Habitual physical activity and cardiometabolic risk factors in adults with cerebral palsy

2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/3.0/).This article has been made available through the Brunel Open Access Publishing Fund.Adults with cerebral palsy (CP) are known to participate in reduced levels of total physical activity. There is no information available however, regarding levels of moderate-to-vigorous physical activity (MVPA) in this population. Reduced participation in MVPA is associated with several cardiometabolic risk factors. The purpose of this study was firstly to compare levels of sedentary, light, MVPA and total activity in adults with CP to adults without CP. Secondly, the objective was to investigate the association between physical activity components, sedentary behavior and cardiometabolic risk factors in adults with CP. Adults with CP (n = 41) age 18–62 yr (mean ± SD = 36.5 ± 12.5 yr), classified in Gross Motor Function Classification System level I (n = 13), II (n = 18) and III (n = 10) participated in this study. Physical activity was measured by accelerometry in adults with CP and in age- and sex-matched adults without CP over 7 days. Anthropometric indicators of obesity, blood pressure and several biomarkers of cardiometabolic disease were also measured in adults with CP. Adults with CP spent less time in light, moderate, vigorous and total activity, and more time in sedentary activity than adults without CP (p < 0.01 for all). Moderate physical activity was associated with waist-height ratio when adjusted for age and sex (β = −0.314, p < 0.05). When further adjustment was made for total activity, moderate activity was associated with waist-height ratio (β = −0.538, p < 0.05), waist circumference (β = −0.518, p < 0.05), systolic blood pressure (β = −0.592, p < 0.05) and diastolic blood pressure (β = −0.636, p < 0.05). Sedentary activity was not associated with any risk factor. The findings provide evidence that relatively young adults with CP participate in reduced levels of MVPA and spend increased time in sedentary behavior, potentially increasing their risk of developing cardiometabolic disease

Associations of sedentary behaviour, physical activity, blood pressure and anthropometric measures with cardiorespiratory fitness in children with cerebral palsy

Background - Children with cerebral palsy (CP) have poor cardiorespiratory fitness in comparison to their peers with typical development, which may be due to low levels of physical activity. Poor cardiorespiratory fitness may contribute to increased cardiometabolic risk. Purpose - The aim of this study was to determine the association between sedentary behaviour, physical activity and cardiorespiratory fitness in children with CP. An objective was to determine the association between cardiorespiratory fitness, anthropometric measures and blood pressure in children with CP. Methods- This study included 55 ambulatory children with CP [mean (SD) age 11.3 (0.2) yr, range 6-17 yr; Gross Motor Function Classification System (GMFCS) levels I and II]. Anthropometric measures (BMI, waist circumference and waist-height ratio) and blood pressure were taken. Cardiorespiratory fitness was measured using a 10 m shuttle run test. Children were classified as low, middle and high fitness according to level achieved on the test using reference curves. Physical activity was measured by accelerometry over 7 days. In addition to total activity, time in sedentary behaviour and light, moderate, vigorous, and sustained moderate-to-vigorous activity (≥10 min bouts) were calculated. Results - Multiple regression analyses revealed that vigorous activity (β = 0.339, p<0.01), sustained moderate-to-vigorous activity (β = 0.250, p<0.05) and total activity (β = 0.238, p<0.05) were associated with level achieved on the shuttle run test after adjustment for age, sex and GMFCS level. Children with high fitness spent more time in vigorous activity than children with middle fitness (p<0.05). Shuttle run test level was negatively associated with BMI (r2 = -0.451, p<0.01), waist circumference (r2 = -0.560, p<0.001), waist-height ratio (r2 = -0.560, p<0.001) and systolic blood pressure (r2 = -0.306, p<0.05) after adjustment for age, sex and GMFCS level. Conclusions - Participation in physical activity, particularly at a vigorous intensity, is associated with high cardiorespiratory fitness in children with CP. Low cardiorespiratory fitness is associated with increased cardiometabolic risk

Transition from child to adult health services for young people with cerebral palsy in Ireland: a mixed-methods study protocol

Introduction The transition from child to adult health services is a challenging and complex process for young people with cerebral palsy (CP). Poorly managed transition is associated with deterioration in health, increased hospitalisations and reduced quality of life. While international research identifies key practices that can improve the experience and outcomes of transition, there is a paucity of data in the Irish context. This research study aims to gain an insight into the experience of transition for young people with CP in Ireland.Methods and analysis A convergent parallel mixed-methods design will be used to collect, analyse and interpret quantitative and qualitative data. Participants will be young people aged 16–22 years with CP, their parent(s)/carer(s) and service providers. Quantitative and qualitative data will be collected through questionnaires and interviews, respectively. Quantitative data will be reported using descriptive statistics. Where sufficient data are collected, we will examine associations between the experience of transition practices and sociodemographic and CP-related factors, respectively, using appropriate regression models. Associations between service provider characteristics and provision of key transition practices may also be explored using appropriate regression models. Qualitative data will be analysed using the Framework Method. A coding matrix based on key transitional practices identified from the literature will be used to identify convergence and divergence across study components at the integration stage.Ethics and dissemination The study has been approved by the RCSI University of Medicine and Health Sciences Research Ethics Committee (REC201911010). Results will be presented to non-academic stakeholders through a variety of knowledge translation activities. Results will be published in open access, peer-reviewed journals and presented at national and international scientific conferences

Mean vigorous physical activity across tertiles of cardiorespiratory fitness.

