Progressive resistance training for adolescents with cerebral palsy: the STAR randomized controlled trial

Abstract

AIM To evaluate the effect of progressive resistance training of the ankle plantarflexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). METHOD Sixty-four adolescents (10-19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I-III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net nondimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention-to-treat. RESULTS Median attendance at the 10 supervised sessions was 80% (range 40-100%). There was no between-group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI]-0.07 to 0.11, p=0.696) or 22 weeks (mean difference:-0.08, 95% CI-0.18 to 0.03, p=0.158). There was also no evidence of between-group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group.

The benefits of strength training in cerebral palsy

“…It targets body function but, as found by Ryan et al, does not transfer well to improved function in motor tasks such as gait. 3 This is also in line with a large number of studies showing limited benefit of strength training for motor abilities in various sports. It is not surprising since strength training from a nervous system point of view is a motor skill involving its own specific motor program quite separate from that involved in the control of gait and other motor abilities.…”

“…However, strength training is not a miracle cure. It targets body function but, as found by Ryan et al., does not transfer well to improved function in motor tasks such as gait 3 . This is also in line with a large number of studies showing limited benefit of strength training for motor abilities in various sports.…”

“…Therefore, the high frequency of adverse effects in the form of muscle soreness as reported in the study by Ryan et al. should not be a cause of worry 3,4 …”

“…Therefore, the high frequency of adverse effects in the form of muscle soreness as reported in the study by Ryan et al should not be a cause of worry. 3,4 However, strength training is not a miracle cure. It targets body function but, as found by Ryan et al, does not transfer well to improved function in motor tasks such as gait.…”

Patterns of Health Service Use Among Young People With Cerebral Palsy in England

“…Young people with CP who participated in a randomised controlled trial examining the effects of a 10-week progressive resistance training programme were included in this study ( 17 ). Participants were recruited from eight National Health Service (NHS) trusts in England, a special education needs school, a University, a primary care organisation in London, national organisations for people with disabilities, and by word of mouth.…”