ContentList volumes - List articles in this issue
Daily stride rate activity and heart rate response in children with cerebral palsy
OBJECTIVE: To compare daily stride rate activity, daily exercise intensity, and heart rate intensity of stride rate in children with cerebral palsy with that of typically developing children.
METHODS: Forty-three children with cerebral palsy, walking without (Gross Motor Function Classification System (GMFCS) I and II) or with (GMFCS III) an aid and 27 typically developing children (age range 7–14 years) wore a StepWatchTM activity monitor and a heart rate monitor. Time spent and mean heart rate reserve at each stride rate activity level and time spent in each mean heart rate reserve zone was compared.
RESULTS: Daily stride rate activity was lower in children with cerebral palsy (39%, 49% and 79% in GMFCS I, II and III, respectively) compared with typically developing children (p < 0.05), while there were no differences in time spent at different mean heart rate reserve zones. Mean heart rate reserve at all stride rate activity levels was not different between typically developing children, GMFCS I and II, while mean heart rate reserve was higher for GFMCS III at stride rates < 30 strides/min (p < 0.05).
CONCLUSION: Stride rate activity levels reflect the effort of walking, in children with cerebral palsy who are walking without aids, similar to that of typically developing, whereas children with cerebral palsy using walking aids show higher effort of walking. Despite a lower stride rate activity in cerebral palsy, daily exercise intensity seems comparable, indicating that the StepWatchTM monitor and the heart rate monitor measure different aspects of physical activity.
Astrid C.J. Balemans, Leontien van Wely, Anouk Middelweerd, Josien J.C. van den Noort , Jules G. Becher, Annet J. Dallmeijer
Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, VU University Medical Center, Amsterdam, 1007 MB Amsterdam, The Netherlands. E-mail: firstname.lastname@example.org
2. Schmidt MD, Cleland VJ, Shaw K, Dwyer T, Venn AJ. Cardiometabolic risk in younger and older adults across an index of ambulatory activity. Am J Prev Med 2009; 37: 278–284.
3. Telama R, Yang X, Viikari J, Valimaki I, Wanne O, Raitakari O. Physical activity from childhood to adulthood: a 21-year tracking study. Am J Prev Med 2005; 28: 267–273.
4. Cans C, Guillem P, Arnaud C, Baille F, Chalmers J, McManus V, et al. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002; 44: 633–640.
5. Bax MC, Flodmark O, Tydeman C. Definition and classification of cerebral palsy. From syndrome toward disease. Dev Med Child Neurol Suppl 2007; 109: 39–41.
6. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39: 214–223.
7. Bjornson KF, Belza B, Kartin D, Logsdon R, McLaughlin JF. Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically. Phys Ther 2007; 87: 248–257.
8. Carlon S, Taylor N, Dodd K, Shields N. Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review. Disabil Rehabil 2013; 35: 647–655.
9. van den Berg-Emons HJG, Saris WHM, de Barbanson DC, Westerterp KR, Huson A, van Baak MA. Daily physical activity of schoolchildren with spastic diplegia and of healthy control subjects. J Pediatr 1995; 127: 578–584.
10. Takken T, Stephens S, Balemans A, Tremblay MS, Esliger DW, Schneiderman J, et al. Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease. Eur J Clin Nutr 2010; 64: 1494–1500.
11. Fowler EG, Kolobe TH, Damiano DL, Thorpe DE, Morgan DW, Brunstrom JE, et al. Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings. Phys Ther 2007; 87: 1495–1510.
12. Tudor-Locke C, Craig CL, Beets MW, Belton S, Cardon GM, Duncan S, et al. How many steps/day are enough? for children and adolescents. Int J Behav Nutr Phys Act 2011; 8: 78.
13. Clanchy KM, Tweedy SM, Boyd R. Measurement of habitual physical activity performance in adolescents with cerebral palsy: a systematic review. Dev Med Child Neurol 2011; 53: 499–505.
14. Bell KL, Davies PS. Energy expenditure and physical activity of ambulatory children with cerebral palsy and of typically developing children. Am J Clin Nutr 2010; 92: 313–319.
15. Maltais DB, Pierrynowski MR, Galea VA, Bar-Or O. Physical activity level is associated with the O2 cost of walking in cerebral palsy. Med Sci Sports Exerc 2005; 37: 347–353.
16. Van Wely L, Becher JG, Balemans ACJ, Dallmeijer AJ. Ambulatory activity of children with cerebral palsy: which characteristics are important? Dev Med Child Neurol 2012; 54: 436–442.
17. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334–1359.
18. Brehm MA, Becher J, Harlaar J. Reproducibility evaluation of gross and net walking efficiency in children with cerebral palsy. Dev Med Child Neurol 2007; 49: 45–48.
19. Armstrong N, Welsman JR. The physical activity patterns of European youth with reference to methods of assessment. Sports Med 2006; 36: 1067–1086.
20. Van Wely L, Becher JG, Reinders-Messelink HA, Lindeman E, Verschuren O, Verheijden J, et al. LEARN 2 MOVE 7–12 years: a randomized controlled trial on the effects of a physical activity stimulation program in children with cerebral palsy. BMC Pediatr 2010; 10: 77.
21. Balemans ACJ, Van Wely L, De Heer SJA, Van Den Brink J, De Koning JJ, Becher JG, et al. Maximal aerobic and anaerobic exercise responses in children with cerebral palsy. Med Sci Sports Exerc 2013; 45: 561–568.
22. Ishikawa S, Kang M, Bjornson K, Song K. Reliably measuring ambulatory activity levels of children and adolescents with cerebral palsy. Arch Phys Med Rehabil 2013; 94:132–137.
23. Coleman KL, Smith DG, Boone DA, Joseph AW, del Aguila MA. Step activity monitor: long-term, continuous recording of ambulatory function. J Rehabil Res Dev 1999; 36: 8–18.
24. McDonald CM, Widman L, Abresch RT, Walsh SA, Walsh DD. Utility of a step activity monitor for the measurement of daily ambulatory activity in children. Arch Phys Med Rehabil 2005; 86: 793–801.
25. Barreira TV, Katzmarzyk PT, Johnson WD, Tudor-Locke C. Cadence patterns and peak cadence in US children and adolescents: NHANES, 2005–2006. Med Sci Sports Exerc 2012; 44: 1721–1727.
26. American College of Sports Medicine. Exercise prescription for healthy populations & special considerations. In: Walter R. Thompson, Nel F. Gordon, Linda S. Pescatello, editors. ACSM’s guidelines for exercise testing and prescription. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
27. Bjornson KF, Song K, Zhou C, Coleman K, Myaing M, Robinson SL. Walking stride rate patterns in children and youth. Pediatr Phys Ther 2011; 23: 354–363.
28. Mackey AH, Stott NS, Walt SE. Reliability and validity of an activity monitor (IDEEA) in the determination of temporal-spatial gait parameters in individuals with cerebral palsy. Gait Posture 2008; 28: 634–639.
29. van Eck M, Dallmeijer AJ, van Lith IS, Voorman JM, Becher J. Manual ability and its relationship with daily activities in adolescents with cerebral palsy. J Rehabil Med 2010; 42: 493–498.
30. Oftedal S, Bell KL, Mitchell LE, Davies PSW, Ware RS, Boyd RN. A systematic review of the clinimetric properties of habitual physical activity measures in young children with a motor disability. Int J Pediatr 2012; 2012: 1–12.
31. Swain DP, Franklin BA. Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. Am J Cardiol 2006; 97: 141–147.
View at PubMed