Low health-related physical fitness in adults with bilateral spastic cerebral palsy

Low health-related physical fitness in adults with bilateral spastic cerebral palsy
1Rehabilitation Medicine, Erasmus MC, Rotterdam;
2Rijndam Rehabilitation Centre, Rotterdam, Netherlands

Background/Objectives: For adults with cerebral palsy (CP), life expectancy is close to that of the general population and therefore life-span health issues such as cardiovascular disease are important to consider. For the general population, physical fitness is considered to be major factor for health promotion. Until now, research on physical fitness in persons with CP has focused strongly on children and adolescents, and little is known about the physical fitness levels of adults with CP. This study aimed to describe the health-related physical fitness in adults with bilateral spastic CP, focusing on aerobic capacity, muscle strength and body composition. Secondarily, relationships of aerobic capacity with personal characteristics and with muscle strength and body composition were explored.
Design: Cross-sectional cohort study.
Participants and Setting: We collaborated with several rehabilitation centre in the western and central region of the Netherlands to include adults with bilateral spastic CP. In total, 50 adults with bilateral spastic CP participated (mean age 36.4 ± 5.8 years; 64% male). Level of gross motor functioning varied across the sample (26% GMFCS level I, 52% level II and 22% level III-IV).
Materials/Methods: Progressive maximal aerobic tests on a cycle ergo meter were performed to determine aerobic capacity (V02peak in L/min). Muscle strength of five large muscle groups of the lower extremity was measured bilaterally with a handheld dynamometer (strength in N). Body composition was assessed with the sum of four skin folds (biceps, triceps, sub scapular, supra-iliac region; in mm). All values were compared with age- and gender-based Dutch reference values for sedentary adults. We performed multiple linear regression analysis to determine whether personal characteristics, muscle strength and body composition were related to aerobic capacity (V0 2 peak).
Results: Mean V02 peak of adults with CP (2.19 ± 0.48 L/min) was 23% lower than the V02 peak of Dutch reference persons (2.86 ± 0.55 L/min, P<0.001). In total, 87% of the participants had impaired muscle strength in at least one of the measured muscle groups, with most impairments found in the ankle dorsal flexors (73% of the participants) and the hip abductors (60%). Mean sum of four skin folds was 56.9 ± 31.5 mm, which is comparable to that of Dutch reference persons (91 ± 51% of reference values; P=0.226). Multiple linear regression analysis revealed that gender and GMFCS level together explained 51% of the variance in aerobic capacity, with no additional influence of either muscle strength or body composition.
Conclusions/Significance: Adults with bilateral spastic CP appear to have a lower health-related fitness than the healthy population especially in aerobic capacity and muscle strength. Aerobic capacity was lower in females and in persons with worse gross motor functioning; we found no relations with muscle strength or body composition.

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