By Dr. Deborah Thorpe

Sixty percent of persons with cerebral palsy (CP) in the United States are over the age of fifteen¹ with life expectancies reaching those of the unaffected population but still strongly related to degree of severity. Cooper et. al. ²in a study on physical activity and health among people with disabilities found that activity level was highly correlated with years of survival in adults with CP. Several investigators ^{3, 4, 5, 6, 7} have concluded that there is evidence that adults with cerebral palsy might not be engaging in sufficient physical activity to produce the improvements in fitness that would be required to experience associated health benefits. van der Slot 7 measured physical activity in adults with hemiplegic CP using an Activity Monitor and found these adults participated to a similar degree as their healthy comparisons. However, more severely impaired adults with cerebral palsy (GMFCS Levels 2-5) that have severe activity limitations most likely develop secondary conditions that lead to decreased health benefits. ⁸ In adults with CP, Johnson et, al. ⁹ found total energy expenditure (TEE) to be highly variable and a significant predictor of ambulatory status in adults with CP.

A few studies ^{10, 11, 12, 13} have addressed progressive resistive strength training on land in adults with CP with significant improvements in muscle strength, walking velocity, and gross motor abilities. Work has begun to validate the use of water as an optional exercise medium to land in this population. ^{14, 15, 16, 17} Utilizing the beneficial properties of water such as buoyancy, neutral warmth, and variable resistance and eliminating the negative effects of gravity, persons with cerebral palsy can optimize their full movement potential in an aquatic environment while maintaining joint integrity.

Unnithan and colleagues ¹⁸ designed a combination of aerobic and strength interval training for 14-18 year olds with CP and found significant improvements in work economy which may have implications for increasing physical activity levels in this population. It has been only recently that therapists and researchers have looked beyond the limitations of the disease and discovered that many children and adults with CP can train at near-normal intensity levels (70-85% of maximum heart rate). ^{10, 11, 13, 14, 15}

There is no information on the impact of exercise and fitness on health outcomes such as body fat, blood lipids, and blood pressure in adults with CP ¹⁹ and no idea if improvements in physical fitness will have similar benefits as in the general population. Future research should include identifying specific types (strengthening, aerobic, flexibility), combinations and doses of exercise and physical activity for adults with CP. Specific physiologic parameters need to be identified that will provide the most reliable and valid information in order to discern fitness need and change. In order to develop physical activity interventions based on individual needs that promote strengthening and aerobic conditioning but also maintain optimal nutritional status valid methods to determine total energy expenditure (TEE) need to be identified. Finally, comprehensive investigations of physical activity are needed to determine the relationships between physical activity, participation, HRQL and psychosocial functioning.