Abstract
BackgroundIn the past, effortful exercises were considered inappropriate for children with spastic cerebral palsy (CP) due to concern that they would escalate abnormalities including spasticity and abnormal movement patterns. Current scientific evidence indicates that these concerns were unfounded and that therapeutic interventions focused on muscle strengthening can lead to improved functional ability. However, few studies have examined the potential benefits of cardiorespiratory fitness exercises in this patient population.Methods/designThe rationale and design of a randomized controlled trial examining the effects of a stationary cycling intervention for children with CP are outlined here. Sixty children with spastic diplegic CP between the ages of 7 and 18 years and Gross Motor Function Classification System (GMFCS) levels of I, II, or III will be recruited for this study. Participants will be randomly assigned to either an intervention (cycling) or a control (no cycling) group. The cycling intervention will be divided into strengthening and cardiorespiratory endurance exercise phases. During the strengthening phase, the resistance to lower extremity cycling will be progressively increased using a uniquely designed limb-loaded mechanism. The cardiorespiratory endurance phase will focus on increasing the intensity and duration of cycling. Children will be encouraged to exercise within a target heart rate (HR) range (70 – 80% maximum HR). Thirty sessions will take place over a 10–12 week period. All children will be evaluated before (baseline) and after (follow-up) the intervention period. Primary outcome measures are: knee joint extensor and flexor moments, or torque; the Gross Motor Function Measure (GMFM); the 600 Yard Walk-Run test and the Thirty-Second Walk test (30 sec WT).DiscussionThis paper presents the rationale, design and protocol for Pediatric Endurance and Limb Strengthening (PEDALS); a Phase I randomized controlled trial evaluating the efficacy of a stationary cycling intervention for children with spastic diplegic cerebral palsy.
Highlights
In the past, effortful exercises were considered inappropriate for children with spastic cerebral palsy (CP) due to concern that they would escalate abnormalities including spasticity and abnormal movement patterns
The purpose of this study is to evaluate the effectiveness of a stationary cycling intervention for children with spastic diplegic CP using a randomized controlled trial (RCT) design
The PEDALS Project for children with CP was designed as a Phase I RCT due to the paucity of previous research that has critically examined the effect of stationary cycling for children with CP
Summary
Effortful exercises were considered inappropriate for children with spastic cerebral palsy (CP) due to concern that they would escalate abnormalities including spasticity and abnormal movement patterns. The prevalence is between 1.5 and 2.5 per 1,000 live births in developed countries [1] and spastic diplegia is the most common form [2] These children exhibit weakness [3,4,5,6,7] and low endurance [8,9,10,11,12]. Scientific evidence has not supported this concern [14,15,16] and current research indicates that resistive exercise is an effective intervention to improve strength and function in children with CP [16,17,18,19,20,21]. There is considerably less research examining the effectiveness of cardiorespiratory fitness for children with CP
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