Exercise intervention programs for children and adolescents with cerebral palsy: A descriptive review of the current research

Objective: A recently published review (2008) on exercise training in children and adolescents with cerebral palsy (CP) concluded that more evidence is needed from higher quality studies using more common outcomes. The aim of the current paper is to provide an update of that review with the following specific questions: (a) How are recent exercise interventions addressing the varying severity levels of CP? (b) What is the main focus of current exercise interventions? (c) Is there any basis for a meta-analysis of these studies? Design: A systematic search of electronic databases from September 2006 to January 2010 included all types of exercise programs, including land-based and aquatic programs focusing on cardiovascular, strength, aerobic, and anaerobic training. Nineteen studies met the inclusion criteria and were analyzed in a Population/patient, Intervention, Control and Outcome (PICO) fashion. Results: Literature published between 2006 and 2010 focused on land-based intervention programs for children and adolescents with less severe CP, Gross Motor Function Classification System (GMFCS) levels I-III. Both the intervention and outcome measures of these studies show extreme heterogeneity, indicating that recent calls for common measures have gone unheeded. Further, there has been no noticeable shift in outcome measures from body function towards daily activity and participation. Conclusion: Serious heterogeneity was found across the entire PICO analysis for exercise programs for children and adolescents with CP. The calls for greater generalizability and meaningful performance outcome measures are still highly relevant for the field of exercise rehabilitation in CP.