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Lyndsay Ruckle
ruckl1lk@cmich.edu
October 5, 2017
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injury or malformation that occurs while the child’s brain is under development… Cerebral Palsy
affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and
balance. It can also impact fine motor skills, gross motor skills and oral motor functioning.1”
weaknesses, and complications (such as those listed above), it is important to understand what
Without intervention, CP can cause patients to become physically inactive, increase the chance of
self-worth, and deterioration to overall health status. One possible intervention for populations
with CP is resistance training. Throughout this paper, several studies regarding resistance
training in populations of people with CP will be evaluated and compared; then it will be
determined if resistance training is a recommended and a viable intervention for persons with CP.
control, muscle coordination, muscle tone, reflex, posture and balance.1” Thus, the general
purpose amongst all of the resistance training studies were predominantly similar. In a study
performed by Reid, Hamer, Alderson, and Lloyd, their goal was “to determine the neuromuscular
outcomes of an eccentric strength-training [program] for children and adolescents with cerebral
palsy.2” In another study performed by Ryan, Theis, and Kilbride, et al., the goal of the study was
to “…evaluate the effect of resistance training on gait efficiency, activity and participation in
adolescents with cerebral palsy. We also aim to determine the biomechanical and neural
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adaptations that occur following resistance training.3” Collectively, due to the musculoskeletal
abnormalities caused by CP, most resistance training interventions looked for favorable
The first study regarding resistance training in populations with CP was performed by
Reid, Hamer, Anderson, and Lloyd. The intervention was a six week program with resistance
training occurring three days a week. Resistance training included ten repetitions of eccentric
lengthening contractions occurring in sets of three. “The training loads were individually
maximum eccentric torque, and, after reassessment of strength at week 3, loads continued to
advance in 5% increments up to 70% by week 6.2” After the resistance training intervention, the
results displayed improved and increased eccentric “peak torque [normalized] to body mass;”
levels decreased and were comparable to that of standard developing children.2 The study as a
whole proved that resistance training can help persons with CP increase overall strength, slightly
increase muscle torque, and help reduce muscle spasticity. Thus, resistance training could be
Another study done looking at the effects resistance training has on populations with CP
was performed by Taylor, Dodd, Baker, and Willoughby. Their intervention protocol involved a
twelve week program with resistance training occurring twice a week. Resistance training
exercises were performed for three sets with ten to twelve repetitions per set; the goal intensity
was targeted at sixty to eighty percent of an individual’s one-repetition maximum. The chosen
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exercises were directed towards muscles involved with gait and ambulation. This study revealed
“the strength of targeted muscles increased by 27% compared with [the] control group.4”
However, these gains in muscles strength did not translate into improvements in ambulation and
mobility. Even though there were no objective improvements in mobility, there was a large
increase in “participant-rated mobility;” meaning the persons with CP believed the resistance
training intervention did help increase their overall mobility.4 Depending on the intended
outcome of resistance training, this study can prove multiple aspects. If the intended goal of
recommended. If the intended outcome is to increase overall mobility, then resistance training
interventions as well as passive and active stretching techniques in populations with CP. This
intervention spanned a sixteen week period with resistance training and stretching occurring
three days a week; two days were completed with a physiotherapist and the third day was
completed at home. The study primarily focused on stretching and strength training of the
muscles that extend the lower extremities. After completing the sixteen week intervention period,
the general results of the study were inconclusive. “For isokinetic muscle strength, spasticity, gait
speed and step length variables there were small and non-significant differences between the two
groups;” the two groups being the control group and the intervention group.5 This study lends
evidence that resistance training might not be the most effective intervention for persons with CP.
The last study to be examined was performed by Scholtes, Becher, and Comuth, et al.
“The intervention group trained for twelve weeks, three times a week, on a five-exercise circuit,
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which included a leg-press and functional exercises. The training load progressively increased
based on the child’s maximum level of strength, determined by the eight-repetition maximum.6”
Each resistance training session lasted between forty-five to sixty minutes. After the resistance
training intervention, there was a significant increase in muscles strength; “Twelve weeks of
14%.6” However, even with the significant increase in muscle strength, there was no
improvement in mobility. Again, this study demonstrates that resistance training could be
effective depending on the intended outcome. If the goal is to improve mobility, then resistance
training would not be recommend. If the goal is to increase general muscular strength, then
because there was no significant increase in mobility, it could be argued whether or not the
increase muscle strength plays a crucial role in the CP populations. “Clinically, our results
suggest that prescription of progressive resistance training for adolescents and young adults with
spastic diplegic CP may not be effective if the aim is to improve objective measures of mobility.
