TUESDAY 6 OCTOBER 2020
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How to exercise right with CP

There is always a lot of noise about the benefit of exercise and physical activity for the human body, regardless of whether you’re able-bodied or living with a disability.  

But how do you cut through that noise to find what really works?

And if you’re a health practitioner working with those living with cerebral palsy (CP), what resources are available to help you get it right for your client?

Mark Liberatore is an exercise physiologist and the Manager of the Health and Wellbeing program at the Cerebral Palsy Alliance (CPA). Here is what he has to say.

Before Mark gets into what actually works, he wants to make sure we’re clear that while the words ‘exercise’ and ‘physical activity’ are often used interchangeably in practice, they are not the same thing.

According to Exercise Right (2019):

  • exercise is planned, structured and repetitive with the aim to improve or maintain one or more components of physical fitness which includes: strength, endurance, aerobic fitness and flexibility
  • physical activity is any movement produced by skeletal muscle that expends energy.

Mark points immediately to the research. He tells us that the most comprehensive research exploring the benefits of structured exercise comes from Olaf (2016) who recommends that people living with CP combine the following two types of exercise weekly:

  1. Cardiorespiratory (aerobic) exercise which rhythmic and continuous in nature. This can include jogging, walking, swimming, rowing, using an arm ergometer, wheeling, etc.
  2. Resistance exercise which involves multi-joint and single-joint exercises utilising resistance-based machines and body weight. This type of exercise is suitable for children, teens and adults under the right supervision and guidance.

Inside the research from Olaf sits a guide to how frequently – and at what intensity – people living with CP should undergo these exercises, further determined by where they sit on the gross motor function classification system (GMFCS).

“It’s important to focus on an individual’s strength and leverage this to ensure positive outcomes in relation to participation,” Mark says.

“Another important tip is to communicate the benefits of both physical activity and exercise, and ensure that the invention is both focussed on the individual’s goals, is interactive, fun and engaging.”

That’s right. It needs to be fun.

Mark says that this can be easily done by implementing games and weekly challenges into the interventions. Exercising in environments which are stimulating, and where participants can build relationships with others following a similar path, is also helpful.

Take this heart-warming example from the CPA:

Mark tells us that one of the most inspiring stories he can share involved an adult client, nearing his 50th birthday, living with quadriplegic CP GMFCS III.

This client had decided he wanted to climb the Sydney Harbour Bridge.

So, a rigorous training program was developed, and the client carried out his regime under the guidance of his exercise physiologist in preparation for the event.

Importantly, the program focused on the client’s existing strengths which included walking long distances.

Along with the walks, there was a particular focus on increasing hip flexion and functional balance due to the nature of the requirements of the climb.

After months of planning – and in liaison with the Sydney Harbour Bridge Climb Team – the client achieved his goal: he conquered the bridge. The impact on the client’s sense of self-worth was immeasurable, and he still talks about the achievement each and every day!

Are there any resources to help professionals plan for their clients?

Mark says there are a plethora of resources available to help health professionals, depending on their location and affiliation with local and state governments, as well as other governing bodies in their country of practice.

In Australia, there are position statements and guidelines for health professionals like this one from NSW Health.

The associations that allied health professionals belong to will also have resources available for them.

For example, in Australia, Exercise and Sport Science Australia (ESSA) runs a campaign called Exercise Right. This movement provides resources for people working with clients who are living with CP or other neurological conditions. You’ll find the resources they have on offer here:

What about resources for people living with CP and their families?

“It is important for all people to follow national guidelines provided by their government health agencies, and also from organisations like the World Health Organisation,” says Mark.

“These guidelines, along with those provided by Olaf (2016) are applicable to people living with CP and are important for the maintenance of good overall health and wellbeing.”

Here are the movement guidelines published by the Australian Government.

References

Department of Health, 2019. Australia’s Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines. Available at: https://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines. [Accessed 25 June, 2019]

Exercise Right, 2019. Exercising for chronic conditions. Available at: https://exerciseright.com.au/chronic-conditions/. [ACCESSED 21 June 2019]

NSW Health, 2018. Management of Cerebral Palsy In Children: A Guide For Allied Health Professionals

Olaf, V., Peterson, M., Balemans, A. Hurvitz, E. 2016. Exercise and Physical Activity Recommendations for People with Cerebral Palsy. Dev Med Child Neurol. 58 (8) p798-808. doi: 10.1111/dmcn.13053