Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?

doi:10.1016/j.apmr.2018.06.010

Archives of Physical Medicine and Rehabilitation

Volume 99, Issue 12, December 2018, Pages 2457-2464.e4

Presented at the ESMAC-Congress, September 6-9, 2017, Trondheim, Norway.

https://doi.org/10.1016/j.apmr.2018.06.010 Get rights and content

Highlights

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This is the first prospective randomized study of high-intensity circuit training for children with cerebral palsy.
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Home-based training is an effective extension to institutional training in children with cerebral palsy.
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High-intensity and progressive resistance strength trainings improved specific functional parameters.
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There was no improvement for other measures of function or participation measures.
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Only high-intensity circuit training enhanced total muscle strength.

Abstract

Objective

Does home-based progressive resistance or high-intensity circuit training improve strength, function, activity, or participation in children with cerebral palsy (CP)?

Design

This was the first study on high-intensity circuit training for children with CP. This study was conducted as a randomized prospective controlled pilot study.

Setting

Evaluation took place at the gait laboratory of the university hospital, training sessions were performed at home.

Participants

Children (N=22) with CP (average age: 12y, 10mo, 19 Gross Motor Function Classification System level I, 3 level II) were randomly assigned either to progressive resistance training (PRT) or high-intensity circuit training (HICT).

Interventions

The PRT group trained with progressive overload, while the HICT group performed as many repetitions as possible within 30-second intervals (8wk, 3 times weekly in both groups).

Main Outcome Measures

Outcome measures stretched over all domains of the International Classification of Functioning, Disability and Health and included muscle strength, muscle power sprint test (MPST), timed stairs test (TST), 6-minute walking test, Gait Profile Score (GPS), timed Up and Go test (TUGT) and participation questionnaires.

Results

Only the HICT group was able to improve strength. Furthermore, the HICT group scored better in the MPST, while PRT participants improved in the TST and TUGT. The HICT-group was able to show improvement in the subscores of the parent-reported participation questionnaire. Other measures of mobility or participation did not change.

Conclusions

Both programs improved function specific to intervention. However, only the HICT group showed significant strength and participation improvements. Compliance was decent in both groups, but the average training unit was shorter in the HICT group. Both exercise programs showed functional benefits, but HICT might be the preferable option for strengthening in highly functional children with CP.

Section snippets

Methods

This study is designed as a randomized prospective pilot study that investigates the difference in the effects of a home-based progressive resistance training and high-intensity circuit training for children with CP.

Children were recruited through the outpatient clinic of the local university hospital. Included children were between 8 and 16 years old with unilateral or bilateral spastic CP, classified as level I or level II on the Gross Motor Function Classification System and with the ability

Results

Twenty-eight children were recruited for this study and participated between April 2015 and July 2017. Of those, 1 child dropped out during the control phase. The remaining 27 children were randomized to one of the interventions; a flow diagram of participants in the study is presented in fig 3. Another 5 participants dropped out during the intervention. Randomization assigned 1 of them to the progressive resistance program and 4 to the high-intensity circuit program. The reason for all

Discussion

An active lifestyle that might include physical therapy and strengthening is strongly encouraged for children with CP to combat the progressive nature of the disorder, which puts an enormous burden on the children, their parents, and health care providers. This study investigated 2 strengthening programs for children with CP: high-intensity circuit training and progressive resistance training. Both home-based strengthening programs were successful at improving function specific to the

Conclusion

This study investigated 2 home-based strengthening programs in children with CP, progressive resistance training and high-intensity circuit training. Children in both groups showed functional improvement specific to the intervention but the strength gain was significant only in the HICT group. The average training time in the HICT group was considerably shorter. Compliance was excellent and comparable in both groups.

The present study shows that home-based high-intensity circuit training might

Suppliers

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MicroFET2; Hoggan Scientific.
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IBM SPSS, version 23.0; IBM Corporation.