Even if prescription of progressive resistance training does not improve objective measures of
mobility, it could have other important psychosocial benefits such as improved perception of
mobility… [also] it could be seen as part of a community recreation program that could help
young people with CP get stronger and achieve physical activity guidelines.4” However, I believe
that other aspects of resistance training should be evaluated as well, in addition to the muscular
A study performed by Faigenbaum and Myer discussed the health benefits associated
with pediatric resistance training. One benefit of resistance training has to do with bone health,
“that childhood and adolescence may be the opportune time for the bone-modeling and
remodeling process to respond to the tensile and compressive forces associated with weight-
bearing activities.7” Populations with CP may struggle with mobility and weight bearing, but it
could still be important to assure proper bone health, development, and remodeling. An increase
in bone density and strength may allow for more secure attachment and insertion points of the
muscle of the heart, decreases peripheral vascular resistance, and much more. These health
In my opinion, even though there was not a drastic increase in overall mobility and
mobility efficiency, I think resistance training should still be recommended for CP populations.
Populations with CP can benefit from resistance training because of the increase in muscle
strength and the decrease in muscle spasticity. An increase in muscle strength can help avoid
early muscle atrophy and degeneration. Another important consideration is the psychological
benefits of resistance training. As mentioned in the study performed by Taylor, Dodd, Baker, and
resistance training is helping their overall mobility, this could increase confidence, self-worth,
and influence their perceptions of themselves. Also, the benefits to bone health and
cardiovascular health are an important result of resistance training. Overall, there are enough
health benefits that I would recommend resistance training to those persons with CP.
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As for the recommended amount and duration of resistance training, one similar factor
amongst a few of the studies was the target range at which the repetitions were to be performed
at. The goal was to perform resistance training exercises between sixty to eighty percent of an
individual’s one-repetition maximum. This target range seemed to produce the largest increase in
muscle strength. The common number of repetitions were in the range of eight to twelve, with
ten being the most common number of repetitions. In one study, resistance training occurred
twice a week while in three studies, resistance training occurred three times a week. The study
with resistance training occurring twice a week did see positive results; “the strength of targeted
muscles increased by 27% compared with [the] control group.4” Thus, proving that twice a week
is satisfactory. When discussing the length of resistance training, there were results seen after just
a six week intervention. However, a majority of the other studies were twelve to sixteen weeks.
So as long as resistance training is occurring over a continuous period of time, results should
occur.
recommended resistance training protocol would include three sets of ten repetitions, with
repetitions occurring between sixty to eighty percent of the patients one-repetition maximum,
targeting both the lower and upper extremities. Resistance training can occur two to three days a
week depending on the individual patient. The protocol would last at least six weeks, but
Reference List
3. Ryan JM, Theis N, Kilbride C, et al. Strength Training for Adolescents with cerebral palsy
(STAR): study protocol of a randomised controlled trial to determine the feasibility,
acceptability and efficacy of resistance training for adolescents with cerebral palsy. BMJ
Open. 2016; 6(10): 1 - 14. http://bmjopen.bmj.com/content/6/10/e012839. Accessed
September 19, 2017.
4. Taylor NF, Dodd KJ, Baker RJ, Willoughby K. Progressive resistance training and mobility-
related function in young people with cerebral palsy: a randomized control trial.
Developmental Medicine & Child Neurology. 2013; 55(9): 806 - 812. http://
onlinelibrary.wiley.com/doi/10.1111/dmcn.12190/full. Accessed September 19, 2017.
5. Fosdahl M, Holm I, Jahnsen R. The effect of progressive resistance exercise training and
stretching of the hamstrings muscle in ambulant children with cerebral palsy – a randomized
controlled trial. Developmental Medicine & Child Neurology. 2017; 59(S3): 48. http://
onlinelibrary.wiley.com/doi/10.1111/dmcn.71_13511/full. Accessed September 19, 2017.
6. Scholtes VA, Becher JG, Comuth A, et al. Effectiveness of functional progressive resistance
exercise strength training on muscle strength and mobility in children with cerebral palsy: a
randomized controlled trial. Developmental Medicine & Child Neurology. 2010; 52(6):
e107–e113. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2009.03604.x/full.
Accessed September 19, 2017.
7. Faigenbaum AD, Myer GD. Pediatric resistance training: benefits, concerns, and program
design considerations. American College of Sports Medicine: Current Sports Medicine
Reports. 2010; 9(3): 161 - 168. Accessed October 4, 2017.