The effects of power exercises on body structure and function, activity and participation in children with cerebral palsy: an ICF-based systematic review

Abstract

Purpose

To systematically review the literature for evidence of effectiveness of power exercises on physical, physiological, and functional outcomes in children and adolescents with cerebral palsy (CP).

Materials and methods

Methodological quality and evidence synthesis were assessed with using the Cochrane Risk of Bias (RoB) Tools and Modified Bakker Scale. Using the International Classification of Functioning (ICF), outcome measures for muscle agriculture, gait, balance, motor function, aerobic/anaerobic fitness, daily living, mobility, and school participation were categorised.

Results

The overall RoB of four randomised clinical trials was low, one had some concerns and two were rated as high. Moderate evidence was found that power exercises increased walking speed, activities of daily living, muscle strength, and enhanced gross motor function more than a routine physical therapy program.

Conclusions

The lack of stronger evidence for power training interventions to improve muscle architecture, muscle function, walking capacity, and mobility in children with CP might be explained by the differences in training protocols and degree to which these meet the physiological definition of power, different methods of measuring power, limited durations of training, and the relative effectiveness of control interventions. Future studies should include a stronger focus on child and family-centred participation goals.

Implications For Rehabilitation

• Power training can improve gross motor function, walking speed, muscle strength, and activities of daily living more than routine physical therapy.

• Results comparing power training versus traditional strength training were less pronounced likely because both are intensive and may have positive effects.

• More research is needed to investigate effects of power training on participation.

Keywords:

• Cerebral palsy
• power training
• strength training
• muscle power
• systematic review

Acknowledgements

The efforts of Dr Diane L. Damiano were supported by the Intramural Research Program of the National Institutes of Health Clinical Center.

PROSPERO database, registration number ID

CRD42020223621.

Author contributions

Conception and design: OKK, CG, DD. Collection and assembly of data: ENT and SM. Analysis and interpretation of data: OKK, CG, SYC. Drafting of the article: OKK, DD. Critical revision of the article for important intellectual content: DD. All authors take responsibility for the integrity of the data analysis.

Disclosure statement

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

Additional information

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.