# Exercise as it relates to Disease/Is HIIT and CP a match made in heaven? Can high functioning Cerebral Palsy children expect the same results as their peers with circuit training?

This factsheet is based on the journal article by Verschuren et al., 2007; Exercise training program in children and adolescents with cerebral palsy: a randomized controlled trial, with analysis by u3081166.

## What is the background to this research

Worldwide there are approximately 17 million people suffering from Cerebral Palsy; it the most common physical disability in Australian children. The symptoms and severity of Cerebral Palsy are broad and very specific to the individual, they can include spasticity, weakness, pain and paralysis effecting between one and four of the individual's limbs. Symptoms can also include, but are not limited to, intellectual, visual, speech, bladder control, sleep, behavioural and salivary control impairments, as well as frequent seizuring There is currently no cure, therefore continual pharmaceutical, medical, orthopaedic and allied health involvement is essential for improving the quality of life for the child and their family.

## Where is the research from?

This research was conducted in the Netherlands on children aged 7–20 years, with spastic-type Cerebral Palsy, and classified with a GMFCS of 1 or 2. The authors have extensive experience in both paediatric Cerebral Palsy and exercise. While this research has been supported by the Dr W.M. Phelps Foundation, the funding body did not participate in any component of the study.

## What kind of research was this?

This research is a pragmatic randomised controlled trial(RCT). In this context, the term pragmatic refers to a study which is more field focused with more flexible participant selection and intervention implementation. RCTs achieve a level 2 for evidence quality; the highest level attainable for individual studies. This means that results achieved can be quite confidently attributed to the intervention, rather than a fault in the study design. The study used a 4-block randomization protocol, therefore reducing the risk of selection bias The study included suitable inclusion and exclusion criteria. The study also used the intention to treat theory when analysing results to reduce the effects of dropout and crossover on group randomisation.

## What did the research involve?

| Domain Tested: | Assessment Used: |
| Aerobic Capacity | 10metre Shuttle-Run Test |
| Anaerobic Capacity | Muscle Power Sprint Test |
| Agility | 10 x 5metre Sprint Test |
| Lower Body Muscle Strength | 30second Repetition Maximum Test |
| Body Composition | Body Mass Index |
| Participant's Perception of Self | Self-Perception Profile for Children |
| Standing, walking, running and jumping | Gross Motor Function Measure (GMFM) |
| Recreational activity participation | Children's Assessment of Participation and Enjoyment (CAPE) |
| Parent-perceived level of pain, autonomy, motor, social, emotional and cognitive functioning of their child | TNO-AZL Questionnaire for Children's Health-Related Quality of Life (TACQOL) |
* Assessments were performed by independent physiotherapists who were blind to participant grouping. Assessments were performed at baseline, 4 months, 8months and at follow-up.
* The intervention involved a 45minute circuit program completed twice per week. The program consisted of a 5minute warm up, 25-35minutes of exercises, followed by a 5minute cool down.
* 8 standardised aerobic exercises lasting 3-6minutes and 8 standardised anaerobic exercises lasting 20-30seconds were used.
* Task-specific exercises such as running, changing body direction abruptly, step-ups, and stair climbing were included in every session.
* The focus of the first 4months was to improve aerobic capacity, whilst the focus of second 4months was to improve anaerobic capacity.

## Basic Results

Statistically significant improvements in aerobic capacity, anaerobic capacity, agility, lower body muscle strength, and some components of the Self-Perception for Children, GMFM and CAPE assessments were seen in the intervention group. All results for the control group remained relatively stable over the assessment period and at follow up. While some reduction in the effects of the intervention occurred by follow-up, the intervention group retained some of the positive gains in aerobic and anaerobic capacity over this time, unlike the control group. The below diagram demonstrates the percentage changes in aerobic and anaerobic capacity by the intervention and control groups:

## Conclusions from the research

Like typically developing children, children with Cerebral Palsy have the capacity to increase their aerobic capacity, anaerobic capacity, and muscle strength by taking part in regular circuit-based exercise programs based on functional activities. Training anaerobic ability is important for children, as the majority of daily childhood activities are of a high intensity and of a short duration (<15seconds). This research fills a gap in the evidence, as it proves that anaerobic training is both possible and beneficial for children suffering from Cerebral Palsy.

## Practical advice

* As with all new exercise programs, participants should consult their doctor before commencing.
* All participants were supervised by qualified physiotherapists throughout the entire process of this trial.

## Further information/resources

* For further information on Cerebral Palsy please refer to: https://www.cerebralpalsy.org.au/about-cerebral-palsy/
* For information on the importance of exercise for children and adults with Cerebral Palsy please refer to: http://www.cerebralpalsy.org/information/health-fitness

## References

* 1 2 3 4 5 Verschuren, O., Ketelaar, M., Gorter, J. W., Helders, P. J., Uiterwaal, C. S., & Takken, T. (2007). Exercise training program in children and adolescents with cerebral palsy: a randomized controlled trial. Archives of pediatrics & adolescent medicine, 161(11), 1075-1081
* ↑ Cerebral palsy alliance. (2013). Australian Cerebral Palsy Register: Report 2013. Retrieved from https://www.cerebralpalsy.org.au/wp-content/uploads/2013/04/ACPR-Report_Web_2013.pdf
* ↑ Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., ... & Jacobsson, B. (2007). A report: the definition and classification of cerebral palsy April 2006. Developmental Medicine & Child Neurology, 49(109), 8-14.
* 1 2 3 Hoffmann, T., Bennett, S. & Del Mar, C. (2013). Evidence-based practice across the health professions. Chatswood: Elsevier Australia.
* ↑ Bailey, R. C., Olson, J. O. D. I., Pepper, S. L., Porszasz, J. A. N. O. S., Barstow, T. J., & Cooper, D. M. (1995). The level and tempo of children's physical activities: an observational study. Medicine and science in sports and exercise, 27(7), 1033-1041.
* ↑ Eisenmann, J. C., & Wickel, E. E. (2009). The biological basis of physical activity in children: revisited. Pediatric Exercise Science, 21(3), 257-272.