Responses of children with cerebral palsy to treadmill walking exercise in the heat
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Updated: Aug 20, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Désirée Maltais1, Boguslaw Wilk, Viswanath Unnithan
1Children's Exercise and Nutrition Centre, Department of Pediatrics, McMaster University, Hamilton, Canada. desiree@mcmaster.ca
Insights
Children and adolescents with cerebral palsy (CP) experience greater heat strain during treadmill walking compared to controls. This is due to higher oxygen uptake (VO2) and increased metabolic heat production in individuals with CP.
Area of Science:
- Exercise Physiology
- Environmental Physiology
- Pediatric Physiology
Background:
- Individuals with cerebral palsy (CP) often exhibit altered metabolic rates during physical activity.
- Previous research indicated higher metabolic rates in CP during treadmill walking compared to arm-cranking.
- Understanding heat strain in CP during ambulation is crucial for exercise prescription and safety.
Purpose of the Study:
- To investigate if higher metabolic heat production in children and adolescents with CP during treadmill walking leads to increased heat strain compared to matched controls.
- To compare physiological responses to heat stress during standardized treadmill exercise between individuals with CP and able-bodied controls.
Main Methods:
- Ten children and adolescents with spastic CP and 10 matched healthy controls (aged 10.3-16.3 years) participated.
- Participants performed three 10-minute treadmill walking bouts in a hot environment (35°C, 50% RH).
- Measurements included oxygen uptake (VO2), heart rate (HR), body temperatures, and rating of perceived exertion (RPE).
Main Results:
- Individuals with CP showed significantly higher steady-state VO2 (40% higher) and rectal temperature (0.4°C higher) compared to controls.
- Heart rate was also elevated in the CP group (37 beats/min higher) during the final minute of exercise.
- No significant differences were observed in sweating rate or rating of perceived exertion between the groups.
Conclusions:
- Subjects with CP experienced greater thermal strain during treadmill walking in the heat.
- Increased metabolic energy requirement and subsequent heat production in CP contribute to heightened heat strain.
- These findings highlight the importance of considering metabolic differences in CP when managing heat exposure during exercise.
Purpose:
When metabolic rate during arm-cranking in the heat is equated between children and adolescents with cerebral palsy (CP) and matched controls (CON), there are no relevant intergroup differences in heat strain. The metabolic rate, however, is known to be higher in CP during treadmill walking. The purpose of this study was to determine if during treadmill walking in the heat, the higher oxygen uptake (VO2), and thus greater metabolic heat production in those with CP would result in greater heat strain compared with able-bodied, matched CON.
Methods:
Ten boys and girls (10.3-16.3 yr) with spastic CP and 10 individually matched (age, body size, biological maturity, gender, race) healthy CON performed 3 x 10-min treadmill walking bouts in 35 degrees C, 50% RH. Body mass, metabolic variables, heart rate (HR), body temperatures, and rating of perceived exertion (RPE) were periodically measured. Individuals within each CP-CON pair walked at the same speed and slope (0.9 +/- 0.4 m x s(-1), 3.3 +/- 0.6%).
Results:
Steady-state VO2 during walking, body temperatures, and HR were all higher in the CP group compared with CON. VO2 was on average 40% higher, rectal temperature was 0.4 degrees C (99% CI = 0.1-0.6 degrees C) higher and HR (during the final minute of each exercise bout) was 37 beats x min(-1) (99% CI = 19-56 beats x min(-1)) higher. There were no differences between the groups in sweating rate (as inferred from body mass changes corrected for fluid intake and output) or in RPE.
Conclusion:
The subjects with CP demonstrated greater thermal strain than CON during treadmill walking where they require more metabolic energy and thus produce more metabolic heat than CON.
