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Program
1947
•  Training
Exercise physiology and training
in children and adolescents with
cerebral palsy
–  Training principles
–  Training in children
•  Training children with CP
–  Practical considerations
Training in children
Muscle Strength
Aerobic
capacity
Training
•  Physical training:
The process whereby repeated “systematic”
exercise leads to functional and morphological
adaptations in the body.
FITNESS
Anaerobic
capacity
“Training principles”
•  The PRINCIPLES of TRAINING are the
rules to follow when using physical
activity programs:
•  Specificity
•  Reversibility
•  Adaptation/Supercompensation
Olaf Verschuren AusACPDM
Specificity
•  In order for a training program to be
beneficial, it must improve the specific
physiological capabilities required to
perform a given sport or activity.
Specificity
•  Example, a goalkeeper needs to focus on
reaction work in their training, in comparison to a
midfielder who should focus on agility, stamina,
speed etc.
•  A runner who wants to improve his leg strength,
should train differently to a cyclist. Both would
need muscular endurance but the training
method should be different !!
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Reversibility
Adaptation/Supercompensation
•  “Use it or lose it.”
•  When you stop training, the training effects
can be reversed – so don’t quit!
•  The training history will be an important
factor. The longer you have trained the
longer the effects will be present.
•  In order to improve through training we
need to apply greater demands on our
body. This is the principle of OVERLOAD.
Is it possible to train children?
Training in typically developing
children
Typically developing children
% improvement
after training
16
14
12
10
8
6
4
2
0
children
adults
•  The body will adapt to the new norm.
The three most important aspects of
training
•  Little progression after training compared to
adults (5-8% vs. 10-15%)
1. FUN
•  Program: “carefully adapted to each
individual’s potential”
2. FUN
3. FUN
Payne VG, Morrow JRJ (1993) Exercise and VO2max in children: a metaanalysis. Res Q Exerc Sport 64:305-13.
Baquet G, van Praagh E, Berthoin S. Endurance training and aerobic fitness in
young people. Sports Med. 2003;33(15):1127-43.
Fitnesslevels in CP
Low fitness
How to develop a fitness training?
Olaf Verschuren AusACPDM
lopers
High fitness
rolstoelrijders
2
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Fitnesslevels in children with CP
Fitnesslevels in children with CP
Muscle strength (HHD)
•  Muscle strength (HHD)
•  Aerobic capacity
–  Lundberg A 1984
•  Low compared to typically developing peers
control
hemiplegic
diplegie
8
7
6
5
4
3
2
1
0
dominant side
PF (F)
DF (F)
PF (E)
muscle groups
DF (E)
QU 30
QU 90
ABD
ADD
HAMS
GLUT
ILOP
Testuitslagen
RECT
PF (F)
muscle groups
DF (F)
PF (E)
DF (E)
QU 30
QU 90
ABD
ADD
HAMS
RECT
Strength
non dominant side
GLUT
ILOP
Strength
control
hemiplegic
diplegic
8
7
6
5
4
3
2
1
0
Percentage of predicted values
–  Damiano et al, 1998
Muscle strength right side (n=47)
Fitnesslevels in children with CP
•  Aerobic capacity
Fitnesslevels in children with CP
Fitnesslevels in children with CP
•  Anaerobic capacity
•  Anaerobic capacity
–  Verschuren et al. 2008 (submitted)
–  Verschuren et al. 2013
–  Bar-Or et al 1996; Parker et al 1992
Female
600
600
Male
550
450
450
II)
400
350
300
Mean Power
250
350
200
S I or
300
y (G
MFC
Mean Power
pals
0
0
50
50
100
100
150
150
bral
400
Typically develo
ping
Cere
250
I or II)
200
Cerebral palsy (GMFCS
no CP
level I
level II
500
550
no CP
level I
level II
500
ing
Typically develop
110
120
130
140
150
160
170
180
110
120
130
Height
Low fitness
High fitness
% of the observation
Fitnesslevels in CP
M
St us
re cle
ng
th
children's play
60
55
50
45
40
35
30
25
20
15
10
5
0
,
irs
sta
ing g k,
alk yin ee
W pla nd s
a
.
e etc
hid
anaëroob
0
3
6
9
12
15
lopers
Aerobic
capacity
us
em
en
Cy Sport t Pa
clin s,
rk,
g,
etc
.
21
24
27
30
33
36
160
170
180
Muscle Strength
FITNESS
aëroob
18
150
Height
Fitnesstraining
Am
duration of the activities (in sec.)
