261\u2005The outcome of a supervised, exercise-programme, for young people with cerebral palsy: effects on physical activity, functional and participation

Abstract

Background Young-people with Cerebral Palsy (CP) have been shown to have reduced physical fitness estimated at 15–28% less than healthy age matched children. As a result, they are at an increased risk of developing secondary health consequences due to a reduction in physical activity levels, lower cardiorespiratory capacity, and a decrease in muscle strength. There is limited research investigating the impact of a targeted exercise-programme for these young-people. The aim of this project was to conduct a service evaluation to explore the effects of a community-based, exercise-programme, for young people (age 9–13 years) with CP (GMFCS Levels-I-III). Objectives To design and implement a community-based exercise-programme for young-people with CP. To investigate the impact on physical activity levels using daily step-count data and Physical Activity Questionnaire for Older Children (PAQ-C) scores. To investigate the impact on functional-mobility using Timed-Up-and-Go (TUG) times. To investigate participation scores using the Child and Adolescent Scale of Participation (CASP) scores. Methods Young people with CP were identified using inclusion and exclusion criteria from a single centre. Approvals were granted and consent was obtained from all participants and their parents/carers. A weekly, individualised, physiotherapy-led, exercise-programme was completed at a large public leisure centre for six consecutive weeks. Outcome measures were completed to measure changes in physical activity, functional-mobility, and participation at pre-intervention, post-intervention and three-month follow-up. Results Eight young-people with CP consented and four participants completed the intervention and outcomes. The mean daily step-count increased from post-intervention for three-participants (range -1914.06–2096.86 steps) and was higher on weekdays (range 6410 (SD=±58.35) to 664.49 steps (SD=±1367.92)) than weekend-days (range 461.35 (SD=±67.84) to 5586.64 steps (SD=±539.17)). The PAQ-C-scores increased for all participants post-intervention (within-participant-difference range (WPDR) 0.21 (SD=±0.38) to 0.58 (SD=±0.70)) and varied at follow-up (WPDR -0.46 (SD=±0.72) to 0.69 (SD=±0.80)). The TUG-times improved for two-participants post-intervention (WPDR -24.29 (SD=±6.13) to 1.28 seconds (SD=±0.57)) and was maintained at follow-up (WPDR -23.70 (SD=±6.22) to 1.17 seconds (SD=±0.42)). The CASP-scores improved for three-participants (range 2 to 11) and was maintained at follow-up (2 to 12). Conclusions The aim of this project was to explore the feasibility and effects of a community-based exercise-group for young-people with CP. Overall the implementation and integration of the programme into the gym-environment was very successful. Attendance levels were 90% and all participants reported excellent subjective levels of enjoyment. The results of this project demonstrate preliminary, positive evidence for the effectiveness of the intervention on physical activity, functional-mobility, and participation measures in this small sample. The sample size and data collection were unfortunately affected by the Covid-19 pandemic. Therefore, additional data collection will be conducted in the future to further investigate the impact of the programme. It is clear that further studies are required to investigate outcome measures, to record the effects of interventions on physical activity, functional-mobility, and participation in young-people with CP. This preliminary study shows promise for the positive impact of community-based, exercise-programmes and should be considered as an additional option to facilitate young-people with CP to increase their participation, and to incorporate physical activity into their daily lives.