Abstract
Objectives: To describe (1) physical strain of walking, (2) the proportion of participants walking above the anaerobic threshold, and (3) 4 phenotypes of physical strain of walking on the basis of deviations in aerobic capacity and walking energy cost (EC) in children and adolescents with cerebral palsy (CP). Design: Cohort study. Setting: Academic medical center. Participants: A sample (N=57) of participants (n=37; mean age, 13.5±4.0y) with CP (Gross Motor Function Classification System [GMFCS] levels I [n=13], II [n=17], and III [n=7]) and typically developing (TD) participants (n=20; mean age, 11.8±3.5y). Interventions: Not applicable. Main Outcome Measures: Oxygen consumption (Vo 2walk), speed, and EC were determined during walking at a comfortable speed. Peak oxygen consumption (Vo 2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was reduce if lower than the 10th percentile, and EC was increased if higher than 3SD. Physical strain was defined as follows: (Vo 2walk/Vo 2peak)×100. Results: Participants with CP had a higher physical strain (GMFCS level I, 55%±12% GMFCS level II, 62%±17%; GMFCS level III, 78%±14%) than did TD participants (40%±11%) (P<.001). Forty-three percent of participants with CP showed a Vo 2walk at or above their anaerobic threshold as compared with 10% of TD participants (P=.007). Phenotypes showed that a reduced Vo 2peak (n=9) or an increased EC (n=9) lead to an 18% to 20% higher physical strain, whereas a combination (n=12) leads to a 40% increase. Conclusions: Children and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable proportion walks close to or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and a reduced Vo 2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in individuals with CP require different intervention strategies.
| Original language | English |
|---|---|
| Pages (from-to) | 2507-2513 |
| Number of pages | 7 |
| Journal | Archives of Physical Medicine and Rehabilitation |
| Volume | 98 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Dec 2017 |
Cite this
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Physical Strain : A New Perspective on Walking in Cerebral Palsy. / Balemans, Astrid C.; Bolster, Eline A.; Brehm, Merel Anne; Dallmeijer, Annet J.
In: Archives of Physical Medicine and Rehabilitation, Vol. 98, No. 12, 01.12.2017, p. 2507-2513.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Physical Strain
T2 - A New Perspective on Walking in Cerebral Palsy
AU - Balemans, Astrid C.
AU - Bolster, Eline A.
AU - Brehm, Merel Anne
AU - Dallmeijer, Annet J.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Objectives: To describe (1) physical strain of walking, (2) the proportion of participants walking above the anaerobic threshold, and (3) 4 phenotypes of physical strain of walking on the basis of deviations in aerobic capacity and walking energy cost (EC) in children and adolescents with cerebral palsy (CP). Design: Cohort study. Setting: Academic medical center. Participants: A sample (N=57) of participants (n=37; mean age, 13.5±4.0y) with CP (Gross Motor Function Classification System [GMFCS] levels I [n=13], II [n=17], and III [n=7]) and typically developing (TD) participants (n=20; mean age, 11.8±3.5y). Interventions: Not applicable. Main Outcome Measures: Oxygen consumption (Vo 2walk), speed, and EC were determined during walking at a comfortable speed. Peak oxygen consumption (Vo 2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was reduce if lower than the 10th percentile, and EC was increased if higher than 3SD. Physical strain was defined as follows: (Vo 2walk/Vo 2peak)×100. Results: Participants with CP had a higher physical strain (GMFCS level I, 55%±12% GMFCS level II, 62%±17%; GMFCS level III, 78%±14%) than did TD participants (40%±11%) (P<.001). Forty-three percent of participants with CP showed a Vo 2walk at or above their anaerobic threshold as compared with 10% of TD participants (P=.007). Phenotypes showed that a reduced Vo 2peak (n=9) or an increased EC (n=9) lead to an 18% to 20% higher physical strain, whereas a combination (n=12) leads to a 40% increase. Conclusions: Children and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable proportion walks close to or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and a reduced Vo 2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in individuals with CP require different intervention strategies.
AB - Objectives: To describe (1) physical strain of walking, (2) the proportion of participants walking above the anaerobic threshold, and (3) 4 phenotypes of physical strain of walking on the basis of deviations in aerobic capacity and walking energy cost (EC) in children and adolescents with cerebral palsy (CP). Design: Cohort study. Setting: Academic medical center. Participants: A sample (N=57) of participants (n=37; mean age, 13.5±4.0y) with CP (Gross Motor Function Classification System [GMFCS] levels I [n=13], II [n=17], and III [n=7]) and typically developing (TD) participants (n=20; mean age, 11.8±3.5y). Interventions: Not applicable. Main Outcome Measures: Oxygen consumption (Vo 2walk), speed, and EC were determined during walking at a comfortable speed. Peak oxygen consumption (Vo 2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was reduce if lower than the 10th percentile, and EC was increased if higher than 3SD. Physical strain was defined as follows: (Vo 2walk/Vo 2peak)×100. Results: Participants with CP had a higher physical strain (GMFCS level I, 55%±12% GMFCS level II, 62%±17%; GMFCS level III, 78%±14%) than did TD participants (40%±11%) (P<.001). Forty-three percent of participants with CP showed a Vo 2walk at or above their anaerobic threshold as compared with 10% of TD participants (P=.007). Phenotypes showed that a reduced Vo 2peak (n=9) or an increased EC (n=9) lead to an 18% to 20% higher physical strain, whereas a combination (n=12) leads to a 40% increase. Conclusions: Children and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable proportion walks close to or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and a reduced Vo 2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in individuals with CP require different intervention strategies.
KW - Cerebral palsy
KW - Physical fitness
KW - Rehabilitation
KW - Walking
UR - http://www.scopus.com/inward/record.url?scp=85023747959&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2017.05.004
DO - 10.1016/j.apmr.2017.05.004
M3 - Article
VL - 98
SP - 2507
EP - 2513
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 12
ER -