Abstract by: Ingrid BergTurk, M.A., Scandale, J., Rosenbaum, P.F., & Weber, R.J. (2001). The health of women with cerebral palsy. Physical Medicine and Rehabilitation Clinics of North America, 12, 153-168.
ReviewTurk et al. reviewed the literature pertaining to the overall health (including exercise participation) of women with cerebral palsy (CP). This information, gleaned from surveys and questionnaires, is limited by the paucity of these surveys, regional differences, and reliance on self-reported data. A discussion of the prevalence of CP and several definitions are included (CP, aging, secondary conditions, associated conditions, comorbidities, health, and physical fitness) that provided context for the health issues facing people with CP. This review demonstrated that gender influences health, including exercise patterns and barriers for people with disabilities. It also provided several cues for exercise scientists to better serve their clients who have CP and illuminated research gaps. However, the review could have provided a more thorough and rigorous discussion of the research studies on physical activity and CP.
Gender is a useful filter to examine the overall health and exercise barriers that persons with disabilities face, including women with CP. According to the article, if women are less active than men at any age and people with disabilities are less active than the general population, then women with disabilities are among the least active of all. Many women with CP face the long-standing belief that they should avoid exertion because of their disability and because of the increasingly outdated notion that girls and women don't play sports. In a study of 215 people with CP (50% women) in the Syracuse, New York, area, only 49% participated in infrequent aerobic activities and 44% participated in flexibility programs. Interestingly, women reported more pain for all body sites questioned than men and were just as likely to utilize routine health care as women without disabilities. Whether women with CP really do experience more pain or are more in tune with or willing to discuss their bodies is unclear. If women with CP utilize health care services regularly, then the physician's office would be an ideal place to pitch an exercise program and refer clients to a nearby fitness facility. Men may need to be reached via another outlet.Exercise physiologists and private trainers have several things to keep in mind when working with female clients who have CP. For example, certain activities might appeal to women with CP more than men. From the Syracuse study, the authors found that participation in sports differed by gender. Men with CP were significantly (p < 0.05) more likely to participate in basketball, track, or tennis than the women. In the studies reviewed, women reported increased spasticity and incontinence during menstruation. The exercise implications for this cyclic change have not been explored. Further, women with CP can and do maintain pregnancies. Again, the exercise needs of women with CP who are pregnant, albeit a small segment of a subpopulation, should also be researched down the road.
Certainly, a review of the overall health of a population would be incomplete without a discussion of exercise; unfortunately, this discussion is too cursory. The authors state that research has demonstrated positive health outcomes when people with CP exercise. They cite one article by Damiano and Abel (1998) that demonstrated strength gains in 11 children with CP. In addition, two books are cited: one on caregiving for people with CP and another on musculoskeletal issues and fitness. It is unclear if these books provide summaries of data or original data.About the same time this article appeared, Rimmer (2001) published a review article on the methodological problems of exercise research conducted on individuals with CP, namely child-only subject pools, short-term studies, small sample sizes, and wide variability in subject age. Within a group of 63 women surveyed from the Syracuse study, 83% reported engaging in at least one common physical activity, such as swimming or walking, and 43% reported engaging in range of motion exercises. These numbers seem high compared to the 49% and 44% reported earlier, and could be elevated due to the nature of self-reporting. No mention was made of how often the subjects engaged in these activities or if the activity was performed at a high enough intensity to glean health benefits, or if any health benefits were measured at all. Exercise testing for people with CP is not mentioned.
The authors note that a review article such as this, focusing on women with cerebral palsy, draws on quite a narrow pool of literature because there is a lack of research on people with disabilities as a whole. Nonetheless, it seems clear that this type of review, synthesizing information on a subpopulation of people with disabilities, can still be very useful in trying to uncover patterns of secondary conditions and functional limitations so that exercise physiologists, physicians, and researchers can better educate their clients and patients - in this case, women with CP - on an exercise regimen that can improve the quality of many lives.