Research

Topic

Stationary Cycling in the pediatric population

"Pediatric Endurance and Limb Strengthening (PEDALS) for Children With Cerebral Palsy Using Stationary Cycling: A Randomized Controlled Trial"

Abstract

Background: Effective interventions to improve and maintain strength (force-generating capacity) and endurance are needed for children with cerebral palsy (CP).

Objective: This study was performed to examine the effects of a stationary cycling intervention on muscle strength, locomotor endurance, preferred walking speed, and gross motor function in children with spastic diplegic CP.

Design: This was a phase I randomized controlled trial with single blinding.

Setting: The interventions were performed in community-based outpatient physical therapy clinics. Outcome assessments were performed in university laboratories.

Participants: Sixty-two ambulatory children aged 7 to 18 years with spastic diplegic CP and Gross Motor Function Classification System levels I to III participated in this study.

Intervention and measurements: Participants were randomly assigned to cycling or control (no-intervention) groups. Thirty intervention sessions occurred over 12 weeks. Primary outcomes were peak knee extensor and flexor moments, the 600-Yard Walk-Run Test, the Thirty-Second Walk Test, and the Gross Motor Function Measure sections D and E (GMFM-66).

Results: Significant baseline-postintervention improvements were found for the 600-Yard Walk-Run Test, the GMFM-66, peak knee extensor moments at 120 degrees /s, and peak knee flexor moments at 30 degrees /s for the cycling group. Improved peak knee flexor moments at 120 degrees/s were found for the control group only, although not all participants could complete this speed of testing. Significant differences between the cycling and control groups based on change scores were not found for any outcomes. Limitations Heterogeneity of the patient population and intrasubject variability were limitations of the study.

Conclusions: Significant improvements in locomotor endurance, gross motor function, and some measures of strength were found for the cycling group but not the control group, providing preliminary support for this intervention. As statistical differences were not found in baseline-postintervention change scores between the 2 groups; the results did not demonstrate that stationary cycling was more effective than no intervention. The results of this phase I study provide guidance for future research.

Citation:

Eileen G. Fowler and others, Pediatric Endurance and Limb Strengthening (PEDALS) for Children With Cerebral Palsy Using Stationary Cycling: A Randomized Controlled Trial, Physical Therapy, Volume 90, Issue 3, 1 March 2010, Pages 367–381, DOI: https://doi.org/10.2522/ptj.20080364

 

"Comparison of dynamic cycling vs static cycling on endurance, balance, and walking ability of children with cerebral palsy"

Abstract

Background: The impairments in cerebral palsy can limit a child’s ability to play and exercise at intensities necessary to develop cardio respiratory fitness. Objective: To compare the effects of dynamic cycling, static cycling and conventional exercises in cardiovascular endurance, balance and walking ability in cerebral palsy children. Materials and Method: A total of 30 subjects were recruited in an experimental pre-post-test study design. Subjects were randomly assigned to 3 different treatment groups. The following outcome measures were measured: resting Heart Rate, 3 Minute Walk Test, GMFM-66, and Pediatric Balance Scale. All the three groups received conventional exercises. The experimental group 1 in addition received dynamic cycling protocol and experimental group 2 received static cycling protocol. The outcome was again evaluated at 6 weeks. Results: All the 3 groups showed significant pre to post improvement for the entire outcomes measured but GMFM-66. Results of the studied showed more significant improvement in both the cycling groups compared to the control group; Dynamic cycling group showing better response than static cycling group. Though all the groups showed improvement in GMFM-66, the dynamic cycling group showed better improvement followed by control group. Conclusion: Dynamic cycling incorporated with conventional exercises improves the cardiovascular endurance, balance and functional abilities than conventional exercises only. KEY WORDS: Cerebral Palsy, Dynamic Cycling, Static Cycling, Balance, Exercise, Walking, Endurance, Ability.

Citation:

Mohanty P, Meshram N, Pattnaik M. Comparison of dynamic cycling vs static cycling on endurance, balance, and walking ability of children with cerebral palsy. Int J Physiother Res 2015;3(4):1163-1170. DOI: http://dx.doi.org/10.16965/ijpr.2015.161

Williams H, Pountney T. Effects of a static bicycling programme on the functional ability of young people with cerebral palsy who are non-ambulant. Dev Med Child Neurol. 2007 Jul;49(7):522-7. DOI: https://doi.org/10.1111/j.1469-8749.2007.00522.x

FES Cycling

"A qualitative analysis of the experiences of children with cerebral palsy and their caregivers in a goal-directed cycling programme"

Abstract

Purpose: This qualitative thematic analysis aimed to capture the experiences of children with cerebral palsy (CP) and caregivers who completed an 8-week goal-directed cycling programme, to provide insights on engagement and programme feasibility.

