Resistance Training for Cerebral Palsy

(RIPT Trial)

Overseen By Elizabeth Condliffe

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Calgary

Disqualifiers: Acute pathology, High neuromotor impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 12 weeks

24 Participants Needed

Trial Summary

What is the purpose of this trial?

Changes related to Cerebral Palsy (CP) include differences in muscle architecture and cortical activity. These result in weakness, decreased functional ability and limited participation in physical activity. Strength training programs, particularly those including power training components, show great potential in improving the gross motor function of youth with CP. However, this intervention is not currently offered in the Calgary area. Delivered via an innovative partnership with community stakeholders, this project will investigate the preliminary effectiveness of the program to enable youth with CP to achieve child and family centered goals. It will also investigate the feasibility of offering this type of program via a community-hospital partnership. Research Question \& Objectives: 1. Can youth with cerebral palsy achieve their goals and improve their motor function through RIPT (Resistance Intensive Personal Training), a power training program offered jointly by specialized physiotherapists and fitness professionals in community settings? 2. What are the barriers and facilitators to delivery of RIPT in a community setting for youth, caregivers, clinicians, and program staff?

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Resistance Intensive Personal Training, Resistance Training, Power Training, Intensive Personal Training for cerebral palsy?

Research shows that intensive physical exercise, including resistance training, can improve motor function in children with cerebral palsy. Studies found that more daily training hours and longer program durations are linked to better outcomes in motor skills. ^{1 2 3 4 5}

Is resistance training safe for people with cerebral palsy?

Research suggests that resistance training, including explosive and progressive heavy-resistance training, is generally safe for individuals with cerebral palsy. Studies have shown improvements in muscle strength and function without significant adverse effects, indicating it can be a safe part of a training program. ^{6 7 8 9 10}

How is the Resistance Intensive Personal Training treatment different from other treatments for cerebral palsy?

Resistance Intensive Personal Training is unique because it focuses on explosive and progressive resistance exercises to improve muscle strength and gait function in individuals with cerebral palsy, which is not typically emphasized in other treatments. This approach aims to enhance the ability to quickly generate muscle force, leading to better movement and reduced fatigue. ^{7 8 10 11 12}

Research Team

Elizabeth Condliffe

Principal Investigator

University of Calgary

Eligibility Criteria

This trial is for young people with Cerebral Palsy, aged 8 to 17 years old, who can understand English and are capable of exerting maximum effort in physical activities. It's not suitable for those who don't meet these age or communication requirements.

Inclusion Criteria

I am 17 years old or younger.

able to follow directions in English

I can perform activities requiring my full effort.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo Resistance Intensive Personal Training (RIPT) for 12 weeks, 2-3 days per week, with 1:1 support in a group setting

12 weeks

2-3 visits per week (in-person)

Follow-up

Participants and families complete assessments and participate in focus groups to evaluate the program's effectiveness and feasibility

2 weeks

1-2 visits (in-person)

Evaluation

Evaluation of outcomes using Goal Attainment Scale, EQ-5D-Y, and other measures to assess the impact of the training program

14 weeks

Treatment Details

Interventions

• Resistance Intensive Personal Training

Trial Overview The study tests a Resistance Intensive Personal Training program designed to improve muscle strength and motor function in youth with CP. The effectiveness and feasibility of delivering this training through a community-hospital partnership are being evaluated.

Participant Groups

Group I: Resistance Intensive Personal Training (RIPT) Experimental Treatment 1 Intervention

All participants will participate in this arm involving 12 weeks of training 2-3 days/week in a group setting with each session involving 1:1 support for each participant's power training.

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Findings from Research

Goal-directed group circuit progressive resistance exercise training (GT) significantly improved motor function in adolescents with cerebral palsy compared to treadmill training (TT), with notable advantages in various functional measures after 30 bi-weekly sessions.

Both training methods were effective, but the GT group showed greater improvements in key assessments like GMFM-66 and TUG, although the differences were less pronounced at the 6-month follow-up.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a group circuit progressive resistance training program compared with a treadmill training program for adolescents with cerebral palsy. Aviram, R., Harries, N., Namourah, I., et al.[2018]

Intensive, goal-directed physiotherapy for three hours a day, five days a week over three weeks significantly improved motor function in children with cerebral palsy, as measured by the Gross Motor Function Measure-66 (GMFM-66), with a mean change of 4.5 points (p < 0.01).

Children classified at GMFCS levels I-II showed greater improvements compared to those at levels III-V, indicating that the therapy was more effective for children with milder impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy. Sorsdahl, AB., Moe-Nilssen, R., Kaale, HK., et al.[2022]

A meta-analysis of 13 trials involving 412 children with cerebral palsy found that intensive exercise-based therapy did not significantly improve gross motor function compared to standard care, as measured by GMFM scores.

However, the study indicated that increasing the number of daily training hours and the duration of the exercise program positively correlated with improvements in gross motor function, suggesting that higher intensity and longer interventions may enhance outcomes for children with CP.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Therapeutic Exercise Intensity on Cerebral Palsy Outcomes: A Systematic Review With Meta-Regression of Randomized Clinical Trials. Hsu, CW., Kang, YN., Tseng, SH.[2023]

A 3-month physical therapy program combining functional training and progressive resistance exercise led to significant improvements in lower extremity strength for an adolescent with cerebral palsy.

