Physical Activity Levels of Adolescents and Adults With Cerebral Palsy in Urban South Africa

Abstract

Background: Research in high income countries shows that people with cerebral palsy (CP) are less physically active than typically developing (TD) peers, but less is known regarding physical activity (PA) in those with CP in low-to-middle income countries. The aim of this study was to determine daily step count and levels of PA in adolescents and adults with CP living in urban South Africa, compared to TD peers, and to determine associations with sex, Gross Motor Function Classification System (GMFCS) level, body mass index and socio-economic status.Materials and Methods: This case–control study included 26 adolescents and 22 adults with CP (GMFCS Level I-V) and matched TD peers (25 and 30, respectively). Participants wore an ActiGraph GT3X for 7 consecutive days to determine step count and time (minutes per hour) spent in PA levels, including sedentary (SED), low physical activity (LPA) and moderate to vigorous physical activity (MVPA).Results: The daily step count and PA levels for ambulant adolescents with CP (GMFCS level I-III) were similar to TD peers, while this was less for adolescents classified in GMFCS level IV-V. Daily step count, SED and MVPA were similar for adults classified in GMFCS level I-II compared to TD adults, while all parameters were lower for adults using assistive devices (GMFCS level III) and non-ambulant adults (GMFCS level IV-V) compared to TD peers. Daily step count and PA levels were inversely associated with GMFCS, while no other associations were found.Conclusion: People with CP who were more mobile dependent (higher GMFCS level) were less active. However, adolescents and adults with CP classified as GMFCS levels I-II living in urban South Africa recorded similar step count and PA levels as their TD peers. This was also the case for adolescents using assistive devices, though not for those in the adult group (GMFCS level III). Furthermore, it was apparent that even the ambulant individuals with CP and TD cohorts were relatively inactive. Intervention programs for CP and TD adolescents should be aimed at finding strategies to keep adolescents physically active well into adulthood, in order to promote physical health, social and emotional well-being and independence.

Attitudes and Behaviors of Physical Activity in Children with Cerebral Palsy: Findings from PLAY Questionnaire

“…These differences were subtle ( Table 2 ), but it is worth noting that children with CP reported slightly more time in their PE and outside play compared to TD children. These findings were different to previous reports regarding physical activity level in young CP population in conjunction with TD children [ 16 , 17 , 18 ]. Comparing teenagers with CP (GMFCS level I–III) and their age-matched TD peers, a study from South Africa reported step counts were comparable [ 17 ].…”

“…These findings were different to previous reports regarding physical activity level in young CP population in conjunction with TD children [ 16 , 17 , 18 ]. Comparing teenagers with CP (GMFCS level I–III) and their age-matched TD peers, a study from South Africa reported step counts were comparable [ 17 ]. However, a report from the Netherlands that compared physical activity level between children with CP (age 5–7 years, GMFCS level I-IV) and the same age TD peers showed lower physical activity level in children with CP than their counterpart TD children [ 18 ].…”

Cerebral palsy in African paediatric populations: A scoping review

“…Several studies measured functional outcomes using standardized and validated tools such as the GMFCS, the 66-item Gross Motor Function Measure, the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) to report the range of function among children living with CP (Table S 1). 9,11,19,20,32,38,41,43,46,54,63,94,[97][98][99][100][101][102] Studies of cohorts drawn from predominantly hospital-based neurology clinics tended to report a larger proportion of children with more severe gross motor impairments, that is, GMFCS or MACS levels IV and V, 11,20,38,41,46,63,83 compared to communitybased studies. 9,32,43,74,94,97,101 The difference in proportion was up to 55%, with a Ethiopian hospital-based study reporting 75.3% of children classified in GMFCS levels IV and V and 75.5% in MACS levels IV and V, 46 versus 20% of children in GMFCS levels IV and V in a community-based Ugandan study.…”

“…9,11,19,20,32,38,41,43,46,54,63,94,[97][98][99][100][101][102] Studies of cohorts drawn from predominantly hospital-based neurology clinics tended to report a larger proportion of children with more severe gross motor impairments, that is, GMFCS or MACS levels IV and V, 11,20,38,41,46,63,83 compared to communitybased studies. 9,32,43,74,94,97,101 The difference in proportion was up to 55%, with a Ethiopian hospital-based study reporting 75.3% of children classified in GMFCS levels IV and V and 75.5% in MACS levels IV and V, 46 versus 20% of children in GMFCS levels IV and V in a community-based Ugandan study. 9 Many studies also reported varying functional impairments according to age, with a larger proportion of younger children more severely affected than older children.…”

“…43 A South African case-control study found that physical activity levels, as measured by step count, were comparable between adolescents with CP classified in GMFCS levels I to III and typically developing adolescents. 101 Health care use, school attendance, and barriers to accessing care CP makes a large contribution to the burden of disease from neurological conditions seen at hospital clinics 37,39,40,60,65,69,70,77,102 and emergency centres 103 in Africa (Table S1). The reported proportion of children with CP between these clinics ranged from 4% 102 to 55.3% of attending children; 70 13.3% of children with an existing diagnosis presenting to the emergency department of an Egyptian tertiary hospital over a 1-year period had CP.…”