Methods: Children with CP (6-18 years, Gross Motor Function Classification Scale (GMFCS) levels II-IV) and caregivers completed semi-structured interviews at the end of the training programme. Interview transcripts were coded by two investigators and systematically organised into themes. A third investigator reviewed the final thematic map.

Results: 17 interviews were conducted with 29 participants (11 children: 7-14 years). Four themes emerged: facilitators and challenges to programme engagement; perceived outcomes; the functional-electrical stimulation (FES) cycling experience; and previous cycling participation. Engagement was facilitated by the “therapist’s connection,” “cycling is fun” and “participant driven goal setting,” while “getting there” and “time off school” were identified as challenges. Participants positively linked improved physical function to greater independence. The FES-experience was “fun and challenging,” and participants had mixed feelings about electrode “stickiness.” Previous cycling participation was limited by access to adapted bikes.

Conclusions: Children with CP enjoy riding bikes. Facilitators and challenges to engagement were identified that hold practical relevance for clinicians. Environmental and personal factors should be carefully considered when developing future programs, to maximise opportunities for success.

Clinical trial registration number: Australian New Zealand Clinical Trials Registry – ACTRN12617000644369pIMPLICATIONS FOR REHABILITATIONAdapted cycling is a fun and engaging activity for young people with cerebral palsy.Environmental and personal factors should be carefully considered when prescribing adapted or FES cycling programs to this group.Engagement in adapted and FES-cycling programs can be facilitated by access to loan equipment, a goal-directed focus, and positive therapist-child relationship.Participation in adapted cycling is limited by access to adapted cycling equipment.

Citation:

Ellen L. Armstrong, Roslyn N. Boyd, Christopher P. Carty, Megan J. Kentish, Benjamin I. Goodlich & Sean A. Horan (2022) A qualitative analysis of the experiences of children with cerebral palsy and their caregivers in a goal-directed cycling programme, Disability and Rehabilitation, 44:12, 2715-2722, DOI: 10.1080/09638288.2020.1839134

Qualify of life changes

"Physical activity predicts quality of life and happiness in children and adolescents with cerebral palsy"

Abstract

Purpose: To examine the associations between physical activity, health-related quality of life and happiness in young people with cerebral palsy.

Method: A total of 70 young people with cerebral palsy (45 males, 25 females; mean age 13 years 11 months, SD 2 years 0 month) took part in a cross-sectional, descriptive postal survey assessing physical activity (Physical Activity Questionnaire for Adolescents), functional ability (Gross Motor Function Classification System), quality of life (Pediatric Quality of Life Inventory 4.0) and happiness (single Likert-scale item). Relationships between physical activity, quality of life and happiness were examined using backward stepwise linear regression.

Results: Physical activity significantly predicted physical quality of life (R(2 )= 0.64, β = 6.12, p = 0.02), social quality of life (R(2 )= 0.28, β = 9.27, p < 0.01) and happiness (R(2 )= 0.08, β = 0.9, p = 0.04). Physical activity was not associated with emotional or school quality of life.

Conclusions: This study found a positive association between physical activity, social and physical quality of life, and happiness in young people with cerebral palsy. Findings underscore the potential benefits of physical activity for the wellbeing of young people with cerebral palsy, in addition to its well-recognised physical and health benefits.

Implications for rehabilitation: Physical activity is a key predictor of quality of life and happiness in young people with cerebral palsy. Physical activity is widely recognised as having physical health benefits for young people with cerebral palsy; however, this study also highlights that it may have important benefits for wellbeing, quality of life and happiness. This emphasises the need for clinical services and intervention studies aimed specifically at increasing physical activity amongst children and adolescents with cerebral palsy.