<p>*Significantly different to “Middle” fitness group, p<0.05.</p

Characteristics of participants (n = 55).

<p>zSBP, z-scores for systolic blood pressure; zDBP, z-scores for diastolic blood pressure; GMFCS, Gross Motor Function Classification System</p><p>Characteristics of participants (n = 55).</p

Mean waist-height ratio across tertiles of cardiorespiratory fitness.

<p>*Significantly different to “Middle” and “High” fitness groups, p<0.001.</p

Mean BMI grade across tertiles of cardiorespiratory fitness.

<p>**Significantly different to “Middle” and “High” fitness group, p<0.01. *Significantly different to “”High” fitness groups, p<0.05.</p

Relationship between cardiorespiratory fitness, systolic blood pressure, body mass index, waist circumference and waist-height ratio.

<p>^aadjusted for age, sex and GMFCS level</p><p>^badjusted for age, sex, GMFCS level and BMI grade; zSBP, z-scores for systolic blood pressure</p><p>Relationship between cardiorespiratory fitness, systolic blood pressure, body mass index, waist circumference and waist-height ratio.</p

Informing health and care services for people with cerebral palsy on the island of Ireland

Introduction Cerebral palsy (CP) is a lifelong condition caused by damage to the developing brain. It affects over 10,000 people on the island of Ireland. People with CP primarily experience problems with movement and posture, however associated impairments of cognition, hearing, vision, speech and epilepsy are common. Clinical presentation varies widely from mild problems to profound disability with high associated health and care costs however numbers and needs of people with CP are not captured by routine healthcare data coding. This presentation summarises (1) the impact of a population-based CP register, and (2) the healthcare needs of the CP population. Methods Prevalence of CP is robustly ascertained by the Northern Ireland CP Register (NICPR) held at Queen’s University Belfast. This prospective, population-based register contains over 40 birth-years of data and is part of the Surveillance of CP in Europe network. Currently, there is no population-wide register of people with CP in Ireland, however, significant progress in understanding the health needs of the Irish CP population has emerged from mixed-methods research from the Royal College of Surgeons in Ireland (RCSI), in collaboration with the Central Remedial Clinic, the Health Services Executive (HSE), and underpinned by involvement with people with CP and parents. Highlights or Results or Key Findings NICPR data and research has (1) underpinned successful business cases for new clinical services; (2) developed cost-effective tools to describe CP that have been adopted internationally, improving communication between healthcare professionals and families and reducing clinical assessment burden; and (3) informed UK and international standards of care, for example, NICE guidelines and a UK National Confidential Enquiry. Data linkage projects have helped understand prescribing practices for pain and sleep medication in children with CP. RCSI research has identified the diverse range of health services required by people with CP, the associated unmet needs of the population, and satisfaction with service provision. Transition from paediatric to adult health services was identified as an area of particular need: a multi-level response that considers the interactions between people, services and systems is required. Service providers’ and service users’ experiences highlighted the need for improved co-ordination, communication and collaboration between agencies. Conclusions Comprehensive, population-based case ascertainment across the island is required. Such data would optimise planning and delivery of health and care services to children with CP, aid preparation of young people with CP for transition, and permit development of services for adults based on need rather than demographics. This approach, underpinned by input from people with CP and their families, is required across jurisdictions, sectors and systems to reduce uncertainty and service fragmentation. Implications for applicability/transferability, sustainability and limitations A variety of research approaches were effectively integrated to develop an informed picture of prevalence, health service use and unmet needs in people with CP on the island of Ireland. Patient and public involvement informed all aspects of the research, including dissemination of findings and subsequent implementation into practice and policy. Findings from this research are used internationally and are contributing locally to development of recommendations and pathways for transition, in both NI and Ireland

Transition from child to adult services for young people with cerebral palsy in Ireland: Influencing factors at multiple ecological levels

AIM: To explore the factors that influence the process of transitioning from child to adult services in Ireland among young people with cerebral palsy, their parents, and service providers.METHOD: This study followed a qualitative descriptive approach. Semi-structured interviews were conducted with 54 participants, including young people with cerebral palsy aged 16 to 22 years (n = 13), their parents (n = 14), and service providers (n = 27). Data were analysed using the Framework Method. Findings were categorized using an ecological model across four levels: individual, microsystem, mesosystem, and exosystem.RESULTS: Limited awareness, preparation, and access to information hindered successful transition. Microsystem factors such as family knowledge, readiness, resilience, and health professional expertise influenced transition experience. Mesosystem factors encompassed provider-family interaction, interprofessional partnerships, and interagency collaboration between child and adult services. Exosystem factors included inadequate availability and distribution of adult services, limited referral options, coordination challenges, absence of transition policies, staffing issues, and funding allocation challenges.INTERPRETATION: Transition is influenced by diverse factors at multiple ecological levels, including interactions within families, between health professionals, and larger systemic factors. Given the complexity of transition, a comprehensive multi-level response is required, taking into account the interactions among individuals, services, and systems.</p