Recumbent cross-training is a feasible and safe mode of physical activity for significantly motor-impaired adults with cerebral palsy.

OBJECTIVE To examine the feasibility and potential benefits of using recumbent cross-training for nonambulatory adults with cerebral palsy (CP). DESIGN Observational. SETTING Clinical center for CP treatment and rehabilitation. PARTICIPANTS Significantly motor-impaired adults with CP (N=11) with a mean age ± SD of 36.3±13.2 years and Gross Motor Function Classification System (GMFCS) levels III and IV. INTERVENTIONS Participants completed a 40-minute session of aerobic exercise using the NuStep Recumbent Cross Trainer, in which resistance was progressively increased at 5-minute intervals. MAIN OUTCOME MEASURES Every 5 minutes during the exercise session, heart rate, blood pressure, oxygen consumption (VO(2)), energy expenditure, and respiratory exchange ratios (RERs) were recorded along with rating of perceived exertion. Immediately after, and 24 hours postexercise, participants received a standard survey to assess levels of pain and discomfort. RESULTS All participants were able to complete the 40-minute exercise protocol. Five of the 11 participants achieved a heart rate of at least 60% maximum throughout the duration, 10 participants had a significant elevation in VO(2) from baseline, and all participants had elevated RER values. Six participants reported pain during exercise, but only 2 reported pain after exercise was over. CONCLUSIONS The NuStep Recumbent Cross Trainer is a feasible exercise modality for significantly motor-impaired adults with CP, GMFCS III and IV. Moreover, this mode was sufficient to stimulate a significant cardiorespiratory response in all participants, and thus it and similar devices may serve as a viable option for aerobic exercise interventions in this population, to prevent obesity and related cardiometabolic consequences.

[1]  Emily Banks,et al.  Sitting time and all-cause mortality risk in 222 497 Australian adults. , 2012, Archives of internal medicine.

[2]  M. Peterson,et al.  Chronic disease risk among adults with cerebral palsy: the role of premature sarcopoenia, obesity and sedentary behaviour , 2013, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[3]  A. Vianello,et al.  Functional status of adults with cerebral palsy and implications for treatment of children , 2001, Developmental medicine and child neurology.

[4]  L. Ada,et al.  Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols , 2011, Physical Therapy.

[5]  V F Froelicher,et al.  Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. , 2001, Circulation.

[6]  P. Rosenbaum,et al.  Variability in Mobility of Children with Cerebral Palsy , 2007, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[7]  G. Heath,et al.  Physical activity among persons with disabilities--a public health perspective. , 1997, Exercise and sport sciences reviews.

[8]  M. Aisen,et al.  Adults with cerebral palsy: a workshop to define the challenges of treating and preventing secondary musculoskeletal and neuromuscular complications in this rapidly growing population , 2009, Developmental medicine and child neurology.

[9]  Kevin C McGill,et al.  Neuromuscular activation and motor-unit firing characteristics in cerebral palsy. , 2005, Developmental medicine and child neurology.

[10]  C. Burant,et al.  Secondary muscle pathology and metabolic dysregulation in adults with cerebral palsy. , 2012, American journal of physiology. Endocrinology and metabolism.

[11]  David W Dunstan,et al.  New exercise prescription: don't just sit there: stand up and move more, more often. , 2012, Archives of internal medicine.

[12]  A. Shortland.  Muscle deficits in cerebral palsy and early loss of mobility: can we learn something from our elders? , 2009, Developmental medicine and child neurology.

[13]  Jürgen Mitternacht,et al.  MRT-measurements of muscle volumes of the lower extremities of youths with spastic hemiplegia caused by cerebral palsy , 2006, Brain and Development.

[14]  E. Mattsson,et al.  Adults with cerebral palsy: walking ability after progressive strength training , 2003, Developmental medicine and child neurology.

[15]  I-Min Lee,et al.  Dose Response Between Physical Activity and Risk of Coronary Heart Disease: A Meta-Analysis , 2011, Circulation.

[16]  K. Pitetti,et al.  Training of ambulatory individuals with cerebral palsy. , 1993, Archives of physical medicine and rehabilitation.

[17]  D. Damiano,et al.  Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy. , 2008, Archives of physical medicine and rehabilitation.

[18]  Zhaoping Li,et al.  Sarcopenic obesity in the elderly and strategies for weight management. , 2012, Nutrition reviews.

[19]  P. Rosenbaum,et al.  Development of the Gross Motor Function Classification System for cerebral palsy , 2008, Developmental medicine and child neurology.

[20]  C. Bouchard,et al.  Sitting time and mortality from all causes, cardiovascular disease, and cancer. , 2009, Medicine and science in sports and exercise.

[21]  A. McCormick,et al.  Stability of the Gross Motor Function Classification System in adults with cerebral palsy , 2007, Developmental medicine and child neurology.

[22]  C G Gajdosik,et al.  Secondary Conditions of the Musculoskeletal System in Adolescents and Adults with Cerebral Palsy , 2002, Physical & occupational therapy in pediatrics.

[23]  Bronwyn K. Clark,et al.  Associations Between Television Viewing Time and Overall Sitting Time with the Metabolic Syndrome in Older Men and Women: The Australian Diabetes Obesity and Lifestyle Study , 2011, Journal of the American Geriatrics Society.

[24]  Lucas J Carr,et al.  Letter to the editor: standardized use of the terms "sedentary" and "sedentary behaviours". , 2012, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[25]  Stuart A Binder-Macleod,et al.  Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy , 2005, Muscle & nerve.

[26]  J. Rimmer,et al.  Physical fitness levels of persons with cerebral palsy. , 2001, Developmental medicine and child neurology.

[27]  J. Rimmer,et al.  Research on physical activity and disability: an emerging national priority. , 1996, Medicine and science in sports and exercise.

[28]  G. Borg.  Borg's Perceived Exertion and Pain Scales , 1998 .

[29]  K P Murphy,et al.  Employment and social issues in adults with cerebral palsy. , 2000, Archives of physical medicine and rehabilitation.

[30]  M. Ketelaar,et al.  Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy. , 2012, The Journal of pediatrics.

[31]  P. Rosenbaum,et al.  Gross Motor Function Classification System used in adults with cerebral palsy: agreement of self-reported versus professional rating. , 2006, Developmental medicine and child neurology.

[32]  B. Abernethy,et al.  Fundamental movement skills and physical activity among children with and without cerebral palsy. , 2012, Research in developmental disabilities.

[33]  E. Heath.  Borg's Perceived Exertion and Pain Scales , 1998 .

[34]  M. Turk,et al.  The health status of women with cerebral palsy. , 1997, Archives of physical medicine and rehabilitation.

[35]  Jo Salmon,et al.  Television time and continuous metabolic risk in physically active adults. , 2008, Medicine and science in sports and exercise.

[36]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[37]  Marc T. Hamilton,et al.  Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease , 2007, Diabetes.

[38]  M. Turk.  Health, mortality, and wellness issues in adults with cerebral palsy , 2009, Developmental medicine and child neurology.

[39]  Jeffrey Fernandez,et al.  Physiological Capacities of Individuals with Cerebral Palsy , 1990, Human factors.

[40]  D. Strauss,et al.  Decline in function and life expectancy of older persons with cerebral palsy. , 2004, NeuroRehabilitation.

[41]  E. Ferriolli,et al.  Relationship between sedentary behaviour, physical activity, muscle quality and body composition in healthy older adults. , 2012, Age and ageing.

[42]  M. Benton,et al.  Sarcopenic Obesity: Strategies for Management , 2011, The American journal of nursing.

[43]  D. Thorpe.  The role of fitness in health and disease: status of adults with cerebral palsy , 2009, Developmental medicine and child neurology.

[44]  H. Stam,et al.  Inactive lifestyle in adults with bilateral spastic cerebral palsy. , 2009, Journal of rehabilitation medicine.

[45]  Kevin J. Sheridan.  Osteoporosis in adults with cerebral palsy , 2009, Developmental medicine and child neurology.

[46]  J. Rimmer,et al.  Exercise Intervention Research on Persons with Disabilities: What We Know and Where We Need to Go , 2010, American journal of physical medicine & rehabilitation.

[47]  J. Rimmer,et al.  Effects of Disability-Associated Low Energy Expenditure Deconditioning Syndrome , 2012, Exercise and sport sciences reviews.