Citation:

Carol Ann Maher, Monica Toohey & Monika Ferguson (2016) Physical activity predicts quality of life and happiness in children and adolescents with cerebral palsy, Disability and Rehabilitation, 38:9, 865-869, DOI: 10.3109/09638288.2015.1066450

"Effects of Adapted Tricycles on Quality of Life, Activities, and Participation in Children with Special Needs (Honors Thesis, East Carolina University)"

Abstract

Children with special needs participate in less physical activity than the typically
developing child. Physical activity and participation within activities is essential for a child’s physical, emotional, and mental health. Riding a bicycle is a typical childhood milestone that many children with special needs are unable to achieve. The American Business Clubs (AMBUCS), a non-profit organization, strives to create mobility and independence for those with disabilities. Through a local chapter of this organization, ENC Ambucs, funds are raised to provide AmTrykes, or specially adapted tricycles, to children with special needs in this region. The increased physical activity that is expected to come from the use of these therapeutic tricycles is projected to improve the children’s health related quality of life. To date research has not investigated the effects of AmTrykes.

The purpose of this study was to determine the effects of AmTrykes on health-related
quality of life (HRQOL), participation, function, and physical activity in children with special
needs. We hypothesized that, after receiving an AmTryke, children would exhibit increased
Sports and Physical Functioning and Global Functioning normative scores, on the PODCI,
Psychosocial HRQOL, Physical HRQOL, and Total HRQOL, on the PedsQL-PR, and play time with other children, physical activity, feeling of independence, and health benefits, as measured by the APS-A. Reliable measures of HRQOL, participation, function, and physical activity were administered before and after receiving an AmTryke. The assessments that were utilized include the Pediatric Outcomes Questionnaire (PODCI), the Pediatric Quality of Life Inventory Parent Report (PedsQL-PR), and the AmTryke Parent Survey-Adapted (APS-A). Parents/guardians were asked to fill out the PODCI and the PedsQL-PR prior to receiving the AmTryke to be used as a pre-test assessment. Four weeks after the child was given their tricycle, the same 5 assessments were sent via mail to the parents/guardians to be used as the post-assessment. The APS-A was sent out via an email link, to these new recipients and to all previous recipients of AmTrykes from ENC Ambucs.

Six children, ranging in age from 4 to 18 (mean=8.2 years) received an AmTryke in February 2016 and were subjects for the pre/post assessments. In addition to these six children, 12 past bike recipients were surveyed using the APS-A. These 18 subjects were between the ages of 4 and 18 (mean=10.9 years). The Global Functioning Scale of the PODCI decreased significantly after the four week intervention period (pre=1.33, post=-8.67, p=0.04). Other
PODCI and PedsQL-PR data were not significant. On the APS-A, 55.6% of parents reported an increase since receiving the AmTryke. An increase in physical activity was reported by 77.8% of parents, and 88.9% reported an increase in their child’s sense of independence. Health benefits were noted by 72.2% of parents. The AmTryke appeared most beneficial for children who were unable to walk independently (n=7, a subset of the 18 respondents to the APS-A). Of those seven parents, 100% reported an increase in their child’s sense of independence and an improvement in their child’s mood.

Use of an AmTryke appears to improve the quality of life, activities, and participation in children with special needs. In terms of their sense of independence and mood, children with special needs who are unable to walk alone may benefit more than others from the use of an AmTryke. Future studies will be important to increase the evidence that providing children with special needs with opportunities to participate in bike riding has many positive effects on their quality of life and their physical and psychosocial development.

Citation:

Hayden, Denay M.. (April 2016). Effects of Adapted Tricycles on Quality of Life, Activities, and Participation in Children with Special Needs (Honors Thesis, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/5649.)

 

"'Every picture tells a story': Interviews and diaries with children with cerebral palsy about adapted cycling"

Abstract

Aims: The study aims to explore the effect of participation in adapted cycling on quality of life for children with cerebral palsy (CP).

Methods: The study used a qualitative approach developing creative mosaic methods using interviews and diaries. This study had two groups of children with CP: those who participated in adapted cycling and a control group who had not yet started. Children with CP aged 2-17 years who were already cycling were invited to take part in two interviews at the beginning and end of a 6-week period and keep a cycling diary during this time. The control group of children with CP aged 2-17 years were asked to keep a diary of physical activities over 6 weeks and to take part in one interview at the end. Welsh, English, Bengali and Arabic were the languages spoken, and some children used communication aids.

Results: Results presented here include the first 25 children’s interviews and diaries. The emergent themes from the analysis are: learning a new skill, the impact on wider family and friends, social participation and future aspirations. The diaries added an emotional dimension, by illustrations drawn by the children.

