The Effects of Aerobic Exercise on Endurance, Strength, Function and Self-Perception in Adolescents with Spastic Cerebral Palsy: A Report of Three Case Studies
Dipti V. Kale
Schlough, K., Nawocsenski, D., Case, L. E., Nolan, K., & Wigglesworth, J. K. (2005). The effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy: A report of three case studies. Pediatric Physical Therapy, 17, 234-250.
To report the effects of aerobic exercise intervention in ambulatory adolescents with spastic cerebral palsy (CP) on change in endurance, strength, function, and self-perception.
- Adolescents with cerebral palsy (Three were included)
- Type of cerebral palsy: hemiplegia or diplegia
- Ambulatory with or without walking aid or lower-extremity bracing
- Able to walk at least 5 minutes without resting
Instrumentation: Treadmill (Precor C964iTM), recumbent stepper (NUSTEP TRS 4000TM), and elliptical machines (Precor EFX 546TM) with minimal adaptations (straps, gait belt for safety).
Outcome measures were:
- Energy Expenditure Index (EEI), used to examine the extent to which walking speed affects heart rate at self-selected walking speeds. Lower EEI values indicate more efficient gait patterns.
- Lower-extremity muscle strength, measured by a handheld dynamometer (Power Track II Commander TM by JTECH).
- Gross Motor Function Measure (GMFM), used to measure present level of independence of ambulation. It is obtained by scoring performances of standing, walking, running, and jumping.
- Self-Perception Profile for College Students (SPPCS), used to measure the perceived competence of the participants.
- Rate of Perceived Exertion Scale (RPE), used to measure exertion as perceived by a person.
A single system (A1B1A2B2) design was used with an initial baseline phase (A1), an intervention phase (B1), a post-test or no training phase (A2), and an extended optional independent intervention phase (B2).
A1: Baseline measures 3 times a week for 2 weeks, no intervention.
B1: Initial intervention, data collected once weekly for 6 weeks.
A2: Post-intervention measures, data collected 3 times a week for 2 weeks, no intervention.
B2: Optional training for additional 15 weeks or as long as participant wished, data collected once every alternate week.
Exercise sessions occurred 3 times a week using a treadmill, stepper, or elliptical machine for each session randomly, so that participants utilized all three pieces of equipment once a week. The goal of the 6-week training period was for each participant to exercise 20 consecutive minutes within the predetermined target heart rate, using Karvonen's formula.
Significant changes at p < 0.05:
Participant 1: Improved EEI, reduced walking velocity, increased resting heart rate, and increased muscle strength.
Participant 2: No significant change in EEI, increased walking velocity, reduced resting heart rate, increased walking heart rate, and increased muscle strength.
Participant 3: Deterioration in EEI, reduced resting heart rate, and increased walking heart rate.
This case study investigates the effect of aerobic exercise on various parameters of adolescents with cerebral palsy, not only highlighting the effect on physical condition of the subject, but also the level of functional independence, psychological impact of exercise on self-esteem, image, and competence. This report suggests that aerobic exercise may help increase leg strength, decrease energy required for ambulation, improve gross motor function, and improve self-perception.