Children and adolescents with CP and GMFCS IV and V have high levels of blood lactate at rest.
A newly published study from Lund University found that just after one bout of exercise in the Innowalk, blood lactate levels was reduced significantly.
The study included 24 children and adolescents with CP GMFCS IV & V. Main findings:
- participants with the highest blood lactate levels at rest had the greatest decrease in blood lactate levels after one bout of exercise.
- the higher GMFCS levels the higher levels of resting blood lactate.
Proven positive effect of dynamic standing in the Innowalk
This study, newly published in Pediatric Exercise Science, a peer review publication, reveals important knowledge about how dynamic standing activity effects blood glucose and blood lactate levels in children with cerebral palsy who are non-ambulatory.
CP is a permanent disorder caused by a lesion in the brain either before, during or after birth. The five level Gross Motor Function Classifications System (GMFCS) is used to describe motor performance. Children at level I to III can either walk and/or stand independently or with support, while children at level IV and V cannot stand and walk, also described as non-ambulatory.
Non-ambulatory CP children and adolescents are less physically active than their peers and spend twice the recommended time in sedentary behaviour.
Non-ambulatory children with CP are at risk of developing diagnosed related secondary muscle pathology and metabolic derangement. During growth, CP increases the risk of developing disorders such as muscular fibrosis and fat infiltration, chronic inflammation involved in insulin resistance, and an increased risk of cardiometabolic disease.
From typical developing children and adolescents, we know that cardiorespiratory and muscular fitness have positive metabolic effects, reducing the insulin requirement. Skeletal muscle is also key in lactate metabolism. Lack of muscle movement could over time, lead to an unbalanced metabolism.
The researchers at the Lund University wanted to understand how blood glucose and blood lactate among people with severe CP are affected by exercise. To their knowledge this has not previously been studied.
You find the full article “Acute Response to One Bout of Dynamic Standing Exercise on Blood Glucose and Blood Lactate Among Children and Adolescents With Cerebral Palsy Who are Non-ambulant” in the peer review journal Pediatric Exercise Science here.
To give you a brief overview of the study, here is an article summary:
What is dynamic standing in the Innowalk?
Innowalk is a dynamic stander enabling assisted movement of the lower and upper limbs in sitting and standing position. The assisted movement of the lower limbs is close to a normal gait pattern with flexion and extension of hips, knees and ankle joints.
What is lactate?
Lactate is a waste product, produced in the muscles when there is insufficient oxygen at the cellular level or when the primary way of producing energy in the body’s cells is disrupted.
What is glucose?
Glucose is the main type of sugar in the blood and major source of energy for the body’s cells. Glucose comes from the food we eat and drink.
Aim of study
The aim of the study was to assess the effect of 30 minutes of dynamic standing on blood glucose and blood lactate levels in children and adolescents with CP GMFCS IV and V (non-ambulatory).
The motorised medical device Innowalk, was used to enable dynamic standing (DyS).
Methods and participants
The study was performed in the Southern part of Sweden and participants were recruited from this same area.
- 24 participants diagnosed with CP GMFCS IV and V
- Mean age 12 years, with a range of 5-17 years.
All testing was performed either in the child’s home environment or at the lab. Just before the participant was positioned in the dynamic stander, a capillary blood sample was taken from the fingertip for measurement of blood glucose and blood lactate. After 30 minutes of exercise in the dynamic stander the final blood sample was taken.
A statical significant reduction of blood lactate level, after exercise, for those participants with higher lactate levels at rest were found, but no significant differences in blood glucose.
The higher GMFCS level the higher blood lactate level at rest.
Only one participant had normal resting blood lactate level (0.7 mmol/L) and one participant reached a lactate level of 8.9 mmol/L which is defined as metabolic acidosis. The study found that the participant with highest lactate level had the greatest change in blood lactate after exercise (8.9 – 5.4 mmol/L).
The study demonstrated that 42% (n = 10) of the participants with CP GMFCS level IV and V had mild hyperlactatemia at rest, and one participant had blood lactate levels corresponding to metabolic acidosis. The children and adolescents with the highest levels of lactate at rest had the most positive effect of one bout of exercise for 30 minutes in the dynamic stander. Moreover, the higher GMFCS levels seem to elevate resting levels of blood lactate.
The authors emphasize the need for more studies on how to prevent chronically high resting levels of lactate with exercise in children with CP GMFCS level IV and V. Moreover, there is also a need to investigate the cause of high lactate level and the long-term health effects on this population.
The research group, Child and family Health at Lund University in Sweden have since 2014 had a special focus on physical activity and people with CP who are non-ambulatory. In all their studies Innowalk has been included. You find all published articles on this topic here.