Aquatic Aerobic Exercise For Children With Cerebral Palsy:
A Pilot Intervention Study
Journal: Physiotherapy Theory & Practice 2014; 30(2): 69–78.
Authors: Fragala-Pinkham MA, Smith HJ, Lombard KA, Barlow C, O’Neil ME.
Six previous studies provide preliminary evidence to suggest that aquatic exercise 2–3 times per week for 6–14 weeks may be effective in improving activity or body function and structure level outcomes for ambulatory children and youth with CP.
N=8, mean age 10 (SD 3); 3 at GMCFS level I; 5 at GMCFS level III; 7 scored in normal range of Social/Cognitive functional level of peers (PEDI-CAT).
Intervention – 2x/week for 14 weeks, 60 minutes per session. Participants to achieve 70-80% of Max Heart Rate. A PT student recorded the specific activities, water depth and HR data (used HR monitor hooked to computer) at 1-minute intervals during most sessions and provided therapists with feedback regarding previous session parameters to assist therapists in progressing the interventions to be more challenging for the children – including altering water depth so more shallow was more challenging re: balance/gait. Sessions consisted of a 2–5 minute warm-up, 40–45 minutes of aerobic exercise, 5–10 minutes of strength training and a 5–10 minute cool down and stretch; used treadmill, racing games, basketball moves; equipment for resistance noodles, fins; reduced depth and/or added jets for balance challenge; rests were allowed (to maintain target HR range). Took place in a Hydroworx variable depth pool – 31-34°C; with treadmill.
Outcome Measurements: 6MWT and GMFM - motor skill dimensions, curl-ups, push-ups, lateral steps, aerobic capacity – shuttle run test, paediatric Berg Balance Test
Results: significant improvement in all measures from baseline to post-intervention. One month post also demonstrated maintenance of gains. Seven of the 8 children went on to participate in community sport (1 mile run, Girls & Boys Club)
Adverse: blisters from T/M managed with footwear and/or bandages
Take Home Message: Applied exercise physiology to youth with CP resulted in functional/social gains. Can consider using PRE instead of HR monitors if technologically challenged since PRE is reliably aligned with HR. Tailoring group exercise and assistance by caregiver/helper reaps benefits in progressive exercise programming.