# Exercise as it relates to Disease/Effects of exercise in children diagnosed with Cerebral Palsy

This is a critique of the original research: "Exercise Training Program in Children and Adolescents With Cerebral Palsy"

## What is the background to this research?

Cerebral Palsyis referred to as an umbrella term as it highlights a group of disorders affecting the movement ability of an individual. Caused by damage to the developing brain during pregnancy or just after birth, the cause of Cerebral Palsy is often unknown due to a large number of factors being possible. With statistics displaying that approximately 2 children per 1000 births are born with Cerebral Palsy worldwide and no known cure, the positives for individuals movement, quality of life, and decreased symptoms rely on medications, surgeries, and therapies, especially physical exercise. In the article, Exercise Training Program in Children and Adolescents With Cerebral Palsy, they focus on evaluating the effects of training on anaerobic and aerobic capacity in children diagnosed with Cerebral Palsy.

## Where is the research from?

The research was conducted at the Rehabilitation Centre “De Hoogstraat”, Netherlands. The 16-month study began in July 2005 and was completed in October 2006. The head researcher, Olaf Verschuren, is a well-known professor focusing his study on paediatric rehabilitation, specifically Cerebral Palsy with over 150 publications and 2500 references. He was assisted by lse Oosterom, Chantal Hiddink, Radmer Schalkx, Jose Ermers, Anneleen de Pagter, Heidi Vogels, Annelies Polman, and Joep Janssen who are all commended in their line of work.

## What kind of research was this?

This study was a Randomized Control Trial consisting of 86 children selected from four special education schools within the Netherlands. Each child was diagnosed with cerebral palsy, aged between 7 and 18 years old. Randomized Control Trials are often referred to as the most reliable method available as it reduces the source of bias with testing and recording.

## What did the research involve?

The intervention involved randomly assigning the children to either the training group (consisting of 32 kids) or the control group (consisting of 33 kids). The training group got together twice per week and trained for a 45 minute consisting of:
* 5 minute warmup
* 25 – 35 minute circuit which included:
* 8 standardized aerobic exercises lasting between 3 to 6 minutes
* 8 standardized anaerobic exercises lasting between 20 to 30 seconds
* 5 minute cooldown.
Both groups then completed a 10 metre shuttle test for aerobic capacity and Muscle Power Sprint test for anaerobic capacity as the primary measure. Other secondary measures taken included participation, health-related quality of life, competency, agility, and strength. Programmed training sessions were delivered by 2 local paediatric physiotherapists at school, helping facilitate the progress and ensuring the children were participating. The tests were then assessed with non-biased and individuals bought in to score when needed (e.g. Health-Related Quality of Life assessment).
Limitations were mainly noticed in participation with 22 individuals not meeting criteria or discontinuing during the study due to various reasons. Also, the minimal previous information produced meant that this study was a breakthrough and was always going to have limitations.

## What were the basic results?

The highlighted results showed improvements on all tests within the training group:
* Aerobic capacity (+38%)
* Anaerobic capacity (+25%)
* Agility (+15%)
* Muscle strength of the lower extremities (+20%)
* Competency (+11%)
* Positive participation
* Increased health-related quality of life
With these results were deemed a success by the researches, as it identified the positives gained with the completion of functional training not only on aerobic and anaerobic factors but other important living aspects.

## What conclusions can we take from this research?

In conclusion, the 8-month prescribed anaerobic and aerobic focused training program not only improved the children’s physical fitness, it enriched their health-related quality of life and participation levels. This study has created the platform for more research to be conducted in regard to the positive effects of exercise on individuals suffering from not only Cerebral Palsy but similar diseases.

## Practical advice

Positive and specialised exercise plans should be developed for each individual or group and when committed to and supported correctly the program will improve individuals physical and overall wellbeing. This should not only be supported for an 8-month time period but a healthy lifestyle should be pursued continuously. The identification of further resources should be mentioned to encourage the monitoring, progression and support if needed when completing a program.

## Further information/resources

For further information on the results and clarification, I encourage you to read the paper: Exercise Training Program in Children and Adolescents With Cerebral Palsy
To learn more about Cerebral Palsy visit:
* https://cparf.org/what-is-cerebral-palsy/
* https://www.cerebralpalsyguidance.com/cerebral-palsy/

## References

* 1 2 3 Verschuren O, Ketelaar M, Gorter JW, Helders PJM, Uiterwaal CSPM, Takken T. Exercise Training Program in Children and Adolescents With Cerebral Palsy: A Randomized Controlled Trial. Arch Pediatr Adolesc Med. 2007;161(11):1075–1081. doi:10.1001/archpedi.161.4.356
* ↑ Jansheski G, 2020 .https://www.cerebralpalsyguidance.com/cerebral-palsy/
* ↑ Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Developmental Medicine & Child Neurology. 2013;55(6):509-19.
* ↑ https://www.researchgate.net/profile/Olaf_Verschuren
* ↑ Murrell D, 2018 https://www.medicalnewstoday.com/articles/280574#takeaway