To evaluate the validity of the ActiGraph accelerometer for the measurement of physical activity intensity in children and adolescents with cerebral palsy (CP) using oxygen uptake (VO(2)) as the criterion measure. Thirty children and adolescents with CP (mean age 12.6 ± 2.0 years) wore an ActiGraph 7164 and a Cosmed K4b(2) portable indirect calorimeter during four activities; quiet sitting, comfortable paced walking, brisk paced walking and fast paced walking. VO(2) was converted to METs and activity energy expenditure and classified as sedentary, light or moderate-to-vigorous intensity according to the conventions for children. Mean ActiGraph counts min(-1) were classified as sedentary, light or moderate-to-vigorous (MVPA) intensity using four different sets of cut-points. VO(2) and counts min(-1) increased significantly with increases in walking speed (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that, of the four sets of cut-points evaluated, the Evenson et al. (J Sports Sci 26(14):1557-1565, 2008) cut-points had the highest classification accuracy for sedentary (92%) and MVPA (91%), as well as the second highest classification accuracy for light intensity physical activity (67%). A ROC curve analysis of data from our participants yielded a CP-specific cut-point for MVPA that was lower than the Evenson cut-point (2,012 vs. 2,296 counts min(-1)), however, the difference in classification accuracy was not statistically significant 94% (95% CI = 88.2-97.7%) vs. 91% (95% CI = 83.5-96.5%). In conclusion, among children and adolescents with CP, the ActiGraph is able to differentiate between different intensities of walking. The use of the Evenson cut-points will permit the estimation of time spent in MVPA and allows comparisons to be made between activity measured in typically developing adolescents and adolescents with CP.

AIM This systematic review compares the validity, reliability, and clinical use of habitual physical activity (HPA) performance measures in adolescents with cerebral palsy (CP).METHOD Measures of HPA across Gross Motor Function Classification System (GMFCS) levels I-V for adolescents (10-18y) with CP were included if at least 60% of items reported HPA performance in the domains of intensity, frequency, duration, and mode.RESULTS Seven measures of HPA performance met the criteria: StepWatch, pedometers, Uptimer, heart rate flex method, accelerometers, and self-report measures including the Children's Activity Participation and Enjoyment (CAPE) scale and the Physical Activity Questionnaire for Adolescents. The CAPE scale had the strongest validity and reliability but was limited by its inability to measure activity intensity. No study was identified that evaluated the psychometric properties of physical activity measures in non-ambulant adolescents with CP (GMFCS levels IV and V).INTERPRETATION When deciding on an appropriate measure of HPA in adolescents with CP, clinicians need to consider their research question including the domains of HPA they are evaluating and the population they wish to assess. Accelerometers provide the most robust information about the patterns of HPA, with some evidence of validity but limited data on reliability. Further research is needed to compare the use of tri-and uniaxial accelerometers.Cerebral palsy (CP) is the most common physical disability in children, occurring in 1 in 500 young people.1,2 Although it is a non-progressive condition, emerging evidence indicates an increased risk of musculoskeletal problems with decreases in functional ability with age.3 In 2007 the total health expenditure for CP in Australia was estimated to be Aus$40.5 million. 4 This highlights the need to maximize the health, fitness, and functioning of individuals with CP in order to reduce the long-term costs of care.Physical activity is defined 'as any bodily movement produced by skeletal muscle contracture that results in caloric expenditure' 5 and includes competitive or recreational sport, exercise, active hobbies (including play), walking, cycling, and some activities of daily living (including room cleaning and household chores). 6 The US Surgeon General published a seminal report establishing that physically inactive people had increased risk of all cause mortality including coronary heart disease, hypertension, colon cancer and diabetes mellitus.7 In response to this, international health authorities have adopted policies that aim to promote habitual physical activity (HPA). [6][7][8][9][10] According to the International Classification of Functioning, Disability and Health, activity is divided into domains of capability and performance.11 'Performance' is what a person does within the context of daily life (e.g. habitual activity). 12 Free-living or HPA is any activity that a person completes as part of their regular daily life. It has four principal dimensions: (1) frequency (how often a pe...

The 12-week intervention effectively increased adoption of PA in a sample of community-dwelling adults with BI immediately after the intervention but not at follow-up. Future studies should explore strategies to foster maintenance of PA participation.

Introduction The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020). Methods This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. Results During the COVID-19 pandemic, 91% (n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% (n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity (n = 33/80, 41%) and safety (n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference (n = 57/71, 80%), physical capacity (n = 35/71, 49%) and access to reliable delivery platforms (n = 27/71, 38%). Zoom (n = 54/71, 76%) and telephone (n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. Conclusions During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted.