This systematic review aimed to estimate the effects of progressive resistance exercise compared to either no intervention or an alternative intervention on strength, activity, and participation outcomes in people with cerebral palsy.
Randomised controlled trials, pseudorandomised controlled trials, and randomised cross-over trials implementing progressive resistance exercise for people with any type of cerebral palsy were included. There were no age restrictions. Trials reported at least one aspect of training volume (e.g., sets, repetitions, load, session and program duration). The control group included either no intervention, usual care, or another intervention that did not involve progressive resistance exercise. Outcomes were muscle strength (primary outcome) in addition to one activity (e.g., Gross Motor Function Measure) and one participation outcome. Meta-regressions were calculated for program volume and program intensity against muscle strength. Adverse events were recorded. The PEDro scale was used to assess methodological quality of included trials to indicate high (>5), moderate (5) and low (<5) quality. GRADE was applied to each meta-analysis to evaluate certainty of evidence.
Sixteen clinical trials were included with 504 participants. Twelve trials included children and adolescents, 2 trials included adolescents and young adults, and 2 trials included adults. Progressive exercise was implemented using resistance machines, weight vests/backpacks, free weights, and/or isokinetic dynamometers. Duration of programs ranged from 6 to 16 weeks, typically 2-3 times per week at 20-40 mins per session. Exercise intensity was high (3 trials), moderate (12 trials) or low (1 trial). Trial quality was reported as high (9 trials), moderate (6 trials) and low (1 trial).
There was low certainty evidence that progressive resistance exercise improved muscle strength in people with cerebral palsy, when compared to no intervention (SMD 0.59, 95% CI 0.16 to 1.01; 11 trials). There was high-certainty evidence from 5 trials that the improvement in muscle strength was maintained at an average of 11 weeks after training ceased (SMD 0.40, 95% CI 0.12 to 0.68). There was moderate certainty evidence that there was no difference between progressive resistance exercise and no intervention for activity (SMD 0.14, 95% CI -0.09 to 0.36, 8 trials) and participation (SMD 0.26, 95% CI-0.02 to 0.54, 6 trials). There was no relationship between progressive resistance exercise intensity or training volume on muscle strength. No serious adverse events were reported.
Progressive resistance exercise is safe and can increase muscle strength for people with cerebral palsy compared to no intervention. This increase in muscle strength does not appear to be related to exercise intensity or dose. No improvements in activity or participation measures were observed.
Bania TA, Taylor NF, Chiu HS, Charitaki G. “What are the optimum training parameters of progressive resistance exercise for changes in muscle function, activity and participation in people with cerebral palsy? A systematic review and meta-regression. Physiotherapy 2023:119;1-16.
