Effects of Exercise Interventions on Habitual Physical Activity and Sedentary Behavior in Adolescents With Cerebral Palsy.

PURPOSE: Exercise interventions have been shown to increase motor capacities in adolescents with cerebral palsy; however, how they affect habitual physical activity (HPA) and sedentary behavior is unclear. The main objective was to correlate changes in HPA with changes in mobility capacity following exercise interventions. METHODS: A total of 54 participants (aged 12-20 y) with bilateral spastic cerebral palsy at Gross Motor Function Classification System (GMFCS) levels II and III received 4 months of group progressive resistance training or treadmill training. Mobility measurements and HPA (averaged over 96 h) were made before and after interventions. RESULTS: Averaged baseline mobility and HPA measures and improvements in each after both interventions were positively correlated in all participants. Percentage of sedentary/awake time decreased 2%, with significant increases in HPA measures of step count (16%), walk time (14%), and upright time (9%). Mobility measures and HPA changes were quite similar between Gross Motor Function Classification System levels, but improvement in HPA after group progressive resistance training was greater than after treadmill training (12% vs 4%) and correlated with mobility improvement. CONCLUSIONS: Mobility capacity improved after these interventions and was clearly associated with improved HPA. The group progressive resistance training intervention seems preferable to improve HPA, perhaps related to greater social interaction and motivation provided by group training.

Comparison of Habitual Physical Activity and Sedentary Behavior in Adolescents and Young Adults With and Without Cerebral Palsy.

PURPOSE: The comparison of habitual physical activity and sedentary time in teenagers and young adults with cerebral palsy (CP) with typically developed (TD) peers can serve to quantify activity shortcomings. METHODS: Patterns of sedentary, upright, standing, and walking components of habitual physical activity were compared in age-matched (16.8 y) groups of 54 youths with bilateral spastic CP (38 who walk with limitations and 16 who require mobility devices) and 41 TD youths in the Middle East. Activity and sedentary behavior were measured over 96 hours by activPAL3 physical activity monitors. RESULTS: Participants with CP spent more time sedentary (8%) and sitting (37%) and less time standing (20%) and walking (40%) than TD (all Ps < .01). These trends were enhanced in the participants with CP requiring mobility devices. Shorter sedentary events (those <60-min duration) were similar for TD and CP groups, but CP had significantly more long sedentary events (>2 h) and significantly fewer upright events (taking <30, 30-60, and >60 min) and less total upright time than TD. CONCLUSION: Ambulant participants with CP, as well as TD youth must be encouraged to take more breaks from being sedentary and include more frequent and longer upright events.

Treading on the unknown-the feasibility of a novel approach to investigating the motor control of walking.

BACKGROUND AND OBJECTIVE: Walking is a complex human behavior, usually performed in a dynamic environment. Gait parameters are thought to reflect this complexity. Re-Step™ is a therapy system in the form of a computerized shoe, originally developed for the training and rehabilitation of individuals with brain damage. This system may be used as model for studying the complexity that underlies gait. As the first step, we present here the feasibility of the model, after establishing the validity and reliability of stride time and stride-time variability, observed in healthy adults. APPROACH: Fifteen healthy adults participated in this study. To establish concurrent validity, we had five participants walk with the Re-Step on a treadmill equipped with a force plate. To establish inter-rater reliability, we used data from ten participants who walked approximately 300 m with the system. Finally, the stride-time variability of perturbed and unperturbed walks was compared to establish the feasibility of the model. RESULTS: The correlation between the stride times observed with the treadmill and those observed with the Re-Step system was r = 0.971. The interclass correlation coefficient between left and right legs was 1.000 for stride time and 0.827 for its variability. A significant increase (mean difference 0.68%) in stride time variability was observed between unperturbed and perturbed walks. SIGNIFICANCE: The results of this study suggest that stride-time measurements and variability observed in the Re-Step system are valid and reliable and that the model increases the challenge to the control system, thereby making Re-Step useful in the investigation of gait.