What do we know about strength exercise for people with CP?
Strength training (or resistance training) is a very common part of sports and physical fitness programs. For many people, the goal of strength training is simply to improve appearance, but here we’ll discuss strength training as a means of improving health, overall function and general well-being.
Strength training has in the past been considered to be contraindicated for people with CP, with the merits and drawbacks being widely discussed. Today however, we know from studies that strength training does not affect spasticity negatively. Still, there is an uncertainty as to what type of training is beneficial, and whom it might benefit.
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What does the research say?
Studies show that strength training can improve strength, flexibility, posture and walking (including the ability to negotiate steps) for young people with cerebral palsy. This is supported by other studies conducted with adults, suggesting that strength exercises can improve (among other things) the ability to move from a sitting to a standing position. Strengthening interventions have also shown to produce large improvements in strength and physical performance among individuals with CP.
That being said, research also suggests that results for strength training in children with CP are mixed; it’s unlikely that it’s an optimal form of therapy for all people with CP. What’s considered as beneficial is very individual, and for that reason, it’s vital to look at what each person is trying to achieve with their therapy before jumping straight into a strength training programme. Not everyone will benefit significantly from strength training; perhaps other types of therapy can be more effective and helpful.
It’s also important to consider each person’s motivation, and not just the clinical increase in strength. One can be a huge football fan dreaming of kicking a ball, others might be empowered by the thought of getting enough strength to walk outside with their family. Even though these goals might not be top of mind for the physiotherapist in the first place, they can be hugely important for the individual, and in some cases crucial for the therapy to be deemed a success.
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What are the recommendations?
As we mentioned above, it’s hard to predict exactly who might benefit from an exercise intervention, but identifying individuals who can be at risk for poor health outcomes is a good start. This is typically done with exercise testing.
Next, it’s important to determine if any deconditioning is a result of inactivity, nutritional factors, disease-specific pathophysiology or a combination of all three. This is also done through testing, and can help you decide what type of training or therapy the individual can benefit from, and if strength training can be to any help.
It’s recommended that clinicians encourage clients with CP to be physically active, and that exercise testing is used when the client experiences limitations in activities because of physical exhaustion.
This article gives the following resistance exercise recommendations, which can give you a picture of what type of training is recommended. Keep in mind that these recommendations are general, and that most people (especially novices) will need familiarization time to get used to the different exercises:
Resistance exercise recommendations
2–4 times a week on non-consecutive days.
1–3 sets of 6–15 repetitions of 50–85% repetition maximum.
No specific duration of training has been
identified for effectiveness. Training period
should last at least 12–16 consecutive weeks
Progression in mode from primarily single-joint, machine-based resistance exercises to machine plus free-weight, multi-joint (and closed-kinetic chain) resistance exercises. Single-joint resistance training may be more effective for very weak muscles or for children, adolescents or adults who tend to compensate when performing multi-joint exercises, or at the beginning of the training.
Do you want to know more about CP?
Rikke Damkjær Moen brings many years of experience as clinical physiotherapist to the Made for Movement team. Her mission is to ensure that everybody, regardless of mobility problems, should be able to experience the joy and health benefits of physical activity. As our Medical Manager, Rikke is passionate about sharing knowledge so that individuals with special needs, families, and clinicians can discover the possibilities and solutions provided by Made for Movement.
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