Estimates of functional muscle strength from a novel progressive lateral step-up test are feasible, reliable, and related to physical activity in children with cerebral palsy.

OBJECTIVE: To determine if estimates of functional muscle strength from a novel progressive lateral-step-up test (LSUT) are feasible, reliable, and related to physical activity in children with cerebral palsy (CP). DESIGN: Cross-sectional; test-retest reliability Subjects/Patients: Children with CP and typically developing control children (n = 45/group). METHODS: An LSUT with 10, 15, and 20 cm step heights was completed. It was repeated 4 weeks later in 20 children with CP. A composite score of LSUT was calculated based on the step height and number of repetitions completed. Physical activity was assessed using monitors worn on the ankle and hip. RESULTS: Only 4 (13%) of the children with CP were unable to complete a lateral step-up repetition without assistance. All children were able to complete at least 1 repetition with assistance, though more than twice as many children with CP required assistance at 15 and 20 cm step heights than at the 10 cm step height (p < 0.01). Children with CP had 59 to 63% lower LSUT performance, 37% lower physical activity assessed at the ankle, and 22% lower physical activity assessed at the hip than controls (all p < 0.01). The intra-class correlation coefficient ranged from 0.91 to 0.96 for LSUT performance at the different step heights and was 0.97 for the composite score. All LSUT performance measures were positively related to ankle physical activity in children with CP (r range = 0.43 to 0.47, all p < 0.01). Only performance at 20 cm and the composite score were positively related to hip physical activity (r = 0.33 and 0.31, respectively, both p < 0.05). The relationship between the LSUT performance and physical activity at both the ankle and hip increased when age and sex were statistically controlled (model r range = 0.55 to 0.60, all p < 0.001). CONCLUSION: Estimates of functional muscle strength from a novel progressive LSUT are feasible, reliable, and positively related to physical activity in children with CP.

Elevated blood pressure in children with cerebral palsy and its relationship with adiposity and physical activity.

BACKGROUND: There is a high prevalance of hypertension in adults with with cerebral palsy (CP). However, less is known about blood pressure in children with CP. OBJECTIVE: The aim was to determine if blood pressure is elevated in children with CP and whether it is related to adiposity and physical activity. METHODS: Thirty children with spastic CP (5-11 y) and 30 age-, sex-, and race-matched typically developing control children were studied. Resting systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were measured, and mean arterial pressure (MAP) was calculated. Visceral fat mass and total body fat mass index (FMI) were determined using dual-energy X-ray absorptiometry. Physical activity was assessed using accelerometer-based monitors. RESULTS: Children with CP had higher DBP and heart rate than controls (p < 0.05). DBP percentile and MAP were also higher in children with CP when BMI was statistically controlled. Children with CP and elevated blood pressure or hypertension (n = 8) had 56% more visceral fat mass than children with CP and normal blood pressure (n = 22; p < 0.05). In the groups combined, blood pressure was directly related to visceral fat mass and FMI, and inversely related to physical activity (p < 0.05). However, in children with CP alone, only visceral fat mass was related to blood pressure (p < 0.05). CONCLUSIONS: Children with CP have higher resting blood pressure than typically developing children. The higher blood pressure is related to higher visceral adiposity. Careful blood pressure screening should start during childhood in individuals with CP.

Cardiometabolic Risk and Its Relationship With Visceral Adiposity in Children With Cerebral Palsy.

Context: Adults with cerebral palsy (CP) display a higher prevalence of cardiometabolic disease compared with the general population. Studies examining cardiometabolic disease risk in children with CP are limited. Objective: The purpose of this study was to determine if children with CP exhibit higher cardiometabolic risk than typically developing children, and to examine its relationship with visceral adiposity and physical activity. Methods: Thirty ambulatory children with CP and 30 age-, sex-, and race-matched typically developing control children were tested for blood lipids, glucose, and the homeostatic model assessment of insulin resistance (HOMA-IR). Visceral fat was assessed using dual-energy x-ray absorptiometry. Physical activity was assessed using accelerometer-based monitors. Results: Children with CP had higher total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol (non-HDL-C), glucose, prevalence of dyslipidemia, prevalence of prediabetes, and visceral fat mass index (VFMI) and lower physical activity than controls (all P < .05). In the groups combined, non-HDL-C and glucose were positively related to VFMI (r = 0.337 and 0.313, respectively, P < .05), and non-HDL-C and HOMA-IR were negatively related to physical activity (r = -0.411 and -0.368, respectively, P < .05). HOMA-IR was positively related to VFMI in children with CP (r = 0.698, P < .05), but not in controls. Glucose was not related to physical activity in children with CP, but it was negatively related in controls (r = -0.454, P < .05). Conclusion: Children with CP demonstrate early signs of cardiometabolic disease, which are more closely related to increased visceral adiposity than decreased physical activity.