Three-month follow-up: does regular exercise affect pain and fatigue in adults with cerebral palsy?

Three-month follow-up: does regular exercise affect pain and fatigue in adults with cerebral palsy?
1 Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL;
2 Lakeshore Foundation, Birmingham, AL, USA

Background/Objectives: To examine the impact of regular exercise on pain and fatigue in adults with cerebral palsy post-intervention and 3 months after a 12-week intervention.
Design: A repeated measures design
Participants and Setting: Twenty-five adults with cerebral palsy who were able to follow directions, understand assessment questions, and reported having pain were recruited from an adult day program and a community facility that promotes independence for persons with physically disabling conditions and provides opportunities to pursue active, healthy lifestyles. Twenty-one adults, including 13 females and 8 males, mean age of 39 years, completed the 12-week exercise intervention. Ten were non-ambulatory and 11 walked either independently or with devices. All but one participant completed the 3 month follow-up assessments.
Materials/Methods: The intervention was provided in 1 hour sessions, 3x per week in groups of 3-6 participants and included both aerobic and resistive activity components. A fitness instructor experienced in working with individuals with disabilities planned and led all sessions with the help of fitness assistants. Adults who were unable to walk participated from their wheelchairs. To monitor exercise intensity, all participants wore heart monitors and reported rating of perceived exertion at the midpoint and end of each session. Outcome measures included pain intensity, number of pain sites, disability due to pain, and fatigue. Pain and fatigue data were collected monthly for 9 months across three phases: 3 months prior to intervention (PRE), 3 months during intervention (INT), and 3 months following intervention (POST). Disability from pain data were collected at the end of each phase.
Results: There were no significant differences between the ambulatory and non-ambulatory groups on demographic variables. For all participants, significant decreases in fatigue post-intervention were found but no significant changes in pain intensity or number of pain sites. An interaction between group and time existed regarding pain disability; ambulatory adults demonstrated decreases in pain disability post-intervention and non-ambulatory adults demonstrated an increase in pain disability in the same time frame. No changes were sustained in the follow-up phase. Adverse events during the intervention included episodes of muscle spasm and a back injury from repeated wheelchair cushion slippage during class sessions.
Conclusions/Significance: Pain as measured was not changed by the exercise intervention; however fatigue was significantly decreased in both ambulatory and non-ambulatory adults. Disability from pain decreases in ambulatory adults suggests that some adults with CP may experience less functional limitation from pain with exercise. The overall health benefits of exercise for adults with CP exist, but its impact on pain remains to be demonstrated.

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