References (27)

D.L. Damiano et al.
Functional outcomes of strength training in spastic cerebral palsy
Arch Phys Med Rehabil
(1998)
S.A. Ross et al.
Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy
Arch Phys Med Rehabil
(2007)
K.J. Dodd et al.
A systematic review of the effectiveness of strength-training programs for people with cerebral palsy
Arch Phys Med Rehabil
(2002)
A. Nsenga Leunkeu et al.
Six-minute walk test in children with cerebral palsy gross motor function classification system levels I and II: reproducibility, validity, and training effects
Arch Phys Med Rehabil
(2012)
R.L. Waters et al.
The energy expenditure of normal and pathologic gait
Gait Posture
(1999)
R. Baker et al.
The gait profile score and movement analysis profile
Gait Posture
(2009)
R.N. Boyd
Functional progressive resistance training improves muscle strength but not walking ability in children with cerebral palsy
J Physiother
(2012)
L. Mutch et al.
Cerebral palsy epidemiology: where are we now and where are we going?
Dev Med Child Neurol
(1992)
D.L. Damiano et al.
Muscle response to heavy resistance exercise in children with spastic cerebral palsy
Dev Med Child Neurol
(1995)
V a Scholtes et al.
Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial
Dev Med Child Neurol
(2010)

N.F. Taylor et al.

Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial

Dev Med Child Neurol

(2013)

D.L. Damiano

Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy

Phys Ther

(2006)

V.A. Scholtes et al.

Lower limb strength training in children with cerebral palsy—a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles

BMC Pediatr

(2008)

Cited by (25)

