Full-Day Physical Activity and Sedentary Behaviour Volumes of 6-12 year old Children with Cerebral Palsy and their Typically Developing Peers in Kuwait
Authors:   , Burahmah Esraa 
Published: September 2024

The main aim of the thesis was to measure physical activity (PA) and sedentary behaviour (SB) volumes of 6-12 year old children with cerebral palsy (CP) and their typically developing (TD) peers in Kuwait. A systematic review was conducted to address a gap in the literature, which is PA and SB volumes of TD children and children with CP in the Middle East. The search yielded 189 relevant papers that were included in the systematic review. There was a large volume of missing data describing covariates in the papers making numerical summary of outcomes difficult. A narrative of results is presented. ActivPAL4 was chosen as the device to measure PA and SB volumes for the main data collection. However, it was a relatively new device and was not tested for validity and reliability nor agreement with activPAL3, thus these characteristics of the monitor were investigated prior to commencing the main data collection. Thirteen participants (6M/7F) were included in the validation and reliability and in the agreement studies (mean age 8.5 years old, SD 1.8, range 6.3–12.2). The validation and reliability of activPAL4 study found that activPAL4 showed strong validity against direct observation for sitting and stepping time but slightly overestimated standing time. Purposeful forward stepping was detected with a high degree of accuracy at normal walking speeds but underestimated at fast walking/jogging. Smaller stepping movements (forward and backward) were not recorded by the activPAL4. The activPAL4 showed a high level of reliability similar to direct observation. Like previous activPAL devices, the activPAL4 records standardised activities well but underestimates faster steps. More research is needed to determine how the activPAL4 counts steps under non-standardised activity protocols. The agreement between activPAL3 and activPAL4 study found that the monitors generally agreed under laboratory and free-living conditions. However, theactivPAL4 had lower standing time and more steps than the activPAL3 in laboratory and free-living data collections. Individual participants' agreement decreased with slow stepping or with the thigh at an inclined angle. Despite good agreement this study shows differences in some activPAL4 and activPAL3 outcomes, suggesting device changes have affected physical behaviour characterisation. These differences should be considered when comparing study results. For the main data collection, no age-related trends in daily step counts among children with CP and TD were found. Boys took more steps compared to girls. Children with CP were more physically active compared to their TD counterparts, with a higher average daily stepping time, which is an unusual finding. The study also found that three participants with CP had the longest accumulation of sedentary time. Also, daily steps taken by children with CP according to their GMFCS level revealed no age-related trends. Similarly, both the number of daily STS transitions and the upright time of children with CP according to their GMFCS levels showed no age-related trends. In addition, there did not seem to be a trend with children's engagement in PA and SB with a change in GMFCS level.