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The Effects of Resistance Training on

Populations with Cerebral Palsy

Lyndsay Ruckle

Doctoral of Physical Therapy Student

ruckl1lk@cmich.edu

Central Michigan University

October 5, 2017
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“Cerebral Palsy is considered a neurological disorder caused by a non-progressive brain

injury or malformation that occurs while the child’s brain is under development… Cerebral Palsy

affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and

balance. It can also impact fine motor skills, gross motor skills and oral motor functioning.1”

Since Cerebral Palsy (CP) produces a diverse amount of musculoskeletal imbalances,

weaknesses, and complications (such as those listed above), it is important to understand what

interventions can be done in order to suppress those abnormal musculoskeletal conditions.

Without intervention, CP can cause patients to become physically inactive, increase the chance of

cardiovascular disease, decrease mobility, decrease social interactions, decrease perception of

self-worth, and deterioration to overall health status. One possible intervention for populations

with CP is resistance training. Throughout this paper, several studies regarding resistance

training in populations of people with CP will be evaluated and compared; then it will be

determined if resistance training is a recommended and a viable intervention for persons with CP.

As mentioned above, effects of CP can include, “[effected] body movement, muscle

control, muscle coordination, muscle tone, reflex, posture and balance.1” Thus, the general

purpose amongst all of the resistance training studies were predominantly similar. In a study

performed by Reid, Hamer, Alderson, and Lloyd, their goal was “to determine the neuromuscular

outcomes of an eccentric strength-training [program] for children and adolescents with cerebral

palsy.2” In another study performed by Ryan, Theis, and Kilbride, et al., the goal of the study was

to “…evaluate the effect of resistance training on gait efficiency, activity and participation in

adolescents with cerebral palsy. We also aim to determine the biomechanical and neural
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adaptations that occur following resistance training.3” Collectively, due to the musculoskeletal

abnormalities caused by CP, most resistance training interventions looked for favorable

adaptations to the musculoskeletal system.

The first study regarding resistance training in populations with CP was performed by

Reid, Hamer, Anderson, and Lloyd. The intervention was a six week program with resistance

training occurring three days a week. Resistance training included ten repetitions of eccentric

lengthening contractions occurring in sets of three. “The training loads were individually

calculated on the basis of participants’ maximum eccentric performance during dynamometry

assessments. Training progressed incrementally by 5% each week, commencing at 50%

maximum eccentric torque, and, after reassessment of strength at week 3, loads continued to

advance in 5% increments up to 70% by week 6.2” After the resistance training intervention, the

results displayed improved and increased eccentric “peak torque [normalized] to body mass;”

levels comparable to that of standard developing children.2 Additionally, electromyography

levels decreased and were comparable to that of standard developing children.2 The study as a

whole proved that resistance training can help persons with CP increase overall strength, slightly

increase muscle torque, and help reduce muscle spasticity. Thus, resistance training could be

recommended to those with CP.

Another study done looking at the effects resistance training has on populations with CP

was performed by Taylor, Dodd, Baker, and Willoughby. Their intervention protocol involved a

twelve week program with resistance training occurring twice a week. Resistance training

exercises were performed for three sets with ten to twelve repetitions per set; the goal intensity

was targeted at sixty to eighty percent of an individual’s one-repetition maximum. The chosen
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exercises were directed towards muscles involved with gait and ambulation. This study revealed

“the strength of targeted muscles increased by 27% compared with [the] control group.4”

However, these gains in muscles strength did not translate into improvements in ambulation and

mobility. Even though there were no objective improvements in mobility, there was a large

increase in “participant-rated mobility;” meaning the persons with CP believed the resistance

training intervention did help increase their overall mobility.4 Depending on the intended

outcome of resistance training, this study can prove multiple aspects. If the intended goal of

resistance training is to increase muscle strength, then resistance training is definitely

recommended. If the intended outcome is to increase overall mobility, then resistance training

might not be an effective intervention.

Fosdahl, Holm, and Jahnsen performed a study focusing on resistance training

interventions as well as passive and active stretching techniques in populations with CP. This

intervention spanned a sixteen week period with resistance training and stretching occurring

three days a week; two days were completed with a physiotherapist and the third day was

completed at home. The study primarily focused on stretching and strength training of the

muscles that extend the lower extremities. After completing the sixteen week intervention period,

the general results of the study were inconclusive. “For isokinetic muscle strength, spasticity, gait

speed and step length variables there were small and non-significant differences between the two

groups;” the two groups being the control group and the intervention group.5 This study lends

evidence that resistance training might not be the most effective intervention for persons with CP.

The last study to be examined was performed by Scholtes, Becher, and Comuth, et al.

“The intervention group trained for twelve weeks, three times a week, on a five-exercise circuit,
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which included a leg-press and functional exercises. The training load progressively increased

based on the child’s maximum level of strength, determined by the eight-repetition maximum.6”

Each resistance training session lasted between forty-five to sixty minutes. After the resistance

training intervention, there was a significant increase in muscles strength; “Twelve weeks of

functional [progressive resistance exercise] strength training increases muscle strength up to

14%.6” However, even with the significant increase in muscle strength, there was no

improvement in mobility. Again, this study demonstrates that resistance training could be

effective depending on the intended outcome. If the goal is to improve mobility, then resistance

training would not be recommend. If the goal is to increase general muscular strength, then

resistance training would be recommended.

After considering various resistance training interventions in populations with CP,

because there was no significant increase in mobility, it could be argued whether or not the

increase muscle strength plays a crucial role in the CP populations. “Clinically, our results

suggest that prescription of progressive resistance training for adolescents and young adults with

spastic diplegic CP may not be effective if the aim is to improve objective measures of mobility.