While improvements in functional strength, agility, and anaerobic power were clinically insignificant, the patient reported enhanced participation in activities and achieved new functional movements, highlighting the importance of personalized goals in therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional movement, strength, and intervention for an adolescent with cerebral palsy. Hedgecock, JB., Rapport, MJ., Sutphin, AR.[2015]

In a study involving 14 children with cerebral palsy, both progressive resistance training (PRT) and conventional rehabilitation (CON) improved ankle muscle control after treatment with botulinum toxin type A, particularly by reducing antagonist muscle co-activity.

However, only the PRT group showed a significant increase in maximal plantarflexion torque, highlighting the added benefits of resistance training in enhancing muscle strength following BoNT treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurorehabilitation with versus without resistance training after botulinum toxin treatment in children with cerebral palsy: a randomized pilot study. Bandholm, T., Jensen, BR., Nielsen, LM., et al.[2012]

Velocity training (VT) significantly improved muscle power, walking speed, and functional walking performance in youth with cerebral palsy compared to traditional strength training (ST), which did not show these benefits.

Both VT and ST increased isokinetic strength, but only VT led to specific adaptations in muscle architecture, such as increased fascicle length, highlighting the importance of incorporating higher velocity movements in rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential adaptations of muscle architecture to high-velocity versus traditional strength training in cerebral palsy. Moreau, NG., Holthaus, K., Marlow, N.[2022]

A 12-week program of explosive and progressive resistance training significantly increased the rate of force development in ankle dorsiflexors among 35 adults with cerebral palsy, suggesting improved muscle function.

The training also enhanced gait function, evidenced by increased toe lift and a more dorsiflexed ankle position during walking, indicating that explosive resistance training could be beneficial for improving mobility in adults with cerebral palsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Explosive Resistance Training Increases Rate of Force Development in Ankle Dorsiflexors and Gait Function in Adults With Cerebral Palsy. Kirk, H., Geertsen, SS., Lorentzen, J., et al.[2018]

An eight-week training program significantly increased the physical work capacity (PWC) of seven ambulatory individuals with cerebral palsy, as measured by exercise tests.

The training also improved the ability of these individuals to perform simulated tasks, allowing them to work for eight hours before feeling fatigued, indicating a positive impact on their endurance and overall physical performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training of ambulatory individuals with cerebral palsy. Fernandez, JE., Pitetti, KH.[2019]

A study involving 14 children with spastic diplegia showed that a 6-week strength training program significantly increased quadriceps muscle strength, demonstrating the efficacy of heavy resistance exercise in this population.

The strength training not only improved muscle strength but also positively influenced gait, leading to better stride length and reduced crouch during walking, suggesting that resistance exercise should be included in treatment plans for children with cerebral palsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia. Damiano, DL., Kelly, LE., Vaughn, CL.[2019]

Strength training has been shown to significantly improve muscular strength in athletes with cerebral palsy (CP), based on a systematic review of 30 studies, although evidence for functional improvements remains limited.

There is a lack of research on specific training interventions for enhancing sports performance in CP athletes, suggesting that coaches should prioritize building muscular strength before tailoring programs to specific sports.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strength Training to Improve Performance in Athletes With Cerebral Palsy: A Systematic Review of Current Evidence. Fleeton, JRM., Sanders, RH., Fornusek, C.[2021]

Individualized progressive resistance training significantly increased muscle strength by 27% in young people with spastic diplegic cerebral palsy over 12 weeks, indicating that this type of training can effectively enhance physical capabilities.

Although participants reported improvements in mobility, these subjective benefits did not translate into measurable changes in objective mobility tests, suggesting that strength gains alone may not directly improve walking performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial. Taylor, NF., Dodd, KJ., Baker, RJ., et al.[2015]

In a study involving 22 children with spastic cerebral palsy, functional progressive resistance training (PRT) led to a significant increase in the thickness of the vastus lateralis muscle, indicating some positive effects on muscle morphology.

However, neither high-intensity circuit training (HICT) nor PRT resulted in significant changes in the gastrocnemius medialis or Achilles tendon properties, suggesting that more intense and longer training may be needed to achieve meaningful improvements in muscle and tendon function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Functional Home-Based Strength Training Programs on the Mechano-Morphological Properties of the Plantar Flexor Muscle-Tendon Unit in Children With Spastic Cerebral Palsy. Kruse, A., Schranz, C., Svehlik, M., et al.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

Effects of a group circuit progressive resistance training program compared with a treadmill training program for adolescents with cerebral palsy. [2018]

2. England pubmed.ncbi.nlm.nih.gov

Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of Therapeutic Exercise Intensity on Cerebral Palsy Outcomes: A Systematic Review With Meta-Regression of Randomized Clinical Trials. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Functional movement, strength, and intervention for an adolescent with cerebral palsy. [2015]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Neurorehabilitation with versus without resistance training after botulinum toxin treatment in children with cerebral palsy: a randomized pilot study. [2012]

6. United States pubmed.ncbi.nlm.nih.gov

Differential adaptations of muscle architecture to high-velocity versus traditional strength training in cerebral palsy. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Explosive Resistance Training Increases Rate of Force Development in Ankle Dorsiflexors and Gait Function in Adults With Cerebral Palsy. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Training of ambulatory individuals with cerebral palsy. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Strength Training to Improve Performance in Athletes With Cerebral Palsy: A Systematic Review of Current Evidence. [2021]

11. England pubmed.ncbi.nlm.nih.gov

Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial. [2015]

12. United States pubmed.ncbi.nlm.nih.gov

The Effect of Functional Home-Based Strength Training Programs on the Mechano-Morphological Properties of the Plantar Flexor Muscle-Tendon Unit in Children With Spastic Cerebral Palsy. [2019]