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Physical activity stimulation program for children with cerebral palsy did not improve physical activity: a
Leontien Van Wely1, Astrid Cj Balemans1, Jules G Becher1
1Department of Rehabilitation Medicine, EMGO+ Institute for Health and Care Research, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
Insights
A 6-month physical activity program did not improve physical activity or mobility in children with cerebral palsy. Further research is needed to explore individual components for potential benefits.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Sports Science
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting motor function.
- Children with CP often experience reduced physical activity, impacting their overall health and well-being.
- Optimizing physical activity levels is crucial for improving functional outcomes in this population.
Purpose of the Study:
- To evaluate the effectiveness of a 6-month physical activity stimulation program compared to usual pediatric physiotherapy.
- To determine if the program improves physical activity, mobility, fitness, fatigue, and attitudes towards sports in children with cerebral palsy.
Main Methods:
- A multicenter randomized controlled trial was conducted with concealed allocation and blinded assessments.
- Forty-nine children (aged 7-13 years) with spastic cerebral palsy (Gross Motor Function Classification System level I-III) participated.
- The intervention included counseling, home-based physiotherapy, and fitness training; the control group received usual physiotherapy.
Main Results:
- No significant differences were observed in primary outcomes (objectively measured physical activity) or secondary outcomes between groups at any assessment point.
- Trends suggested potential short-term improvements in parent-reported moderate-to-vigorous physical activity and Gross Motor Function Measure-66 (GMFM-66) at 6 months, but these were not sustained at 12 months.
- Attitudes towards sports showed minor, clinically irrelevant trends at 6 and 12 months.
Conclusions:
- The combined physical activity stimulation program was not effective in improving physical activity or functional outcomes in children with cerebral palsy.
- Further research is recommended to investigate the efficacy of individual intervention components, such as fitness training or counseling, in this population.
Question:
In children with cerebral palsy, does a 6-month physical activity stimulation program improve physical activity, mobility capacity, fitness, fatigue and attitude towards sports more than usual paediatric physiotherapy?
Design:
Multicentre randomised controlled trial with concealed allocation, blinded assessments and intention-to-treat analysis.
Participants:
Forty-nine walking children (28 males) aged 7-13 years with spastic cerebral palsy and severity of the disability classified as Gross Motor Function Classification System level I-III.
Intervention:
The intervention group followed a 6-month physical activity stimulation program involving counselling through motivational interviewing, home-based physiotherapy, and 4 months of fitness training. The control group continued their usual paediatric physiotherapy.
Outcome Measures:
Primary outcomes were walking activity (assessed objectively with an activity monitor) and parent-reported physical activity (Activity QUESTIONnaire for Adults and Adolescents). Secondary outcomes were: mobility capacity, consisting of Gross Motor Function Measure-66 (GMFM-66), walking capacity and functional strength, fitness (aerobic and anaerobic capacity, muscle strength), self-reported fatigue, and attitude towards sport (child and parent). Assessments were performed at baseline, 4 months, 6 months and 12 months.
Results:
There were no significant intervention effects for physical activity or secondary outcomes at any assessment time. Positive trends were found for parent-reported time at moderate-to-vigorous intensity (between-group change ratio=2.2, 95% CI 1.1 to 4.4) and GMFM-66 (mean between-group difference=2.8 points, 95% CI 0.2 to 5.4) at 6 months, but not at 12 months. There was a trend for a small, but clinically irrelevant, improvement in the children's attitudes towards the disadvantages of sports at 6 months, and towards the advantages of sports at 12 months.
Conclusions:
This physical activity stimulation program, that combined fitness training, counselling and home-based therapy, was not effective in children with cerebral palsy. Further research should examine the potential of each component of the intervention for improving physical activity in this population.
Trial Registration:
NTR2099.