Even if prescription of progressive resistance training does not improve objective measures of

mobility, it could have other important psychosocial benefits such as improved perception of

mobility… [also] it could be seen as part of a community recreation program that could help

young people with CP get stronger and achieve physical activity guidelines.4” However, I believe

that other aspects of resistance training should be evaluated as well, in addition to the muscular

system; for example, cardiovascular and psychological benefits.

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A study performed by Faigenbaum and Myer discussed the health benefits associated

with pediatric resistance training. One benefit of resistance training has to do with bone health,

“that childhood and adolescence may be the opportune time for the bone-modeling and

remodeling process to respond to the tensile and compressive forces associated with weight-

bearing activities.7” Populations with CP may struggle with mobility and weight bearing, but it

could still be important to assure proper bone health, development, and remodeling. An increase

in bone density and strength may allow for more secure attachment and insertion points of the

muscles, especially if spasticity is an issue. Another important consideration is the cardiovascular

benefits of resistance training. Resistance training improves metabolism, strengthens cardiac

muscle of the heart, decreases peripheral vascular resistance, and much more. These health

benefits are crucial to the general health status of any population.

In my opinion, even though there was not a drastic increase in overall mobility and

mobility efficiency, I think resistance training should still be recommended for CP populations.

Populations with CP can benefit from resistance training because of the increase in muscle

strength and the decrease in muscle spasticity. An increase in muscle strength can help avoid

early muscle atrophy and degeneration. Another important consideration is the psychological

benefits of resistance training. As mentioned in the study performed by Taylor, Dodd, Baker, and

Willoughby, there was an increase in “participant-rated mobility.4” If CP populations believe that

resistance training is helping their overall mobility, this could increase confidence, self-worth,

and influence their perceptions of themselves. Also, the benefits to bone health and

cardiovascular health are an important result of resistance training. Overall, there are enough

health benefits that I would recommend resistance training to those persons with CP.
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As for the recommended amount and duration of resistance training, one similar factor

amongst a few of the studies was the target range at which the repetitions were to be performed

at. The goal was to perform resistance training exercises between sixty to eighty percent of an

individual’s one-repetition maximum. This target range seemed to produce the largest increase in

muscle strength. The common number of repetitions were in the range of eight to twelve, with

ten being the most common number of repetitions. In one study, resistance training occurred

twice a week while in three studies, resistance training occurred three times a week. The study

with resistance training occurring twice a week did see positive results; “the strength of targeted

muscles increased by 27% compared with [the] control group.4” Thus, proving that twice a week

is satisfactory. When discussing the length of resistance training, there were results seen after just

a six week intervention. However, a majority of the other studies were twelve to sixteen weeks.

So as long as resistance training is occurring over a continuous period of time, results should

occur.

In conclusion, resistance training is an effective intervention for populations with CP. My

recommended resistance training protocol would include three sets of ten repetitions, with

repetitions occurring between sixty to eighty percent of the patients one-repetition maximum,

targeting both the lower and upper extremities. Resistance training can occur two to three days a

week depending on the individual patient. The protocol would last at least six weeks, but

hopefully be incorporated in as a lifestyle due to the overall health benefits.

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Reference List

1. Stern KA. Definition of cerebral palsy. My child at cerebralpalsy.org. http://

www.cerebralpalsy.org/about-cerebral-palsy/definition. Accessed October 2, 2017.

2. Reid S, Hamer P, Alderson J, Lloyd D. Neuromuscular adaptations to eccentric strength

training in children and adolescents with cerebral palsy. Developmental Medicine & Child
Neurology. 2010; 52(4): 358 - 363. http://onlinelibrary.wiley.com/doi/10.1111/j.
1469-8749.2009.03409.x/full. Accessed September 19, 2017.

3. Ryan JM, Theis N, Kilbride C, et al. Strength Training for Adolescents with cerebral palsy
(STAR): study protocol of a randomised controlled trial to determine the feasibility,
acceptability and efficacy of resistance training for adolescents with cerebral palsy. BMJ
Open. 2016; 6(10): 1 - 14. http://bmjopen.bmj.com/content/6/10/e012839. Accessed
September 19, 2017.

4. Taylor NF, Dodd KJ, Baker RJ, Willoughby K. Progressive resistance training and mobility-
related function in young people with cerebral palsy: a randomized control trial.
Developmental Medicine & Child Neurology. 2013; 55(9): 806 - 812. http://
onlinelibrary.wiley.com/doi/10.1111/dmcn.12190/full. Accessed September 19, 2017.

5. Fosdahl M, Holm I, Jahnsen R. The effect of progressive resistance exercise training and
stretching of the hamstrings muscle in ambulant children with cerebral palsy – a randomized
controlled trial. Developmental Medicine & Child Neurology. 2017; 59(S3): 48. http://
onlinelibrary.wiley.com/doi/10.1111/dmcn.71_13511/full. Accessed September 19, 2017.

6. Scholtes VA, Becher JG, Comuth A, et al. Effectiveness of functional progressive resistance
exercise strength training on muscle strength and mobility in children with cerebral palsy: a
randomized controlled trial. Developmental Medicine & Child Neurology. 2010; 52(6):
e107–e113. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2009.03604.x/full.
Accessed September 19, 2017.

7. Faigenbaum AD, Myer GD. Pediatric resistance training: benefits, concerns, and program
design considerations. American College of Sports Medicine: Current Sports Medicine
Reports. 2010; 9(3): 161 - 168. Accessed October 4, 2017.