Description of Exercise Participation of Adolescents With Cerebral Palsy Across a 4-Year Period

“How should I apply this information?” Regular physical activity (PA) has been recognized as a key determinant of health and wellness. Strong evidence indicates that low levels of PA are linked with morbidity and mortality in adults. Information on PA levels during childhood and adolescence is scarce. The lack of longitudinal data, in particular, makes it difficult to draw conclusions about how activity levels in life track into adulthood. Moreover, most of the research has focused on increasing physical fitness rather than increasing PA. As a result, less is known about the effect of PA on the health of children compared with adults. In recent years, PA has been strongly promoted to prevent secondary conditions because children and adolescents are known to have lower levels of PA than peers without disabilities. It has been shown that young children with cerebral palsy (CP) not only are participating less in activities that are of enough intensity to have an effect on their health but also tend to choose activities with a slower tempo than do their peers. A number of studies suggest that PA patterns established during childhood and youth are important in laying the foundation for activities in the future. In contrast to PA, there is little documented information on exercise participation of youths with CP. This information is essential for designing PA guidelines and programs for physical therapists to tailor PA and exercise that have an effect on the health of these children, now and in the future. Current (Canadian) standards are at least 60 minutes of daily PA and 30 minutes of vigorous PA. This study described the types of exercise participation of adolescents with CP by sex and level of GMFCS, the weekly duration of exercises and determined how the PA level compares with the recommended health guidelines. It is concluded that the unacceptable and declining levels of exercise participation in adolescents with CP indicate that sustained efforts to promote PA and exercise are required. PA is an integral part of health care and wellness in all children and youth. Much of a child's activity will be achieved through short bouts rather than continuous activity. They should be encouraged to participate in lifestyle activities, sports, aerobic activities, muscular strength, and endurance and flexibility activities. Are all these feasible in children and adolescents with CP? Valid and reliable PA assessment measures are critical for identifying relevant trends in PA patterns of young people and determining the effect of intervention programs—measures that accurately reflect the levels of PA and not only levels of physical fitness. Currently, commonly used objective instruments include accelerometers, pedometers, and heart rate monitors. They quantify levels of PA and sometimes also can measure duration, intensity, and patterns of daily PA. However, many of these instruments are not yet validated for use in a population of persons with CP. Although this study provided important information about the exercise participation of adolescents with CP, the one million dollar question remains: how do we effectively increase the exercise participation in children with disability? “What should I be mindful about in applying this information?” PA promotion is an often neglected, but important role of the (pediatric) physical therapist. A recent review identified only 1 trial investigating the effectiveness of physical therapists to increase physical activities. That study showed that patients who received a PA promotion intervention delivered by a physical therapist did not increase their PA levels significantly over a control group who did not receive this PA counseling.1 The information presented by Brunton and Bartlett definitely show that there is a need for PA promotion in adolescents with CP. How to effectively perform this exercise counseling, however, remains unclear. One way to increase PA participation might be the school environment. Schools have the responsibility of creating an environment that supports the lifelong habit for daily PA and for healthy lifestyles (physical education). However, the home environment is important as well because many children fall back in PA levels and adopt a sedentary lifestyle during school holidays, especially during the summer break. Tim Takken, PhD, MSc Paul Helders, PhD, MSc, PT, PCS Faculty of Medicine, Division of Pediatrics, Utrecht University, Child Development and Exercise Center, University Medical Center and Children's Hospital, Utrecht, The Netherlands

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