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Exercise Interventions

Aerobic Exercise

Aerobic exercise can improve cerebral palsy (CP) patients’ aerobic fitness[1] and general motor function[2]. CP patients can improve peak aerobic power[3], which refers to the muscle's ability to use oxygen to generate energy[4], by doing aerobic exercise, such as cycling, running, swimming. Another advantage of conducting aerobic training is that their muscle strength is enhanced and the energy required for CP patients to ambulate is reduced, which in turn assists them to cope with the motor impairments and activity restriction related to CP[1]. Though aerobic exercise promotes CP patients’ mobility and ability to execute daily tasks, they may have difficulties to exercise since cerebral palsy fatigue always resulted in poor movement economy[5], which means more energy is needed to achieve the same intensity of physical activity. These obstacles can be addressed by tailoring the type, intensity and duration of exercise to patients with different levels of the disease[5]. CP patients should also pay attention to proper head, trunk and joints position during the workout, since they are more subject to overuse injuries[5].

Aquatic exercise

Aquatic exercise, which refers to the aerobic exercise in water, may overcome several problems associated with CP patients practicing exercises. CP patients with impaired balance, joint problems, together with instability, serious contracture are unable to perform some land-based exercises. On the other hand, in the water environment, the buoyancy could ease the effect of poor posture control and balance on the performance of exercise. And patients improve gross motor function, including flexibility and muscle strength, through aquatic workout[2].

Resistance training

Resistance training can improve cerebral palsy (CP) patients’ muscle strength by working against a weight or force. To protect the patients from potential hurt, appropriate warm-up, stretching and cool-down should be performed in slow and dynamic muscle strengthening exercise (4). The major benefits of this kind of exercise are improved neuromuscular performance, as well as motor function. Enhanced strength, flexibility and fine-motor cooperation (5) enable the patients to perform better in daily activities (6). For example, strengthening the knee extensor could support patients’ standing, walking, running and jumping (6). In specific, resistance exercise particularly trains the weak muscle groups that oppose hypertonic muscle, with excess passive tightness or stiffness, so as to balance the abnormal muscle tone through reciprocal inhibition (4). Therefore, it is important to identify any asymmetrical weakness, through individual muscle group’s assessment, and weaker muscle could generate greater power through more effective contraction. On the other hand, stretching before exercise could reduce muscle spasticity.

Cardiorespiratory Endurance

Cerebral Palsy (CP) is known to be related to lowered cardiorespiratory endurance in CP patients[6], while cardiorespiratory endurance is the ability of the lungs, heart, and blood vessels of delivering oxygen to the rest of the body[7]. CP increases the risk of cardiovascular disease and respiratory disease, including risks of angina, upper respiratory infections, and pneumonia[8][9] as it directly affects muscles that are crucial for heart and lung functioning. It is necessary for CP patients to improve their cardiorespiratory endurance in order to enhance own physical fitness, which directly affects the ability to carry ouy tasks without fatigue thus predict potential life quality[10].

Exercise is one of the ways to improve cardiorespiratory endurance. With CP, it is normal that patients have a lower threshold of exercise intensity, nevertheless, cardiorespiratory endurance is not about the intensity but the ability to sustain a moderate level of exercise. It is suggested that patients should set a goal depending on their heart rate in order to improve cardiorespiratory endurance. While the target heart rate during an exercise should be kept between 40-85% of their maximal heart rate with a recommended duration of 10 minutes for cardiorespiratory fitness[11]. The heart rate should be monitored well during exercise for CP patients as a heart rate of too high is risky given that CP patients are more likely to develop heart failure[12], while a low heart rate is not effective in cardiorespiratory endurance training. It is important to note that CP patients are not suggested to do trainings that stimulates a sudden and immediate increase in heart rate, the pace should be slowly built[12]. Some suitable exercises for CP patients to train their cardiorespiratory endurance are jogging and biking, for patients with problems of using their legs, arm exercisers upper extremity ergometers which act same as a bike can be used instead, more will be explained in later sections. While it is also suggested that swimming program is effective in improving lung function and breathing efficiency by enhancing muscles involved especially in children, as they are in a critical stage of body development[9].

Others

Several new researches have suggested some innovative ways to help CP patients through exercising, while dancing is one of them. Dancing requires good skills in balancing movements, effective strength usage, and endurance, while these are usually the weaknesses of CP patients as their muscles function decline with age. Through dancing, these weaknesses could be trained and improved, researches also proved that dancing helps improving neurorehabilitation for CP[13].

Yoga is also said to be a beneficial exercise for CP patients, and is commonly introduced to children with CP. One thing about yoga is that it can be modified according to each individual's needs and limitations[14], which is important for CP patients as they usually have different extents of physical limitations and weaknesses. It is stated that yoga improves respiration for CP patients by allowing a rhythmic and deeper breathing[15], it can also reduce muscle tone hence improving flexibility of patients, leading to an increase of range of motion, which plays an important role in mobility[14][15].

