The physical activity status and patterns in adults with Cerebral Palsy - an accelerometry study

Master Thesis


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One of the most common causes of physical disability acquired during childhood is cerebral palsy (CP). Due to improvements in medical care over the past decades, almost all children with CP survive into adulthood nowadays. In addition, based on a stable incidence rate and longevity of individuals with CP, currently most persons with CP are adults. Therefore, it is appropriate to draw awareness to focus on rehabilitation in adults with CP. Due to the nature of their physical disability, adults with CP are at risk to an inactive lifestyle, which can lead to increased health risks. Physical inactivity may be the predisposition to developing a cycle of deconditioning, in which reduced levels of PA (physical activity) may lead to lower levels of physical fitness. Lower levels of physical fitness cause individual’s with CP to expend more energy during daily activities such as walking. As a consequence, individuals with CP may experience earlier fatigue, pain or other factors that increase the impact of the disorder on daily functioning. It is therefore important to intervene in this vicious cycle of physical inactivity. This thesis provides an overview of the methods used to record PA and reports on PA levels in adults with CP. The literature review evidently showed that adults with CP were less physically active compared to TD (typically developed) peers and spent more time in sedentary behaviour compared to TD adults. Various methods have been shown to be available to assess levels of PA, such as questionnaires, pedometers, and more advanced accelerometers that allow for measuring acceleration in three directions (x-y-z axes). Previously, research studies’ most commonly used hip-worn devices among adults with CP to assess PA levels, such as the Actigraph that has been used and validated in various populations with and without disabilities. Unfortunately, the Actigraph is not water resistant, which does not allow individuals to continuously wear the device. Alternatively, wrist-worn devices can be used to assess PA levels, such as the Polar Loop 2, which is convenient to wear and water-resistant. However, no previous research has proven the validity of the Polar Loop 2 to assess PA levels in a cohort with CP. In addition, most studies focused on adults with CP in developed countries, while no studies have been conducted in developing countries. Therefore, the aim of the second study was to determine differences in PA between adults with CP and TD adults living in South Africa, assessed with the Actigraph and Polar Loop 2 accelerometers. In addition, we aimed to determine the validity of the Polar Loop 2 compared to the Actigraph for different levels of PA. This study showed that adults with CP were less physically active than TD adults, based on findings that the number of steps taken per day were substantially lower, they spent more time being sedentary and less time in low and moderate intensity PA. The Polar Loop 2 showed to be a valid measure for PA in adults with CP and TD adults. Since the Polar Loop 2 is water-resistant and convenient to wear it can be a useful tool to measure PA in clinical practice. The reduced levels of PA presented in this thesis highlight that adults with CP are at risk of reduced fitness levels and secondary complications during daily life activities. This cycle of deconditioning may progress during ageing in adults with CP. More PA and exercise, at the correct intensity and duration, can break the barrier of this vicious cycle. Regular exercise can have a variety of beneficial effects on the health of adults with CP. For example, it may reduce the incidence of obesity, improve muscle function and muscle strength. Furthermore, exercise can reduce the incidence of chronic health conditions like diabetes, cardiovascular diseases and osteoporosis. In order to avoid health issues at older ages and to prevent inactive lifestyles, it is important to encourage a healthy and active lifestyle during early adulthood to promote physically active when growing older. Regular exercise also positively influences the development of the musculoskeletal system, which may prevent the decline in mobility.