140
267
Anaerobic
capacity
rolstoelrijders
Olaf Verschuren AusACPDM
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Effect of aerobic training
Muscle Strength
Training is
??
Training is
??
3 RCTs: van den Berg-Emons et al. 1995, Unnithan et al. 2007, Verschuren et al. 2007
Trainingsprogram 2-4 months à ↑ aerobic fitness of 18–22%
Trainingsprogram 8-9 months à ↑ aerobic fitness of 26-41%
Content aerobic training
Cerebral Palsy
Aerobic
capacity
Cerebral Palsy
Fitnesstraining
Duration of the training:
18-45 minutes
2 to 4 times a week
3-9 months
Trainingsintensity between 60-80 % of HRmax.
FITNESS
Anaerobic
capacity
Training is
??
Typically developing
Trainingsprogram of 5 months à ↑ anaerobic fitness of approx. 25%
No clear evidence in current literature. Training seems beneficial
Different training modalities
-
Progressive Resistance Exercise
Cerebral Palsy
1 RCT: Verschuren et al. 2007
Trainingsintensity between 55-­‐89% of HRmax. Content anaerobic training
Typically developing
Cerebral Palsy
Effect of anaerobic training
Trainingsprogram 4 weeks tot 18 months à ↑ aerobic fitness of 5-10%
Typically developing
Typically developing
ACSM guidelines: Duration of the training:
20-60 minutes
3 times a week
4-12 months
Strength
training in
children with
Cerebral Palsy
Trainingsintensity maximal during exercises of 20-30 seconds
Guideline short-term and intermediate term anaerobic capacity
Trainingsintensity maximal during exercises of 10-30 seconds
Effect of resistance training on
MUSCLE STRENGTH
Effect of resistance training on
GMFM
Lower
extremity
Lower
extremity
Upper
extremity
Electro
stimulation
Electro
stimulation
-  Electro stimulation
What works? N= 119
Olaf Verschuren AusACPDM
Muscle strengthening is not effective in children and adolescents with cerebral palsy:
A systematic review. Scianni A, Butler JM et al. Aust J Physiother 2009; p81-87
N= 99
Muscle strengthening is not effective in children and adolescents with cerebral palsy:
A systematic review. Scianni A, Butler JM et al. Aust J Physiother 2009; p81-87
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Effect training on WALKING
SPEED
Lower
extremity
Discussion
•  Different methods in 1 review / metaanalysis
Electro
stimulation
•  If there is no effect on muscle strength or
activity level à is training still worthwhile?
N= 63
Progressive resistance exercise is most o0en used. Is this method effec7ve? Muscle strengthening is not effective in children and adolescents with cerebral palsy:
A systematic review. Scianni A, Butler JM et al. Aust J Physiother 2009; p81-87
Effect of resistance training for
the lower extremity in children and
adolscents CP
NSCA guidelines
Important ingredients according to
the NSCA guidelines
•  Warming-­‐up (5-­‐10 minutes) •  Type of exercise •  Intensity •  Frequency (2-­‐3 7mes a week) •  DuraPon of the programme •  Progression during the programme •  Age of children Dodd et al. 2003
Liao et al. 2007
Lee et al. 2008
Scholtes et al. 2010
Total
N= 105
Verschuren et al. PT journal 2011 RCTs in children with CP
Type
Result on muscle group level.
Type of exercises:
mostly functional based
Type of exercises NSCA
guidelines
Dodd: multi-joint exercises” (heel raises, half squats and stepSingle-joint and
ups)
multi-joint exercises
Liao: multi-joint exercises” (sit-to-stand) loaded (using weight
vest)
Lee: multi-joint exercises (squat to stand, lateral step up, stair
up and down) loaded (using weight cuffs),
Scholtes: multi-joint exercises (leg press) and loaded (using a
weight vest)
Study
What is the trainingseffect on the muscle
groups that were targeted?
Dodd et al.
Muscle groups targeted in 4 RCT’s:
• Knee-extensors
• Hip-extensors
• Plantar flexors
Ankle
plantar
flexors
-
Lee et al.
Liao et al.
Scholtes et
al.
