Staying active and exercising have historically been perceived by many as incompatible with having cerebral palsy. This isn’t true! Although cerebral palsy (CP) makes movement more difficult,[1] it is important that whenever possible people with CP stay active to support their lifelong health and wellbeing. Improved health of the cardiovascular and muscular systems can prevent negative health outcomes such as cardiovascular disease,[2][3] which is important considering people with CP may be at a greater risk for chronic diseases such as hypertension, diabetes, and stroke.[4][5][6] Becoming more active may also improve mental health,[7] reduce pain[8][9]* or improve work or school performance.[7] It can also improve range of motion and coordination of movement.[10][11][12]

*It is important that the clinical team identify the source of pain and discuss appropriate treatment strategies. It is also important that the person with cerebral palsy consult with a healthcare provider prior to beginning an exercise program.

Cerebral Palsy and Physical Activity

The CP Research Network provides the cerebral palsy community with information about getting and staying active. Their health and wellbeing count on it!

How someone chooses to stay active is unique to the individual and should be based on what they enjoy and what they are able to do or access (through their own ability or through modifications or adaptations). Recreation, sport, and exercise provide traditional opportunities for moving, but someone may also be active naturally throughout the day. Perhaps they are active at work, school, home, or by how they get from place to place.[13]

Consider the following:

  1. Some activity is better than no activity, as recommended by the World Health Organization (WHO) 2020 Guidelines on Physical Activity and Sedentary Behaviour.[13]
  2. You may be more active than you think you are. We typically think of activity occurring in recreation, sport, or exercise settings.

Cerebral Palsy Health & Fitness: Maximizing Movement

Activity exists on a continuum of intensity that includes light, moderate, moderate-to-vigorous, and vigorous.[3]These descriptions are based on how the body reacts (i.e. increased heart rate and breathing) when performing certain tasks:[14]

  1. Light activities are those that involve movement, but do not result in a significant increase in heart rate or breathing.
  2. Moderate activities are slightly more strenuous, where a person still feels comfortable and able to talk, but they breathe more heavily.
  3. Vigorous activities are those where breathing is harder and borderline uncomfortable. Moderate-to-vigorous activity is somewhere between the previous two.

The intensity of an activity will vary individually, therefore it’s important to consult with a medical professional prior to beginning an exercise program or trying new types of activities. For example, activities of daily living such as bathing may be considered light activity for some people with cerebral palsy, but may be more strenuous for others.

Most people perform activities on a daily basis that fall into each of these categories. This is great news! The challenge is balancing activities that we like to do with types of movement that maximize our abilities.

Cerebral Palsy Health & Fitness: Are You Moving Enough?

The current activity guidelines from the World Health Organization align with many recommendations for exercise and physical activity guidelines for people with cerebral palsy developed by researchers and clinicians.[15]

In 2021 the National Institutes of Health held a workshop bringing together researchers, clinicians and consumers to understand more about establishing appropriate exercise guidelines for wheelchair users. Although this workshop is a starting point in developing more specific national guidelines for this segment of people with disabilities, it signals the need to consult with knowledgeable professionals about how to approach developing a personal exercise program.

People with CP have diverse abilities. When starting an exercise program, there are many considerations such as current activity level, function, and coexisting conditions.[15]
Here are some general strategies and areas of focus for getting active that are included in these documents:

  1. Each day reduce sedentary time, especially screen time.
  2. Incorporate moderate to vigorous daily activity into your routine (this will be unique to the individual).
  3. Over time increase activity in both intensity and duration that is suitable to the individual’s fitness level and any special considerations (contraindications).
  4. Try to establish a few days of activity to strengthen muscles and bones.

Cerebral Palsy Health & Physical Activity: Overcoming Barriers

Although physical activity is very important to prevent chronic disease among people with cerebral palsy,[4] both children and adults with cerebral palsy are less active than typically developing individuals. Often people with cerebral palsy do not meet the recommended physical activity guidelines.[16][17] Getting and staying activity can be very challenging, as people with cerebral palsy face many barriers to participation such as lack of accessible facilities, attitudes of others, and lack of opportunities.[17][18][19]

Most people with cerebral palsy know that activity is important but may not know where to start. The Cerebral Palsy Research Network works with a team of experts to provide information and examples about different ways of getting active.