Conclusion: The children who took part in adapted cycling enjoyed this experience and it improved their sense of well-being. Some in the control group went on to participate in adapted cycling. Physiotherapists can carry out creative research to hear the voices of children and young people with CP and incorporate their views and ideas into the development of service model delivery and treatment programmes.

Citation:

Pickering D, Horrocks LM, Visser KS, Todd G. ‘Every picture tells a story’: Interviews and diaries with children with cerebral palsy about adapted cycling. J Paediatr Child Health. 2013;49(12):1040-4. DOI: https://doi.org/10.1111/jpc.12289

Improving physical function through cycling in children with disabilities

"Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline"

Abstract

Aim: To provide recommendations for interventions to improve physical function for children and young people with cerebral palsy.

Method: An expert panel prioritized questions and patient-important outcomes. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods, the panel assessed the certainty of evidence and made recommendations, with international expert and consumer consultation.

Results: The guideline comprises 13 recommendations (informed by three systematic reviews, 30 randomized trials, and five before-after studies). To achieve functional goals, it is recommended that intervention includes client-chosen goals, whole-task practice within real-life settings, support to empower families, and a team approach. Age, ability, and child/family preferences need to be considered. To improve walking ability, overground walking is recommended and can be supplemented with treadmill training. Various approaches can facilitate hand use goals: bimanual therapy, constraint-induced movement therapy, goal-directed training, and cognitive approaches. For self-care, whole-task practice combined with assistive devices can increase independence and reduce caregiver burden. Participation in leisure goals can combine whole-task practice with strategies to address environmental, personal, and social barriers.

Interpretation: Intervention to improve function for children and young people with cerebral palsy needs to include client-chosen goals and whole-task practice of goals. Clinicians should consider child/family preferences, age, and ability when selecting specific interventions.

Citation: 

Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, et al. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Dev Med Child Neurol. 2021. DOI: 10.1111/dmcn.15055.

"State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy"

Abstract

Purpose of Review

Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012–2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019.

Recent Findings

Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy.

Summary

We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

Citation:

Novak I, Morgan C, Fahey M. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Current Neurology & Neuroscience Reports. 2020;20(2):1–21. DOI: https://doi.org/10.1007/s11910-020-1022-z

"Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis"

Abstract

Objectives: The aim of this study was to determine the efficacy of cycling to improve function and reduce activity limitations in children with cerebral palsy; the optimal training parameters for improved function; and whether improvements in function can be retained.

Method: Six databases were searched (until February 2019) and articles were screened in duplicate. Randomized or quasi-randomized controlled trials and pre-post studies were included. Methodological quality was assessed using the Downs and Black scale. Outcomes were reported under the International Classification of Functioning, Disability and Health domains of body functions and activity limitations. Quantitative analyses were completed using RevMan V5.3.

Results: A total of 533 articles were identified and 9 studies containing data on 282 participants met full inclusion criteria. Methodological quality ranged from low (14 of 32) to high (28 of 32). Significant improvements were reported for hamstring strength (effect size = 0.77-0.93), cardiorespiratory fitness (effect size = 1.13-1.77), balance (effect size = 1.03-1.29), 3-minute walk test distance (effect size = 1.14) and gross motor function (effect size = 0.91). Meta-analysis suggested that cycling can improve gross motor function (standardized mean difference = 0.35; 95% confidence interval = (-0.01, 0.70); P = 0.05); however, the effect was insignificant when a poor-quality study was omitted.

Conclusion: Cycling can improve muscle strength, balance and gross motor function in children with cerebral palsy; however, optimal training doses are yet to be determined. There was insufficient data to determine whether functional improvements can be retained. Conclusions were limited by small sample sizes, inconsistent outcome measures and a lack of follow-up testing.

Citation:

Armstrong EL, Spencer S, Kentish MJ, Horan SA, Carty CP, Boyd RN. Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Clin Rehabil. 2019 Jul;33(7):1113-1129.