Assistive Technologies

Various types of technologies can be used to assist CP patients during exercises.

Hip-extensor tricycle is a bicycle designed to strengthen hip extensor muscles, it works by applying different amount of extra weight thus controls the pressure of cycling and is more effective and safe in terms of muscle training[16]. It is commonly applied on children with CP to improve the gait, as walking impairment is one of the symptoms of CP, and the tricycle is said to be able to improve patients' gait thus walk movements through assisting motor control in gait[17][18]. Upper extremity ergometers are devices similar to hip-extensor tricycle that functions in a same mechanism except they are arm exercisers. These devices can be widely used by CP patients to improve limb muscles strength thus enhancing their mobility.








  1. ^ a b Rogers, Anna; Furler, Barbara-Lynne; Brinks, Stephen; Darrah, Johanna (2008). "A systematic review of the effectiveness of aerobic exercise interventions for children with cerebral palsy: an AACPDM evidence report". Developmental Medicine & Child Neurology. 50 (11): 808–814. doi:10.1111/j.1469-8749.2008.03134.x. ISSN 1469-8749.
  2. ^ a b "Exercise Reduces Secondary Conditions in Children with Cerebral Palsy : NCHPAD - Building Inclusive Communities". National Center on Health, Physical Activity and Disability (NCHPAD). Retrieved 2020-04-03.
  3. ^ Ryan, Jennifer M; Cassidy, Elizabeth E; Noorduyn, Stephen G; O'Connell, Neil E (2015-04-15), The Cochrane Collaboration (ed.), "Exercise interventions for adults and children with cerebral palsy", Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, pp. CD011660, doi:10.1002/14651858.cd011660., retrieved 2020-04-03 {{citation}}: Check |doi= value (help)
  4. ^ "Aerobic Power Testing -". exercise.trekeducation.org. Retrieved 2020-04-03.
  5. ^ a b c "Exercise Programming for Clients with Cerebral Palsy : NCHPAD - Building Inclusive Communities". National Center on Health, Physical Activity and Disability (NCHPAD). Retrieved 2020-04-03.
  6. ^ Hombergen, Susan P.; Huisstede, Bionka M.; Streur, Marjolein F.; Stam, Henk J.; Slaman, Jorrit; Bussmann, Johannes B.; Berg-Emons, Rita J. van den (2012-05-01). "Impact of Cerebral Palsy on Health-Related Physical Fitness in Adults: Systematic Review". Archives of Physical Medicine and Rehabilitation. 93 (5): 871–881. doi:10.1016/j.apmr.2011.11.032. ISSN 0003-9993.
  7. ^ "Alert Diver | Improving Cardiovascular Endurance". www.alertdiver.com. Retrieved 2020-04-01.
  8. ^ MSc, Iqra Mumal (2018-10-01). "Heart Disease Can Trouble Cerebral Palsy Patients as Adults, Study..." Cerebral Palsy News Today. Retrieved 2020-04-01.
  9. ^ a b "Cerebral Palsy and Respiratory Health". www.cerebralpalsyguidance.com. Retrieved 2020-04-01.
  10. ^ "President's Council on Sports, Fitness & Nutrition (PCSFN)". HHS.gov. 2017-01-10. Retrieved 2020-04-01.
  11. ^ American Academy for Cerebral Palsy and Developmental Medicine. "Physical Fitness and Exercise for Adults with Cerebral Palsy" (PDF).{{cite web}}: CS1 maint: url-status (link)
  12. ^ a b "Cerebral Palsy Heart Problems: Can You Prevent Them?". Flint Rehab. 2020-01-23. Retrieved 2020-04-01.
  13. ^ Grinstein, Jonathan (2019-01-23). "Dance Benefits Neurorehabilitation and Social Engagement for CP..." Cerebral Palsy News Today. Retrieved 2020-04-02.
  14. ^ a b "Yoga for Cerebral Palsy". www.cerebralpalsyguidance.com. Retrieved 2020-04-02.
  15. ^ a b yogainternational.com https://yogainternational.com/article/view/how-yoga-can-benefit-children-with-cerebral-palsy/. Retrieved 2020-04-02. {{cite web}}: Missing or empty |title= (help)
  16. ^ Howell, Glade; Brown, Don; Bloswick, Donald; Bean, Jeffrey; Gooch, Judith (1993-02-01). "Design of a Device to Exercise Hip Extensor Muscles in Children with Cerebral Palsy". Assistive technology : the official journal of RESNA. 5: 119–29. doi:10.1080/10400435.1993.10132216.
  17. ^ "Cerebral Palsy : NCHPAD - Building Inclusive Communities". National Center on Health, Physical Activity and Disability (NCHPAD). Retrieved 2020-04-02.
  18. ^ Effgen, Susan K., 1949- (2013). Meeting the physical therapy needs of children. F.A. Davis Co. ISBN 978-0-8036-1942-5. OCLC 842003351.{{cite book}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
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