-
Knee
extensors
+
Knee
flexors
-
Hip
extensors
+
-
Hip
flexors
Hip
abductors
-
-
-
-
Hip
adductors
-
Be aware of compensaPon during exercises! Olaf Verschuren AusACPDM
5
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Duration of the programme
Intensity of the programme
RCTs in children with CP
Intensity
Dodd:
Liao:
3 sets of 8-12 repetitions to fatigue
1 set of 10 repetitions at 20% 1RM
1 set of repetitions until fatigue at 50% 1RM
1 set of 10 repetitions at 20% 1RM
Lee:
2 sets of 10 repetitions (low load and no progression)
Scholtes: 3 sets of 8 RM
RCTs in children with CP
NSCA
guidelines
1-3 sets of 6-15
repetitions of
50-85% RM
Duration
Dodd:
Liao:
Lee:
Scholtes:
NSCA
guidelines
6 weeks
6 weeks
5 weeks
6 weeks (12 week program)
Effect of resistance training of the
lower extremity in typically
developing children
8-20 weeks
No study is in line with the NSCA guidelines Only 2 of the 4 studies are in line with the NSCA guidelines Significant relaPon between duraPon and trainingseffect: Behringer et al. Pediatrics Oct 25, 2010 Content of resistance training Age of training
RCTs in children with CP
Age
Dodd:
mean 13.1, SD 3.1, range 8-18 years of age
Liao:
mean 7.4, SD 1.6, range 5-12 years of age
Lee:
mean 6.3, SD 2.5, range 4-12 years of age
Scholtes: mean 10.5, SD 1.1, range 6-13 years of age
NSCA
guidelines
Age 7 and onwards
In 3 out of the 4 studies included children younger than the recommended 7 years of age. Variabels
RCTs in children with CP
NSCA guidelines
Type
Dodd:
Liao:
Lee:
multi-joint exercises” (heel raises, half squats and step-ups)
multi-joint exercises” (sit-to-stand) loaded (using weight vest)
multi-joint exercises (squat to stand, lateral step up, stair up and down)
loaded (using weight cuffs), single joint exercises
Scholtes: multi-joint exercises (leg press) and loaded (using a weight vest)
Single-joint and multi-joint
exercises utilizing
concentric and eccentric
contractions
Intensity/
volume
Dodd:
Liao:
3 sets of 8-12 repetitions to fatigue
1 set of 10 repetitions at 20% 1RM
1 set of repetitions until fatigue at 50% 1RM
1 set of 10 repetitions at 20% 1RM
Lee:
2 sets of 10 repetitions
Scholtes: 3 sets of 8 RM
1-3 sets of 6-15 repetitions
of 50-85% RM
Duration
Dodd:
6 weeks
Liao:
6 weeks
Lee:
5 weeks
Scholtes: 6 weeks (12 week program)
8-20 weeks
Age
Dodd:
mean 13.1, SD 3.1, range 8-18 years of age
Liao:
mean 7.4, SD 1.6, range 5-12 years of age
Lee:
mean 6.3, SD 2.5, range 4-12 years of age
Scholtes: mean 10.5, SD 1.1, range 6-13 years of age
Age 7 and onwards
N= 1728
Recommendations
•  Longer interventions with sufficient intensity,
for example, 12 weeks, may be needed to see
significant or meaningful improvements in
strength.
Verschuren et al. PTjournal 2011
Recommendations
Single-joint resistance training may be more
effective for very weak muscles or for children or
adolescents who tend to compensate when
performing multi-joint exercises, or at the
beginning of the training.
Olaf Verschuren AusACPDM
Recommendations
Depending on the complexity of the exercise and
the level of motor impairment, children and
adolescents with CP may need more than 1
minute of rest between bouts (perhaps up to 3
minutes).
Recommendations
Since strength training, as it is traditionally done,
requires maximal effort and can include somewhat
complicated activities, older children and
adolescents, over 7 years old, are perhaps better
suited to this intervention that younger children.
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Recommendations
Training is
effective
Fitnesstraining
CP
Aerobic
capacity
Children or adolescents with more impairment
might also benefit from strength training, but if it is
difficult for them to contract voluntarily,
methods such as electrical stimulation, mental
imagery and biofeedback could be helpful.