"Pilot evaluation of a school-based programme focused on activity, fitness, and function among children with cerebral palsy at GMFSC level IV: single-subject research"

Abstract

Purpose: Children with cerebral palsy (CP) who function at Gross Motor Function Classification System (GMFCS) Level IV have difficulty achieving sufficient levels of physical activity to promote fitness. The purpose of this pilot evaluation was to investigate the practicability and impact of a school-based supported physical activity programme, using adaptive bicycles, on cardiorespiratory fitness and gross motor function among children with CP at GMFCS Level IV. Method: We used a single-subject, A-B-A-B research design replicated across three participants aged 8-14 years with CP at GMFCS Level IV who attended three different schools. Cardiorespiratory fitness was assessed weekly during all study phases using the energy expenditure index (EEI). Gross motor function was assessed using the Gross Motor Function Measure-66 (GMFM-66) and goal attainment scaling (GAS). During the intervention phases, an adaptive bicycle-riding programme was carried out daily at school for up to 30 minutes. Results: One participant demonstrated significant improvement on the EEI. All participants demonstrated improvement in gross motor function as determined by the GMFM-66 and GAS. Insights were garnered pertaining to the design for large-scale future studies. Conclusions: This pilot evaluation supports further investigation of school-based adaptive bicycle-riding programmes for children who have CP at GMFCS Level IV.

Citation:

Daly C, Moore CL, Johannes S, et al. Pilot evaluation of a school-based programme focused on activity, fitness, and function among children with cerebral palsy at GMFSC level IV: single-subject research. Physiotherapy Canada. 2020;72(2):195-204. DOI: https://doi.org/10.3138/ptc-2018-0053

Physical Activity

"Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities—A Systematic Review"

Abstract

Objective: Perform a systematic review of the available literature regarding the effectiveness of exercise interventions on children with any type of social, emotional, or behavioral disability (SEBD), with attention to a range of physiological, behavioral, and mood outcomes.

Methods: Six databases were searched using a systematic methodology. References of included studies, as well as relevant reviews, were also examined. The review was limited to studies published since 2000 reporting a quantitative analysis of the effects of a physical activity (PA) intervention on at least 1 behavioral, psychological, or cognitive outcome in children aged 21 and under, diagnosed with a SEBD. Only studies with a control group were included.

Results: We identified 24 eligible studies. Studies varied in design, participant characteristics, and intervention characteristics (single-bout vs repeated exposure, duration, intensity level, mode of exercise). Of the 20 behavioral outcome assessments, there was 1 negative finding, 12 null findings, 5 positive findings, and 2 mixed findings. For the 25 executive functioning outcome assessments, there were 5 null findings, 18 positive findings, and 2 mixed findings. For the remaining outcome domains, 1 of 2 studies looking at academic performance, 3 of 6 studies looking at objective neurological measures, and 1 of 3 studies looking at affect outcomes found positive results. All other results were null or mixed.

Conclusion: Although additional research is warranted to further understand the mechanisms by which PA affects behavioral and cognitive outcome measures in children with SEBDs, PA offers a safe and alternative form of treatment for this population.

 

Citation:

Ash, Tayla MPH*,†; Bowling, April MA, ScD; Davison, Kirsten PhD*,†; Garcia, Jeanette PhD§. Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities—A Systematic Review. Journal of Developmental & Behavioral Pediatrics 38(6):p 431-445, July/August 2017. | DOI: 10.1097/DBP.0000000000000452\

 

 

"Differences in Leisure Physical Activity Participation in Children with Typical Development and Cerebral Palsy"

Abstract

Aim: To compare participation in leisure physical activities in children with typical development (TD) and cerebral palsy (CP).

Methods: A total of 170 children with TD (n = 101) and CP (n = 69) aged 8 to 18 years reported participation in 16 extracurricular physical activities. Non-parametric statistics examined differences between groups.

Results: Children with TD participated more frequently in individual physical activities (p = .018), team sports (p = .026), and bicycling (p = .001), and less in horseback riding (p = .031) than children with CP in GMFCS II-V. The differences between children with TD and CP in GMFCS I and within the CP group were not statistically significant. We did not find differences between groups in enjoyment.

Conclusion: Children with CP in GMFCS II-V tend to participate less in leisure physical activities that require higher motor and perceptual skills. Support in the adaptation of physical recreation and sports may help improve participation.

