Progressive resistance training for adolescents with cerebral palsy: the STAR randomized controlled trial

• Published in: Developmental medicine and child neurology 2020-11, Vol.62 (11), p.1283-1293
• Main Authors: Ryan, Jennifer M, Lavelle, Grace, Theis, Nicola, Noorkoiv, Marika, Kilbride, Cherry, Korff, Thomas, Baltzopoulos, Vasilios, Shortland, Adam, Levin, Wendy
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Ankle - physiopathology; Biomechanical Phenomena - physiology; Cerebral Palsy - complications; Cerebral Palsy - rehabilitation; Child; Exercise - physiology; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - rehabilitation; Humans; Muscle Strength - physiology; Muscle, Skeletal - physiopathology; Outcome Assessment, Health Care; Resistance Training - adverse effects; Resistance Training - methods; Treatment Failure; Young Adult
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1111/dmcn.14601

Aim To evaluate the effect of progressive resistance training of the ankle plantarflexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). Method Sixty‐four adolescents (10–19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I–III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net nondimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention‐to‐treat. Results Median attendance at the 10 supervised sessions was 80% (range 40–100%). There was no between‐group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI] –0.07 to 0.11, p=0.696) or 22 weeks (mean difference: –0.08, 95% CI –0.18 to 0.03, p=0.158). There was also no evidence of between‐group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group. Interpretation We found that 10 supervised sessions and 20 home sessions of progressive resistance training of the ankle plantarflexors did not improve gait efficiency, muscle strength, activity, participation, or any biomechanical outcome among adolescents with CP. What this paper adds Thirty sessions of progressive resistance training of the ankle plantarflexors over 10 weeks did not improve gait efficiency among ambulatory adolescents with cerebral palsy. Resistance training did not improve muscle strength, activity, or participation. Ninety percent of participants experienced an adverse event. Most adverse events were expected and no serious adverse events were reported. What this paper adds Thirty sessions of progressive resistance training of the ankle plantarflexors over 10 weeks did not improve gait efficiency among ambulatory adolescents with cerebral palsy. Resistance training did not improve muscle strength, activity, or participation. Ninety percent of participants experienced an adverse event. Most adverse events were expected and no serious adverse events were reported. This article is commented on by Nielsen and Lorentzen on page 1232 of this issue.