Training can be
more effective
EXAMPLE STUDY
Muscle strength
FITNESS
Anaerobic
capacity
Training is
effective
Randomized Clinical Trial
Aerobic
capacity
Muscle strength
Goes
Zwolle
FUNCTIONAL
Breda
N=86
Utrecht
N=65
FITNESS
Trainingsscheme
• 
• 
• 
• 
8 months
2 times a week for 45 minutes
2 physical therapists
2 groups
1.  7 - 12 year
2.  13 - 20 year
Randomized
GMFCS level (I or II)
Anaerobic
capacity
Fitnessprogram
Experimental group
Control group
N = 32
N = 33
HRmax in children with CP
Ingredients for training
•  In the training we used 8 standardized TASKSPECIFIC aerobic and anaerobic exercises,
which were based on walking activities, such as
–  Running / Walking fast
–  Step up and down
–  Stepping over
–  Bending
–  Turning
–  Getting up from the floor
Olaf Verschuren AusACPDM
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Fitnesstraining
guidelines
The exercises
Aerobic exercises
Frequency:
2 days per week
8 standardized exercises
Intensity:
60 - 80% max. HR
Aerobic
capacity
Duration:
Anaerobic exercises
45 minutes
Activity:Rest:
8 standardized exercises
Fitnesstraining
guidelines
Frequency:
Training
1.
Anaerobic
capacity
2.
3.
maximal
Duration:
Warming-up
Training focus
–  In circuit format (with 2 children in each
group) for aerobic part (month 1-3)
–  In group format for anaerobic part (month 4-8)
30 - 45 minutes
Activity:Rest:
4.
1:3 1:5
Introduction
–  Explain purpose of training and give children
heart rate monitor
2 days per week
Intensity:
1:1
The effects of a functional
fitness program in children
and adolescents with
Cerebral Palsy:
a randomized trial
Closure of the training
Olaf Verschuren, Marjolijn Ketelaar, Jan Willem Gorter, Paul Helders, Tim Takken
Randomization
Aerobic
capacity
Muscle strength
FUNCTIONAL
FITNESS
•  Experimental
group (n=32)
•  Control group
(n=33)
GMFCS I n=23
GMFCS II n=9
GMFCS I n=22
GMFCS II n=11
11.6 (2.5) years
Boys/girls 18/14
12.7 (2.7) years
Boys/girls 23/10
Objectives
•  Primary objective; Study the effects on:
•  aerobic capacity
(10-m Shuttle Run Test)
•  anaerobic capacity
(Muscle Power Sprint Test)
•  Secondary objective; Study the effects on:
•  Functional muscle strength
•  Agility
•  Participation
•  HRQoL
Baseline
Controlgroup:
Anaerobic
capacity
Olaf Verschuren AusACPDM
Traininggroup:
4 months
8 months
Follow-up:12 months
REGULAR PHYSIOTHERAPY
TRAINING + REGULAR THERAPY
REGULAR THERAPY
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Results
Aerobic and anaerobic capacity
8
months
Control group
4
months
8
months
4
months
% improvement
P<0.001
baseline
Experimental group
60
50
40
30
20
10
0
-10
-20
8
months
4
months
8
months
baseline
4
months
baseline
% improvement
Mean Muscle Power (MPST)
Control group
baseline
10-m Shuttle Run Test
Experimental group
60
50
40
30
20
10
0
-10
-20
P=0.004
P-values: group(2) x time(3) interaction of repeated-measures analysis of variance
Body Function and Structure
Functional muscle strength
30-sec Repetition Maximum
Experimental group
P<0.001
Control group
Olaf Verschuren et al. Ped Phys Ther 2007;19:108-115
•  Children’s Assessment of Participation and
Enjoyment (CAPE).
Intensity 1,5
Significant (p<0.05)
1,4
Not significant
1,3
control
group
1,2
8
months
4
months
8
months
1,1
baseline
% improvement
8
months
4
months
8
months
baseline
-10
baseline
0
-5
4
months
5
4
months
& improvement
15
10
16
14
12
10
8
6
4
2
0
Olaf Verschuren et al. Physical Therapy 2006;86(6): 1107-1117
For info MPST:
Participation (intensity)
1,6
10x5 meter sprint test
Control group
20
baseline
Experimental group
25
Participation
Children’s Assessment of Participation and Enjoyment (CAPE)
Agility
For info 10-m SRT:
exp group
1
Recreational activities (+10%)
Social activities (+0%)
Self-improvement activities (+6%)
Skill-based activities (+20%)
Physical activities (+24%)
0,9
0,8
P<0.001
0,7
Overall activities (+27%)
0,6
P-values: group(2) x time(3) interaction of repeated-measures analysis of variance
baseline
+ 4 months
+ 8 months
For info 10x5 meter:Olaf Verschuren et al. Ped Phys Ther 2007;19:108-115
Health-related Quality of Life
P-values: group(2) x time(3) interaction of repeated-measures analysis of variance
Conclusion
Follow-up
Aerobic and anaerobic capacity
•  TACQOL-PF
10 meter shuttle run test
Experimental group
Control group
10
Olaf Verschuren AusACPDM
12
months
8 months
baseline
15
10
5
12
months
baseline
12
months
8 months
0
-5
P-values: group(2) x time(3) interaction of repeated-measures analysis of variance
Control group
20
4 months
Effective and Fun
% improvement
Global negative emotions (+2%)
4 months
12
months
8 months
Mean Power (Watts) MPST
Experimental group
25
8 months
Easy to implement
Cognitive functioning (+4%)
4 months
Functionally based
Global positive emotions (+2%)
4 months
0
-10
Social functioning (+2%)
Autonomy (+4%)
20
baseline
Not significant
Pain and symptoms (+1%)
Basic motor functioning (+10%)
30
baseline
Significant (p<0.05)
% improvement
40
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Follow-up
Participation
Follow-up
Muscle strength and agility
Results of more studies
Functionele spierkracht (30-sec HM)
25
Experimental group
Control group
1,6
% improvement
20
15
Intensity
1,3
0
-5
1
0,7
0,6
+4
months
+8
months
follow-up
12
months
8 months
4 months
baseline
12
months
8 months
4 months
baseline
baseline
% improvement
0,8
Control group
End of training Muscle Strength
Based on rationale for
RCT’s in published
papers.