Citation: 

Fabio Vila-Nova, Cristina Dos Santos Cardoso de Sá, Raul Oliveira & Rita Cordovil (2021) Differences in Leisure Physical Activity Participation in Children with Typical Development and Cerebral Palsy, Developmental Neurorehabilitation, 24:3, 180-186, DOI: 10.1080/17518423.2020.1819461

"Updated National Estimates of Disparities in Physical Activity and Sports Participation Experienced by Children and Adolescents With Disabilities"

Abstract

Background: Children and adolescents with disabilities often report low levels of physical activity (PA). Estimating the magnitude of PA disparities has been previously challenged by underreporting and variability in subsampling of disability. Using the National Survey of Children’s Health, this study estimated the population-level PA disparities experienced and the association between disability status and PA engagement. Methods: Weighted prevalence of PA engagement (National Physical Activity Guidelines for Americans (2nd edition) and sports participation) was compared across disability groups for children (n = 20,867, 6–11 y) and adolescents (n = 28,651, 12–17 y) and found to be 12%. Age-stratified multivariable logistic regressions estimated the likelihood of PA engagement as a function of disability status and type, after adjusting for child and household factors. Results: Children, but not adolescents, with disabilities had significantly lower odds of being sufficiently active compared with peers without disabilities (adjusted odds ratio = 0.75; 95% confidence interval, 0.60–0.94). Across age groups, the lowest prevalence rates were observed among those experiencing function and mobility disabilities. Children and adolescents were significantly less likely to participate in sports compared with peers. Conclusion: Children with function and mobility disabilities were identified as priority subpopulations least likely to be sufficiently active. The disparity in sports participation highlights a critical intervention point for increasing PA among children with disabilities.

Citation: 

Ross, S. M., Smit, E., Yun, J., Bogart, K., Hatfield, B., & Logan, S. W. (2020). Updated National Estimates of Disparities in Physical Activity and Sports Participation Experienced by Children and Adolescents With Disabilities: NSCH 2016–2017. Journal of Physical Activity and Health, 17(4), 443-455. Retrieved Jul 25, 2023, from DOI: https://doi.org/10.1123/jpah.2019-0421

"The Physical Activity Guidelines for Americans"

Abstract

Importance  Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

Objective  To summarize key guidelines in the Physical Activity Guidelines for Americans, 2nd edition (PAG).

Process and Evidence Synthesis  The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. The committee addressed 38 questions and 104 subquestions and graded the evidence based on consistency and quality of the research. Evidence graded as strong or moderate was the basis of the key guidelines. The Department of Health and Human Services (HHS) based the PAG on the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.

Recommendations  The PAG provides information and guidance on the types and amounts of physical activity to improve a variety of health outcomes for multiple population groups. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.

Conclusions and Relevance  The Physical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population.

Citation:

Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020–2028. doi:10.1001/jama.2018.14854

"Physical Activity Participation and Barriers for Children and Adolescents with Disabilities"

Abstract

Children and adolescents with disabilities benefit from physical activity. However, this population has lower fitness levels and higher rates of obesity than their peers, suggesting that they are not meeting physical activity guidelines and are experiencing barriers to participation. The purpose of this study was to quantify physical activity participation and barriers experienced by children and adolescents with disabilities in our area. Forty-five parents or caregivers of children aged 2‒18 with physical and/or intellectual disabilities completed a questionnaire regarding physical activity participation in an average week and barriers to participation, prior to the SARS-CoV-2 pandemic. Data were analysed using quantitative and qualitative methodologies. Ninety-one percent (41/45) of the children and adolescents with disabilities did not participate in sufficient physical activity to meet physical activity guidelines irrespective of type and severity of the disability (p > 0.05). Physical activity participation decreased with increasing age (r = −0.478, p = 0.001). The most commonly identified barrier was ‘environments and programmes not able to handle nature of disability.’ In our sample, the majority of children and adolescents with disabilities did not meet physical activity guidelines, with access reported as a primary barrier. This may have negative consequences on the physical and mental health of children and adolescents with disabilities. The SARS-CoV-2 pandemic may have worsened the rates of physical activity participation noted in our study.

Citation:

Sarah MacEachern, Nils Daniel Forkert, Jean-Francois Lemay & Deborah Dewey (2022) Physical Activity Participation and Barriers for Children and Adolescents with Disabilities, International Journal of Disability, Development and Education, 69:1, 204-216, DOI: 10.1080/1034912X.2021.1952939

"Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review"

Abstract

Purpose: To systematically review and compare the daily habitual physical activity levels and sedentary times of young people with cerebral palsy to their typically developing peers and to physical activity guidelines.

Method: After searching electronic databases, two reviewers independently applied criteria. Studies were required to include young people with cerebral palsy (up to 18 years) and to quantitatively measure habitual physical activity, defined as activity across at least one day. Data extraction was independently verified, and quality analysis completed by two reviewers.

