The temporal and bi-directional relationship between physical activity and sleep in ambulatory children with cerebral palsy

Abstract

Purpose

Exploring the temporal and bi-directional relationship between device-based measures of physical activity and sleep in ambulatory children with cerebral palsy (CP).

Materials and Methods

24-hour activity data were collected from children with CP (n = 51, 43% girls, mean age (range); 6.8 (3–12) years; Gross Motor Function Classification System levels I to III). Nocturnal sleep parameters and daily physical activity were measured for seven consecutive days and nights using ActiGraph GT3X accelerometers. Linear mixed models were constructed to explore the relationships between sleep and activity.

Results

Light and moderate-to-vigorous activity were negatively associated with sleep efficiency (SE) (resp. p = 0.04, p = 0.010) and total sleep time (TST) (resp. p = 0.007, p = 0.016) the following night. Sedentary time was positively associated with SE and TST the following night (resp. p = 0.014, p = 0.004). SE and TST were positively associated with sedentary time (resp. p = 0.011, p = 0.001) and negatively with moderate-to-vigorous physical activity (resp. p < 0.001, p = 0.002) the following day. Total bedtime and TST were negatively associated with light physical activity (resp. p = 0.046, p = 0.004) the following day.

Conclusions

The findings from this study suggest that ambulatory children with CP may not sleep better after physical activity, and vice versa, indicating that the relationship is complex and needs further investigation.

Implications for rehabilitation

• The use of device-based accelerometry is a feasible method to measure 24-hour activity patterns with sleep and physical activity in ambulatory children with cerebral palsy.

• The relationships between sleep and physical activity in children with cerebral palsy are not as expected based on patterns shown in peers with typical development.

• Interventions for sleep in children with cerebral palsy require a holistic approach, focusing on daily physical activity patterns and relevant child- and contextual factors.

Keywords:

• Cerebral palsy
• children
• sleep
• physical activity
• accelerometry

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was kindly supported by a grant from JKF Kinderfonds and Kinderrevalidatiefonds Adriaanstichting, foundations aimed at improving the quality of life of children and adolescents with physical disabilities in The Netherlands.