Dodd et al.
Lee et al.
Scholtes et al.
N= 105
and/or
PERFORMANCE related problems
Verschuren et al. PTjournal 2011
Aerobic capacity
HEALTH related problems
Olaf Verschuren AusACPDM
Anaerobic capacity
Trainingsprogram 4 months à ↑ anaerobic fitness 10% Trainingsprogram 8 months à ↑ anaerobic fitness 25% Agility
Walking Speed
Trainingsprogram 2-­‐4 months à ↑ aerobic fitness 18–22% Trainingsprogram 8-­‐9 months à ↑ aerobic fitness 26-­‐41% PERFORMANCE related
factors
PERFORMANCE related
factors
GMFM
CEREBRAL PALSY Berg-Emons et al. 1998: after 3 months ↓ 17%
Verschuren et al. 2007: after 4 months ↓ 9 %
Liao et al.
GOAL
Aerobic capacity Muscle strength Body Mass Index FOLLOW-UP
HEALTH related factors
Exercise programs: What’s the GOAL?
Anaerobic capacity Motor skill Agility / Speed exp group
0,9
10x5 meter sprint test
Experimental group
16
14
12
10
8
6
4
2
0
control
group
1,1
12
months
8 months
4 months
12
months
baseline
8 months
4 months
1,2
baseline
-10
1,5
1,4
10
5
Trainingsprogram 4 months à ↑ agility 8% Trainingsprogram 8 months à ↑ agility 14% End of training FOLLOW-UP
Verschuren et al. 2007: a0er 4 months Anaerobic capacity ↓ 9 % Agility ↓5% 10
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Exercise programs: What’s the effect?
Only during the intervenPon What have we done?
? follow-­‐up too short HEALTH related problems
and/or
PERFORMANCE related problems
No effect (at follow-­‐up) Difficult to be acPve in daily life. LEARN 2 MOVE 7-12
Group fitness training
Recent study
LEARN 2 MOVE 7-12
Lifestyle intervention
LEARN 2 MOVE 7-12
Program designed to improve physical
activity
Motivational Interviewing
“A directive, client-centered counseling style
to elicit behavior change by helping clients
explore and resolve ambivalence.”
(Rollnick & Miller 1995)
+
3 x 12 hh
Training
•  16 weeks 1-2 times a week for an
hour
15-20 seconds maximal!
Motivational interviewing
•  2-5 children per group
Olaf Verschuren AusACPDM
11
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Are we satisfied when we become
succesful in increasing PHYSICAL
ACTIVITY ?
Results Learn to Move
•  The combination of counselling, homebased physiotherapy and fitness
training was not effective in improving
fitness, social participation in recreation
and leisure, self-perception or quality of
life.
30-60 min
What have we done?
Part 2.
PHYSICAL ACTIVITY
exercise continuum
Sitting and mortality
Sedentary physiology in children with CP
Uptime (Pirpiris and Graham 2004)
Sedentary pursuits
Fitness level and mortality
Definitions of Sedentary Behavior
Evolution of definitions of sedentary behavior:
• 2010. Sedentary behavior should be defined as the muscular activity
rather than the absence of exercise.
