Habitual physical activity in independently ambulant children and adolescents with congenital hemiplegia: Are they doing enough?

Abstract

Objective: Individuals with cerebral palsy are thought to perform inadequate levels of habitual physical activity (HPA). This study aimed to assess HPA of children and adolescents with congenital hemiplegia, identify characteristics associated with performance, and compare results to international public health recommendations. Design: Cross-sectional study. Method: Sixty children and adolescents with congenital hemiplegia (males n=30; aged 11y 4mo [2y 5mo], range 8-17yr) classified at GMFCS levels I (n=30) and II (n=30) were evaluated in a community setting. HPA and step counts were recorded over 4 days using the ActiGraph®GT3X+ tri-axial accelerometer. Activity counts were converted into activity intensity using Evenson cut-points to classify time spent sedentary and at light or moderate-to-vigorous physical activity (MVPA). Activity capacity was measured using 6-minute walk distance (6 MWD), functional strength, and the Mobility Questionnaire (MobQues47). Paired and independent two-sided t-tests were calculated between weekday and weekend activity, and GMFCS levels. Pearson correlations (q) were calculated between HPA and activity capacity. Data are mean (SD). Results: Two hundred and thirty-seven of a potential 240 days (99%) were collected. On 88% of recorded days, children did not meet public health recommendations of 60 minutes MVPA. On average, participants wore the ActiGraph for 11:58 (1:49) hours daily. During this time, participants averaged 419 (228) counts/min and took 7373 (3206) steps. When cut-points were applied, participants were sedentary for 8:40 (0:49) hours (72% recorded time), and participated in 2:37 (0:51) hours of light activity (22% recorded time), and 0:41 (0:23) hours MVPA (6% recorded time) daily. Step counts (1457 [standard error SE: 5.4] steps, p=0.001) and MVPA (0:11 [SE: 0.19] hours, p=0.001) were significantly greater on weekdays than weekends. Children classified as GMFCS I participated in more light activity (0:34h, p=0.001) and took more steps (1400 steps, p=0.001) than GMFCS II, however there was no difference in MVPA (0:07h, p=0.11). Activity capacity was greater in children at GMFCS I for functional strength (23.6 repetitions, p=0.001) and MobQues47 (8 points, p=0.05), interestingly 6MWD was comparable between GMFCS levels (23.4 m, p=0.41). Age, GMFCS or measures of activity capacity were not correlated to MVPA or steps counts (all q>0.05). Conclusion: Ambulatory children and adolescents with CP do not perform sufficient physical activity to meet international public health recommendations, particularly on weekends. This is independent of age, GMFCS or activity capacity. This may place even the most capable children with hemiplegia at risk of poor health due to physical inactivity. Population based interventions may be required to ensure appropriate levels of HPA.L716833052014-11-18 <br />