What are the optimum training parameters of progressive resistance exercise for changes in muscle function, activity and participation in people with cerebral palsy? A systematic review and meta-regression
2023, Physiotherapy (United Kingdom)
Citation Excerpt :
After screening for titles and abstracts, 699 articles were excluded. We considered the eligibility of 86 full text reports, from which we included 20 reports of 16 trials [34–38,40,45–58]. Citation tracking of included articles yielded no additional trials (Fig. 1).
To explore the effect of progressive resistance exercise (PRE) on impairment, activity and participation of people with cerebral palsy (CP). Also, to determine which programme parameters provide the most beneficial effects.
Electronic databases searched from the earliest available time.
Randomised controlled trials (RCTs) implementing PRE as an intervention in people with cerebral palsy were included.
Methodological quality of trials was assessed with the PEDro scale. Meta-analysis and meta-regression were completed.
We included 20 reports of 16 RCTs (n = 504 participants). Results demonstrated low certainty evidence that PRE improved muscle strength (pooled standardised mean difference (SMD)= 0.59 (95%CI: 0.16–1.01; I²=70%). This increase in muscle strength was maintained an average of 11 weeks after training stopped. Τhere was also moderate certainty evidence that it is inconclusive whether PRE has a small effect on gross motor function (SMD= 0.14 (95%CI: −0.09 to 0.36; I²=0%) or participation (SMD= 0.26 (95%CIs: −0.02 to 0.54; I²=0%). When PRE was compared with other therapy there were no between-group differences.
Meta-regression demonstrated no effect of PRE intensity or training volume (frequency x total duration) on muscle strength (p > 0.5). No serious adverse events were reported. There is lack of evidence of the effectiveness of PRE in adults and non-ambulatory people with CP.
PRE is safe and increases muscle strength in young people with CP, which is maintained after training stops. The increase in muscle strength is unrelated to the PRE intensity or dose.
- •
  PRE increases muscle strength of people with CP
- •
  Increased muscle strength following PRE is maintained for at least 11 weeks after training stops
- •
  It is inconclusive whether or not PRE has an effect on gross motor function or participation
- •
  There is no association between the PRE dose parameters and effects on muscle strength
Relationship between kinematic gait quality and caregiver-reported everyday mobility in children and youth with spastic Cerebral Palsy
2023, European Journal of Paediatric Neurology
3D gait analysis (3DGA) is a common assessment in Cerebral Palsy (CP) to quantify the extent of movement abnormalities. Yet, 3DGA is performed in laboratories and may thus be of debatable significance to everyday life.
The aim was to assess the relationship between kinematic gait abnormality and everyday mobility in ambulatory children and youth with spastic CP.
73 paediatric and juvenile patients with uni- or bilateral spastic CP (N = 21 USCP, N = 52, BSCP, age: 4–20 y, GMFCS I-III) underwent a 3DGA, while the MobQues47 Questionnaire quantified caregiver-reported mobility. We calculated the Gait Profile Score (GPS), a metric that summarizes how far the lower limb joint angles during walking deviate from those of matched controls.
The GPS correlated well with indoor and outdoor mobility (rho = −0.69 and −0.70, both p < 0.001) and the relationships were not significantly different for USCP and BSCP. Still, mobility was lower in BSCP (p < 0.001) and more compromised outdoors (p = 0.002). Indoor mobility could be predicted by walking speed, GPS and age (adj. R² = 0.62). Outdoor mobility was best predicted by walking speed and GPS (adj. R² = 0.60). The additive explained variance by the GPS was even higher outdoors than indoors (17.1% vs. 11.4%).
Measuring movement deviations with 3DGA seems equally meaningful in uni- and bilaterally affected children and has considerable relevance for real-life ambulation, particurlarly outdoors, where children with spastic CP typically face greater difficulties. Therapeutic strategies that achieve faster walking and reduction of kinematic deviations may increase outdoor mobility.
Feasibility and efficacy of home-based neurofunctional exercise vs. resistance exercise programs for ambulatory disability of multiple sclerosis patients with cognitive impairment
2022, Multiple Sclerosis and Related Disorders
Ambulatory disability and cognitive impairment are common and co-occuring manifestations of multiple sclerosis (MS). Neurofunctional training is a specific intervention performed in realistic environments that may have beneficial effects on ambulatory disability in persons with MS who have cognitive impairment. This pilot sudy investigated the feasibility and efficacy of an eight-week home-based neurofunctional training (HBNFT) program vs. home-based resistance training (HBRT) on ambulatory performance in MS patients with cognitive impairment.
Thirty males/females with MS (age 18–50 years, Expanded Disability Status Scale (EDSS) score ≤ 6, and processing speed score ≤ 41.5 as a marker of cognitive impairment) were randomly assigned into HBNFT and HBRT groups. After one week (three sessions) of center-based, supervised training for learning the programs and maximizing safety, the participants completed eight weeks (three sessions per week) of the home-based training programs. The programs were supported through videos, brochures and Digital Video Discs (DVDs) provided during clinic visits (weeks 1 and 5). Ambulatory performance (tandem stance test; tandem walk test; timed up-and-go (TUG); six-minute walk test (6MWT), 10- meter walking test (10MWT); timed 25 foot walk test (T25FWT); five times sit to stand test (5TSTS); six spot step test (SSST); and hand grip) was measured before and after the exercise programs. Feasibility and acceptability of exercise programs was assessed after the eight-week period.
HBNFT significantly improved tandem walk test (P = 0.018), SSST (P = 0.026), and 6MWT (P = 0.037) compared with HBRT. No significant changes or differences were observed in other outcomes (P ≥ 0.05). HBNFT was well tolerated and resulted in no adverse events, whereas there were reports of pain, muscle cramps, and extreme fatigue among HBRT participant.
The current pilot study provided initial support for HBNFT as a safe and feasible approach for improving some aspects of ambulation in persons with MS who have cognitive impairment. Such a pilot study provides initial proof-of-concept data for the design and implementation of an appropriately-powered randomized controlled trial (RCT) of neuro-functional training vs. traditional resistance exercise in a larger sample of persons with MS who present with co-occurring impairments in mobility and cognition.