Results: Of 895 identified studies, six moderate to high quality studies were included. There were four measures of habitual physical activity. Participants were aged 5 to 18 years and typically had moderate to high gross motor function. Across all ages and levels of motor function, young people with cerebral palsy participated in 13% to 53% less habitual physical activity than their peers. Levels of activity were approximately 30% lower than guidelines. Sedentary times were twice the maximum recommended amount.

Conclusions: Young people with cerebral palsy participate in significantly lower levels of habitual physical activity than their peers, and less than recommended guidelines. Long-term negative health consequences of inactivity such as metabolic dysfunction, cardiovascular disease and poor bone density are therefore more likely.

Citation:

Stacey L. Carlon, Nicholas F. Taylor, Karen J. Dodd & Nora Shields (2013) Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review, Disability and Rehabilitation, 35:8, 647-655, DOI: 10.3109/09638288.2012.715721

Adaptive Cycling Programs with participants with Cerebral Palsy

"Is adapted cycling training achievable in children with cerebral palsy with poor motor function?"

Abstract

Introduction

In children with cerebral palsy (CP), lower muscle strength and cardiorespiratory fitness are associated with lower locomotion capacities, especially in children with poor gross motor function (GMFCS II-IV). Cycling exercise could be a promising approach to improve walking efficiency, due to its potential impact on these physiological systems. The objectives of this study were:

– to assess if tricycle cycling exercise is in accordance with Verschuren’s recommendations, in terms of intensity and duration;

– to report the physical limitations which could impact training feasibility.

Material and methods

Thirteen children with spastic CP, who were able to ride a tricycle (Trivel, Montréal, Canada) were included (aged 5–11 years; GMFCS level II-IV). A 9-week training program (2 sessions/week) was implemented on stationary tricycle in a school for children with motor disabilities (Victor-Doré, Montreal, Canada). Four bouts of 5-minute exercise, with standardized encouragement, were planned for each session. Intensity and duration of exercise were evaluated during each session. Lower limb range of motion (RoM), muscle strength, and walking % heart rate reserve were assessed before training.

Results

The mean intensity and the duration while cycling were 45.2 ± 9.8% of reserve heart rate and 18.0 ± 2.3 min, respectively. Children performed 12.8 ± 2.9 training sessions. Two participants were not able to achieve the targeted minimal exercise recommendations (Both with GMFCS II). Muscle strength is related to exercise duration whereas walking % heart rate reserve is related to exercise intensity and duration.

Conclusion

The achievement of tricycle training is possible in children with poor motor function, even in those with low muscle strength. However, physical limitations could impact exercise performance if not properly considered.

https://doi.org/10.1016/j.neucli.2019.10.040

"Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis"

Abstract

Objectives: The aim of this study was to determine the efficacy of cycling to improve function and reduce activity limitations in children with cerebral palsy; the optimal training parameters for improved function; and whether improvements in function can be retained.

Method: Six databases were searched (until February 2019) and articles were screened in duplicate. Randomized or quasi-randomized controlled trials and pre-post studies were included. Methodological quality was assessed using the Downs and Black scale. Outcomes were reported under the International Classification of Functioning, Disability and Health domains of body functions and activity limitations. Quantitative analyses were completed using RevMan V5.3.

Results: A total of 533 articles were identified and 9 studies containing data on 282 participants met full inclusion criteria. Methodological quality ranged from low (14 of 32) to high (28 of 32). Significant improvements were reported for hamstring strength (effect size = 0.77-0.93), cardiorespiratory fitness (effect size = 1.13-1.77), balance (effect size = 1.03-1.29), 3-minute walk test distance (effect size = 1.14) and gross motor function (effect size = 0.91). Meta-analysis suggested that cycling can improve gross motor function (standardized mean difference = 0.35; 95% confidence interval = (-0.01, 0.70); P = 0.05); however, the effect was insignificant when a poor-quality study was omitted.

Conclusion: Cycling can improve muscle strength, balance and gross motor function in children with cerebral palsy; however, optimal training doses are yet to be determined. There was insufficient data to determine whether functional improvements can be retained. Conclusions were limited by small sample sizes, inconsistent outcome measures and a lack of follow-up testing.

Citation: 

Armstrong EL, Spencer S, Kentish MJ, Horan SA, Carty CP, Boyd RN. Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Clin Rehabil. 2019 Jul;33(7):1113-1129. doi: 10.1177/0269215519837582. Epub 2019 Apr 2. PMID: 30935240.

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