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, Montreal, 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-Dore, 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.