The formula for health and well‐being in individuals with cerebral palsy: physical activity, sleep, and nutrition

SIR–Good health across the lifespan is critical, but may be challenging for individuals with cerebral palsy (CP). Recently, Peterson et al.1 explored the health concerns of adults with CP. They found not only significantly higher odds for secondary musculoskeletal issues (e.g. arthritis and joint pain), as might be expected in an aging population with CP, but also a higher prevalence of diabetes, and pulmonary and cardiovascular conditions. Consistent with the idea of aging, a recent study has shown the potential for longitudinal assessments of both traditional and novel cardiovascular disease risk indicators in adults with CP, such as arterial stiffness and endothelial function.2 Evidently, interventions focusing on health optimization in inviduals with CP across the lifespan are necessary. Until now, physical activity promotion has been the main focus to optimize health in clinical practice and research in this population. However, for professional athletes physical activity and exercise training are just part of their formula for success. Elite athletes know the importance of nutrition and sleep as key factors of sport success. Physical activity, sleep, and nutrition are considered the three main components that allow an individual's body to achieve its goals related to physical activities in daily life. In 2007, the American College of Sports Medicine launched a global initiative to mobilize physicians and health care professionals to promote exercise in their practice or prescribe activities to prevent, reduce, manage, or treat diseases that impact health. This ‘Exercise Is Medicine’ initiative has received support from numerous national organizations. It is therefore no surprise that there has been an increasing interest in exercise and physical activity programs for individuals with CP. At present however, opportunities to promote health and to prevent disease are missed. In this opinion piece, we hope to motivate physicians and other health care practitioners to include, in addition to physical activity promotion, nutrition and sleep management in patient encounters. In the general population, low cardiorespiratory fitness is associated with shorter life expectancy and a higher risk of developing type II diabetes, cardiovascular disease, and some types of cancer. Children and adults should be physically active on a daily basis. Children with CP usually have poor physical fitness, due to both primary impairments (e.g. muscle biology and strength) and the resulting secondary impairments (e.g. contractures and movement limitations). Given the high prevalence of sedentary lifestyles in individuals with CP,3 and the concomitant risk of chronic conditions in adults with CP,1 physical activity promotion is vital for health preservation across the lifespan. A well-balanced diet should contain carbohydrates, proteins, fats, vitamins, and minerals. Various factors, including posture, intake, absorption, and endocrinal and gastrointestinal problems can contribute to poor nutrition in individuals with CP. Undernutrition can have various adverse consequences, including growth failure, decreased cerebral function, impaired immune function, reduced circulation time, and diminished muscle strength. Children with CP frequently experience challenges with nutrition and growth, which have a negative impact on their health, neurodevelopmental outcome, and survival.4 Details of nutritional interventions for individuals with CP remain unclear and are an important focus for further research. Sleep has important biological functions regarding physiological processes, learning, memory, and cognition. At the onset of sleep, changes in almost all human physiological processes occur. Although the function of sleep is not fully understood, it is generally accepted that it serves to permit recovery from previous wakefulness and/or prepare for functioning in the subsequent waking period. A wealth of evidence supports the fundamental role sleep plays in protecting us from severe problems with our health and well-being: poor sleep increases the risk of chronic illnesses including high blood pressure, diabetes, depression, cancer, heart attack, and stroke. There is overwhelming evidence that children with CP have a 7 to 12 times increase in the frequency of sleep disorders, notably disorders of initiation and maintenance of sleep, when compared with their peers.5 Tailored physical activity promotion, consistent nutrition, and time to rest and restore oneself together form the formula to health and well-being in individuals with CP. Physicians and other health care professionals should consider and help individuals with CP to manage their health through assessment of physical activity, nutrition and sleep. We believe that managing these three components, preferably in a comprehensive fashion, will afford a vitally important opportunity to promote the health of individuals with CP across the lifespan. The need for routine assessments and health promotion might be even more important for individuals with CP at greater risk for health issues, in particular those who are non-ambulatory.

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