Article Summary: Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?
Schranz C, Kruse A, Belohlavek T, et al. Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy? Archives of Physical Medicine and Rehabilitation. 2018;99(12). doi:10.1016/j.apmr.2018.06.010.
This article researched the effects of progressive resistance training (PRT) and high-intensity circuit training (HICT) in children with Cerebral Palsy. The participants were between the ages of 8-16 and included high functioning children capable of walking (Class I and Class II on the Gross Motor Function Classification system). Children were recruited from an outpatient facility and were randomized into treatment groups by a third party provider uninvolved in the research design.
The same 5 exercises were performed in both groups, but the method of exercise was different. In the PRT group, the exercises were progressed by increasing the weight of a vest, while the HICT group progressed by increasing the speed of the activity. The HICT group was instructed to perform the exercises at their maximal effort. Both groups were given the same frequency (3x/week) to perform the intervention at home. This was to facilitate an independent exercise environment similar to what is traditionally practiced with these patients.
The researchers utilized a variety of outcome measures to analyze the effect on each domain of the ICF model (body structure/function, activity, participation). In the “body structure/function” category, the outcome measures included Hand-Held Dynamometer, Range of Motion and the Modified Ashworth Scale. In the “activity” category, the outcome measures included the Muscle Power Sprint Test, Timed Up and Go, Timed Stairs Test, 6 Minute Walk Test, Energy Expenditure Index and Gait Profile Score. In the “participation” category, the outcome measures included the Activity Scale for Kids performance and the Pediatric Outcome Data Collection Instrument.
With regard to the results, each group made improvements in the outcome measures that specifically trained the method of measurement. In the between-groups analysis, the PRT group had significant improvements in the Timed Up and Go and the Timed Stairs Test, while the HICT group had significant improvements in the Muscle Power Sprint Test. The authors noted how the improvement in the Muscle Power Sprint Test is likely due to the focus on rapid force production, which is a key characteristic of both the intervention style and the outcome measure. With regard to the within-groups analysis, only the HICT group had significant gains in hand-held dynamometer strength gains.
This research design was extremely effective in identifying the benefits of each individual training style. The authors noted that the HICT sessions were 33% shorter in duration, but required a significant level of motivation by the child and parent. This can be beneficial if prescribed for the appropriate patient. It is clear that this article further supports the theory of specificity, in that significant changes will appear in outcome measures that mimic training style. The important take away is that both training styles resulted in improvements in various measures of strength and activity.
The authors mentioned that strength gains in children with cerebral palsy do not always translate to increased function and that the rapid force production generated in HICT could address those limitations. There were many outcome measures addressing the “activity” and “participation” categories in the ICF model that were not statistically significant in either group. This makes it difficult to determine if their original hypothesis about the impact of HICT on function was supported by their findings.The authors hypothesized that there could have been a potential ceiling effect since their sample was high functioning, or that the sample size was simply not big enough. Since this was a pilot study, further investigation should determine the additional impact of HICT on function.
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I like the way the outcome measures were categorized. Was that done by the authors or your interpretation for your review KT?