Effects of resistance exercise in patients with spasticity: Systematic review
2021, Apunts Sports Medicine
Citation Excerpt :
On the other hand, it is possible that in the study by Coote et al.26 the NMES group obtained better results than the PRT group because they performed significantly more sessions (p=0.036) than the PRT group. Based on the review, it is logical to think that in all the studies the function of the patients increased in one way or another since in all but two studies22,28 strength increased. This could reinforce the previously discussed idea that strength gains and function are related.30,31
Spasticity is a common disorder in neurological patients. It causes an involuntary or sustained activity of the muscles and it is usually accompanied by weakness and loss of function. Resistance training could thus be an interesting therapeutic tool, so the objective of this review was to analyze the current literature on this type of exercise in spasticity, strength and function in this population. For this, a search was carried out in MEDLINE, CINAHL and SCOPUS and a total of 10 randomized controlled trials were obtained to carry out the analysis. In line with other research, it appears that resistance exercise does not worsen spasticity and could also improve the strength and functionality of these patients, so its practice under appropriate professional supervision is strongly recommended.
Is there a relationship between muscle-tendon properties and a variety of functional tasks in children with spastic cerebral palsy?
2021, Gait and Posture
Citation Excerpt :
A better understanding of the direct influence of specific mechano-morphological muscle-tendon properties on functional tasks might help to improve our understanding of spastic muscle and provide clinicians with the possibility for more targeted interventions. This is a retrospective analysis performed on data collected as part of a strengthening study in children with spastic CP [12,13]. In the present study, the available data from the baseline measurements of this study was used for further analysis.
Cerebral palsy (CP) is the most common motor and movement disability in childhood. The mechano-morphological alterations of the spastic muscle itself as well as the functional limitations in CP are well documented. However, the relationship between muscle tendon properties and functional tests in CP remains unknown.
The aim of this study was to explore the relationship between spastic muscle mechano-morphological properties and functional performance in children with CP.
This study included retrospective data from 22 children with spastic cerebral palsy with a mean age of 12.8 years (19 GMFCS I/3 GMFC II, 15 male/7 female, 8 unilateral involved/14 bilateral). Mechano-morphological properties of gastrocnemius (GM) and Achilles tendon (AT) were correlated with a variety of functional measures, maximal isometric strength, the Muscle Power Sprint test (MPST), 6-minute walk test (6MWT) and 3D-gait analysis using the Pearson Coefficient.
Muscle-tendon properties were normalized to remove anthropometric dimensions because of strong associations with anthropometric data. Higher isometric muscle strength was related to longer normalized GM fascicle lengths (r = 0.67, p < 0.01). The distance reached in the 6MWT positively correlated with normalized GM fascicle lengths (r = 0.61, p < 0.01). Higher AT stiffness was associated with faster performance in the MPST (r = 0.77, p < 0.01). Finally, there was an association between ankle power and both longer normalized AT length and shorter muscle belly (r = 0.60 and r = 0.54, p < 0.01).
The findings of this study give more insight into the function specific adaptations of a spastic muscle-tendon unit. While walking, assessed through the 6MWT, was related to normalized gastrocnemius fascicle length, sprint performance was associated with an increased AT stiffness. These results provide a better understanding of the relationship between functional tasks and spastic muscle-tendon properties, which offers potential for improved and targeted interventions in CP.
Effects of functional power training on gait kinematics in children with cerebral palsy
2019, Gait and Posture
Muscle weakness is one of the most prevalent symptoms in children with cerebral palsy (CP). Although recent studies show that functional power training can improve strength and functional capacity in young children with CP, effects on specific gait parameters have not previously been reported.
What are the effects of functional power training on gait in children with CP? Specifically, we investigated effects of training on gait kinematics and spatiotemporal parameters, and whether these were dependent on walking speed.
Ten children with CP (age 5–10 years, GMFCS I–II) participated in a functional power training program. At the start and end of the program, children underwent 3D gait analysis on a treadmill at a gradual range of walking speeds (70–175% of their comfortable walking speed). Multilevel (linear mixed model) analysis was used to evaluate effects pre-post training at different walking velocities.
Although children’s self-chosen comfortable walking speed improved (0.71 ± 0.25 to 0.85 ± 0.25 m/s, p < .05), effects on gait kinematics at similar speed were limited and only exceeded statistical and clinically meaningful thresholds when children walked at higher walking speed. At fast speeds, improvements up to 5° were found in knee and hip extension during stance (p < .01).
This study demonstrates that gait kinematics can improve after functional power training, but the magnitude of effects is dependent on walking speed. In this light, improvements are underestimated when evaluating gait at pre-training comfortable walking speed only.

View all citing articles on Scopus

: Clinical Trial Registration No.: NCT02319122.

: Disclosures: none.

View full text

Original researchDoes Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?

Highlights

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Suppliers

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Gait Posture

Gait Posture

J Physiother

Cerebral palsy epidemiology: where are we now and where are we going?

Dev Med Child Neurol

Muscle response to heavy resistance exercise in children with spastic cerebral palsy

Dev Med Child Neurol

Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial

Dev Med Child Neurol

Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial

Dev Med Child Neurol

Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy

Phys Ther

Lower limb strength training in children with cerebral palsy—a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles

BMC Pediatr

Original research
Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?