensity in all children contributes to higher levels of physical and psychological health. While essential, children with cerebral palsy (CP) often lack the physical capacity, resources, and knowledge to engage in physical activity at a sufficient intensity to optimize health and well-being. Low levels of physical activity place them at risk for declining fitness and health, contributing to a sedentary lifestyle. From this perspective, we describe a framework to foster a lifelong trajectory of fitness in ambulatory children with CP (GMFCS I–III) as they progress into adolescence and adulthood, implemented in conjunction with a training program to augment bone and muscle health. First, we recommend that altering the fitness trajectory of children with CP will require the use of methods to drive behavioral change prior to adolescence. Second, to promote behavior change, we suggest embedding lifestyle intervention into fitness programming while including meaningful activities and peer socialization to foster self-directed habit formation. If the inclusion of lifestyle intervention to drive behavior change is embedded into fitness programs and found to be effective, it may guide the delivery of targeted programming and community implementation. Participation in comprehensive programming could alter the long-term trajectory of musculoskeletal health while fostering strong self-efficacy in persons with CP.

Treatment of Chronic Degenerative Hip Pain in a Male Patient With Cerebral Palsy Four Decades After Reverse Osteotomy

“…The successful rehabilitation of the patient in this case without the use of intra-articular injections may be attributed in part to consistent physical activity in childhood. It is well documented that CP patients who are able to participate in consistent moderate-intensity physical activity in childhood and adolescence have a greater chance of lifelong mobility [ 12 ].…”

The Journey to Sustainable Participation in Physical Activity for Adolescents Living with Cerebral Palsy

“…Adolescents and parents highlighted the challenge of ‘being active’ now and ‘staying active’ into the future and the lack of awareness of potentially effective strategies. Achieving sustainable participation in physical activity will require a multi-faceted approach that supports health behaviour change [ 23 , 48 , 76 , 77 , 78 ], grounded in the individual’s subjective experience of involvement, meaning, and mastery, and that considers the wider environment [ 23 , 79 , 80 , 81 , 82 ]. The themes support moving beyond meeting physical activity guidelines to promote the development of quality physical activity experiences, particularly when embarking on a new activity or when pre-existing activity levels have been very low [ 17 , 61 ].…”

“…Implementation of such strategies may move adolescents with cerebral palsy from high levels of inactivity to habitual activity. However, research addressing experiences longitudinally before, during, and after an intervention to increase physical activity is lacking, with most knowledge gleaned from interviews of children and adolescents with disabilities as a ‘snap shot’ during or at the end of an intervention programme [ 17 , 18 , 19 , 20 , 21 , 22 ] or from surveys [ 23 ].…”