Resources

Here is a resource from the Cerebral Palsy International Sports and Recreation Committee that professionals may use to help them start programs to get people with cerebral palsy involved with physical activity and sports. If you are a parent or caregiver, you may wish to pass this information along to local parks and recreation leaders, or to your child’s physical education department.

The NCHPAD website is an excellent source of information for consumers and professionals. NCPAD offers information, resources and opportunities related to physical activity, health promotion, and disability. They serve people with physical, sensory and cognitive disability across the lifespan.

For more information, download our free cerebral palsy tool kit.

References
    1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (2020, December 31). What is cerebral palsy? Retrieved June 14, 2021, from https://www.cdc.gov/ncbddd/cp/facts.html
    2. Ortega, F., Silventoinen, K., Tynelius, P., & Rasmussen, F. (2012, November 20). Muscular strength in male adolescents and premature Death: Cohort study of one million participants. Retrieved June 14, 2021, from https://www.bmj.com/content/345/bmj.e7279
    3. Al-Mallah, M., Sakr, S., & Al-Qunaibet, A. (2018, January). Cardiorespiratory fitness and cardiovascular Disease Prevention: An update. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/29340805/
    4. Peterson, M., Ryan, J., Hurvitz, E., & Mahmoudi, E. (2015, December 1). Chronic conditions in adults with cerebral palsy. Retrieved June 14, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862577/
    5. Peterson, M., Gordon, P., & Hurvitz, E. (2013, February). Chronic disease risk among adults with cerebral palsy: The role of premature sarcopoenia, obesity and sedentary behaviour. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/23094988/
    6. Peterson, M., Haapala, H., & Hurvitz, E. (2012, May). Predictors of cardiometabolic risk among adults with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/22541309/
    7. Biddle, S., & Asare, M. (2011, September). Physical activity and mental health in children and adolescents: A review of reviews. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/21807669/
    8. Colquitt, G., Moreau, N., Li, L., Kendall, K., Vogel, R., & Dipita, T. (2015, September 30). The effect of an upper extremity power training intervention on pain and power among young people with cerebral palsy. Retrieved June 14, 2021, from https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.67_12887
    9. Russchen, H., Slaman, J., Stam, H., Markus-Doornbosch, F., Berg-Emons, R., & Roebroeck, M. (2014, December 11). Focus on fatigue amongst young adults with spastic cerebral palsy. Retrieved June 14, 2021, from https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-11-161
    10. Fosdahl, M., Jahnsen, R., Kvalheim, K., & Holm, I. (2019, July). Stretching and progressive resistance exercise in children with cerebral palsy: A randomized controlled trial. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/31220010/
    11. Reid, S., Hamer, P., Alderson, J., & Lloyd, D. (2010, April). Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/19737297/
    12. Johnston, T., Watson, K., Ross, S., Gates, P., Gaughan, J., Lauer, R., . . . Engsberg, J. (2011, August). Effects of a supported speed treadmill training exercise program on impairment and function for children with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/21679357/
    13. Bull FC;, Al-Ansari SS;, Biddle S;, Borodulin K;, Buman MP;, Cardon G;, . . . Willumsen, J. (2020, December). World health Organization 2020 guidelines on physical activity and sedentary behaviour. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/33239350/
    14. Borg, G. (1998). Borg’s perceived exertion and PAIN SCALES. Champaign,, IL: Human Kinetics. doi:https://www.amazon.com/Borgs-Perceived-Exertion-Pain-Scales/dp/0880116234
    15. Hurvitz, E., Verschuren, O., Peterson, M., & Balemans, A. (2016, August). Exercise and physical activity recommendations for people with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/26853808/
    16. Ryan, J., Crowley, V., Hensey, O., Broderick, J., McGahey, A., & Gormley, J. (2014, September). Habitual physical activity and cardiometabolic risk factors in adults with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/24864052/
    17. Shields, N., Taylor, N., Dodd, K., & Carlon, S. (2013, April). Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: A systematic review. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/23072296/
    18. Walker A;, Colquitt G;, Elliott S;, Emter M;, & Li L;. (2020, December). Using participatory action research to examine barriers and facilitators to physical activity among rural adolescents with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/31088164/
    19. Ketelaar, M., Wiart, L., & Hermans, D. (2012, September). Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy. Retrieved June 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/22494875/