CP
Cerebral palsy
Mean hours per week
diplegia
hemiplegia
Typically developing
(Maher et al. 2007)
CP = Coach Potato Low sedentary
• 2011. The origins of the word ‘‘sedentary’’ hint at a simpler, more
workable definition. The word sedentary derives from the Latin verb
sedere—to sit. When sitting or lying, the majority of the body’s largest
muscle groups are under relaxation; in contrast, when standing, even
if still, a large proportion of the body’s musculature are under tension.
Therefore any non-exercise activity that involves sitting or lying can be
considered sedentary.
Regardless of Physical Activity
Van der Ploeg H et al. Arch Intern Med 2012:172(6):494-500
Important factors of Sedentary
Behaviour
•  Posture (sitting or reclining)
•  Energy expenditure (≤ 1.5 METs)
•  Muscular inactivity
• 2012. Sedentary behaviour is any waking behaviour characterized by
an energy expenditure ≤ 1·5 METs while in a sitting or reclining
posture.
High sedentary
Olaf Verschuren AusACPDM
12
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What do we know about
sedentary behavior in children
with CP?
?
?
?
EMG acPvity Energy expenditure EMG acPvity Energy expenditure EMG acPvity Energy expenditure Sitting
Lying and sitting
?
?
?
Standing
Energy expenditure (METS)
GMFCS
level
0 (n=4)
Rest
(lying)
1.0
Sit with support
I (n=4)
1.0
II (n=3)
1.0
III (n=6)
Standing
Standing
1.14 ± .07
Sit without
support
1.17 ± .10
1.10 ± .10
1.11 ± .17
1.53 ± .04
1.10 ± .09
1.18 ± .15
1.54 ± .19
1.0
1.21 ± .19
1.33 ± .25
1.60 ± .25
IV(n=2)
1.0
1.03 ± .13
not possible
1.70 ± .06
V (n=1)
1.0
1.42
not possible
1.88
1.58 ± .10
Stand up for your health and
ask a question?
Muscle activity
Summary
GMFCS
level
0 (n=4)
Rest
(lying)
1.0
Sit with support Sit without
support
1.33 ± .59
1.38 ± .24
Standing
I (n=4)
1.0
1.17 ± .58
.91 ± .21
2.35 ±1.0
II (n=3)
1.0
1.10 ± .47
1.68 ± 1.0
5.64 ±1.6
III (n=6)
1.0
1.22 ± .70
1.69 ± .73
4.76 ± 3.0
IV(n=2)
1.0
1.58 ± .46
Not possible
8.80 ± 2.6
V (n=2)
1.0
.77 ± .57
Not possible
1.7 ± 1.4
•  Children with CP have low fitness levels.
•  Children with CP are able to increase their
fitness levels.
•  It is difficult to become and stay physically
active.
•  Even if we (or they) succeed, we are not
doing enough.
•  We need to get them less sedentary.
3.77 ± .67
Take home message!
Sleep Sedentary behavior* Light physical activity cut down, replace by
Wake up
Moderate physical activity Intense activity HEALTH ENHANCING PHYSICAL ACTIVITIES
x
passive transportation*
Trip to and
- walk or bike to school
-brisk walk or bike fast to school
- break up sitting every hour
-PA lesson with Heart Rate > 64% HRmax
from school
sitting/reclining*
- active play (recess)
School
After school
Bed time
Olaf Verschuren AusACPDM
- break up sitting every hour
-moderate to vigorous activities
screen time*
- active play (out- or indoors)
-play (competitive) sports
x
8 hours
1 sitting/reclining*
15 hours
30-60 minutes
13
12-03-14
Kind met een hulpvraag*
Onderzoek**
(oa. CP onderzoek, GMFM,
krachttesten, GMFCS)
Beperkt
uithoudingsvermogen
GMFCS I + II
GMFCS III
Beperkte kracht/
verwacht
krachtsverlies***
GMFCS I + II
GMFCS III
Beperkt krachtuithoudingsvermogen
GMFCS I + II
GMFCS III
CP
trainingsgroep
POPEYE +
Principes CP
trainingsgroep
individueel
Voor en/of na
interventie****
CP
trainingsgroep
Principes CP
trainingsgroep
individueel
CP
trainingsgroep
POPEYE
* Kinderen met CP met een hulpvraag die gericht is op kracht en/of uithoudingsvermogen
** Meetinstrumenten volgens POPEYE- protocol
*** Treedt vaak op pre- of postoperatief, na inactieve periode of tijdens Botox
**** met interventie wordt hier bedoeld: Botox, SDR, of multilevel chirurgie
Olaf Verschuren AusACPDM
14