Cardiovascular Health

• Youth who have low physical activity and fitness levels in addition to high body fat levels are more likely to have cardiovascular disease risk factors that include elevated blood pressure and serum cholesterol;
• The report noted the recent CDC expert panel recommendation that daily participation in developmentally appropriate, moderate to vigorous physical activity lasting 60 minutes or longer can improve aerobic fitness, reduce body fat, and encourage weight loss in non-disabled youth (ages 6-18);
• Children with CP were found to exhibit from two to three times higher energy expenditure during walking than children without disabilities.
• In laboratory studies, children with CP were found to have poor cardiovascular health; however, fewer studies have been conducted to examine how this affects activities and participation in the community. A few self-report studies found that children with CP reported decreased activity levels compared with their peers without disabilities.
• Children with CP were also found to spend more time sitting compared to children without disabilities.
• One study found that children with CP take significantly fewer steps per day (4,244) as compared with non-disabled children (6,740).
• Aerobic exercise training has been found to be beneficial for children with CP. Specific programs included:
  • o Lower-limb cycling for 3 sessions per week of 20 minutes each over a period ranging from 1.5 to 16 months improved cardiorespiratory fitness in a sample of 22 children and young adults with CP;
  • Sport and exercise programs involving individual or group games followed by mat exercises or swimming improved fitness in one study;
  • A school-based sports and exercise program that included swimming, wheelchair propulsion, running, and mat exercises was shown to improve fitness (an increase in fat mass was noted in a control group of children who didn't exercise over the same period of time); and
  • Aerobic dance routines were adapted to require minimal balance effort so children with CP could participate to the level of achieving cardiovascular fitness.

Secondary Conditions

The expert panel noted that the most common secondary conditions experienced by youth with CP were: low bone mass, increased musculoskeletal weakness and pain. Pain is a commonly reported secondary condition in children with CP. The committee cited reports that found as many as 67% of children with CP reported having pain, and chronic pain is often reported in the spine, hip, knee, ankle, and foot. Children with CP who have exhibited low vitamin D levels, poor nutrition, use of anticonvulsants, have a history of previous fractures, and alterations in pubertal and skeletal maturation are at particular risk for fractures.

Implications for Health Promotion

Children with CP are at risk for developing and maintaining sedentary behaviors because of physical, cognitive, and/or environmental barriers to physical activity participation. For example, there is evidence that sedentary behaviors, such as watching television and/or playing video games, have already been linked to reduced physical activity levels among these youth. Although the Individuals with Disabilities Education Act (IDEA) requires that all children and adolescents with disabilities are included in physical education, the majority of youth with disabilities do not receive the same amount of physical activity as youth without disabilities.

It is an unfortunate paradox that children with CP experience secondary conditions as a result of inactivity (i.e., deconditioning), yet secondary conditions (i.e., pain, impaired balance) often prevent children with CP from participating in physical activity that could have a beneficial impact on secondary condition prevention. This report provides a good basis for understanding the current state of fitness among populations of children with CP, and the findings lead to an understanding of the importance of accessible and engaging fitness programs that will involve these children in physical activity at a young age with the potential for forming a lifelong commitment to improved health and fitness.

Reference:

• Fowler,E.G., Kolobe, T.H., Damiano, D.L., et al. (2007). Promotion of Physical Fitness and Prevention of Secondary Conditions for Children with Cerebral Palsy: Section on Pediatrics Research Summit Proceedings. Physical Therapy, 87 (11), 1495-1510.