OPTIMUM TRAINING PARAMETERS OF PROGRESSIVE RESISTANCE EXERCISE TO EFFECT CHANGE IN PEOPLE WITH CEREBRAL PALSY: A SYSTEMATIC REVIEW AND META-REGRESSION

T. Bania¹, N. Taylor², H.-C. Chiu³

¹University of Patra, Department of Physiotherapy, Patra, Greece, ²La Trobe University and Eastern Health, Allied Health, Bundoora, Melbourne, Australia, ³I-Shou University, Department of Physical Therapy, Kaohsiung, Taiwan

Background: Muscle strengthening guidelines suggest that programmes should be progressed over time to increase volumes with heavier loads for large muscle groups, to maximise gains in muscle strength, hence the term progressive resistance exercise (PRE). To understand the comprehensive effect of progressive resistance exercise on individuals with cerebral palsy, it is necessary to identify exercise prescription parameters, such as the intensity, duration or frequency of the programmes and their effects in people with cerebral palsy.

Purpose: To explore the effect of PRE on impairment, activity and participation of people with cerebral palsy. Also, to determine which programme parameters provide the most beneficial effects.

Methods: Electronic databases searched from the earliest available time. Randomised controlled trials (RCTs) implementing PRE as an intervention in people with cerebral palsy were included. Methodological quality of trials was assessed with the PEDro scale. Meta-analysis and meta-regression were completed. The Grades of Research, Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis to evaluate the certainty of evidence across trials. The review protocol was registered prospectively in PROSPERO (CRD42020208119).

Results: We included 20 reports of 16 RCTs (n= 504 participants). Results demonstrated low certainty evidence that PRE improved muscle strength (pooled standardised mean difference (SMD) = 0.59 (95%CI: 0.16 to 1.01; I²=70%). This increase in muscle strength was maintained an average of 11 weeks after training stopped. Τhere was also moderate certainty evidence that it is inconclusive whether PRE has a small effect on gross motor function SMD=0.14 (95%CI: -0.09 to 0.36; I²=0%) or participation (SMD= 0.26 (95%CIs: -0.02 to 0.54; I²=0%). When PRE was compared with other therapy there were no between-group differences.
Meta-regression demonstrated no effect of PRE intensity on muscle strength (R²= 0.004; p=0.87) or training volume (frequency x total duration) on muscle strength (R²= -0.008; p=0.61). No serious adverse data were reported after PRE. There is lack of evidence of the effectiveness of PRE in adults and non-ambulatory people with cerebral palsy.

Conclusions: PRE is safe and increases muscle strength in young people with cerebral palsy, which is maintained after training stops. The increase in muscle strength is unrelated to the PRE intensity or dose. To improve activity or participation in people with cerebral palsy, practice of the targeted activities and inclusion of other factors such social interaction or the familiarity of the environment may be required.

Implications:● PRE is a safe exercise programme and increases muscle strength of people with CP.
● Increased muscle strength following PRE is maintained for at least 11 weeks after training stops.
● It is inconclusive whether or not PRE has an effect on gross motor function or participation.
● For programmes meeting PRE guidelines, there is no association between dose parameters and effects on muscle strength.

Funding acknowledgements: No funding

Keywords:
progressive resistance exercise
PRE
cerebral palsy

Topics:
Paediatrics: cerebral palsy
Disability & rehabilitation

Did this work require ethics approval? No

Reason: The study is a systematic review that does not need ethical approval.