Balemans Astrid C J, van Wely Leontien, Becher Jules G, Dallmeijer Annet J
A.C.J. Balemans, PhD, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and EMGO+ Institute for Health and Care Research, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
L. van Wely, PhD, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, and EMGO+ Institute for Health and Care Research, VU University Medical Centre.
Phys Ther. 2015 Jul;95(7):996-1005. doi: 10.2522/ptj.20140270. Epub 2015 Feb 5.
A vicious circle of decreased physical fitness, early fatigue, and low physical activity levels (PAL) is thought to affect children with cerebral palsy (CP). However, the relationship of changes in physical fitness to changes in PAL and fatigue is unclear.
The objective of this study was to investigate the associations among changes in physical fitness, walking-related PAL, and fatigue in children with CP.
This study was a secondary analysis of a randomized controlled trial with measurements at baseline, 6 months (after the intervention period), and 12 months.
Twenty-four children with bilateral spastic CP and 22 with unilateral spastic CP, aged 7 to 13 years, all walking, participated in this study. Physical fitness was measured by aerobic capacity, anaerobic threshold, anaerobic capacity, and isometric and functional muscle strength. Walking-related PAL was measured using an ankle-worn activity monitor for 1 week. Fatigue was determined with the Pediatric Quality of Life (PedsQL) Multidimensional Fatigue Scale. Longitudinal associations were analyzed by random coefficient regression analysis.
In children with bilateral CP, all fitness parameters showed a positive, significant association with walking-related PAL, whereas no associations between physical fitness and walking-related PAL were seen in children with unilateral CP. No clinically relevant association between physical fitness and fatigue was found.
Although random coefficient regression analysis can be used to investigate longitudinal associations between parameters, a causal relationship cannot be determined. The actual direction of the association between physical fitness and walking-related PAL, therefore, remains inconclusive.
Children with bilateral spastic CP might benefit from improved physical fitness to increase their PAL or vice versa, although this is not the case in children with unilateral CP. There appears to be no relationship between physical fitness and self-reported fatigue in children with CP. Interventions aimed at improving PAL may be differently targeted in children with either bilateral or unilateral CP.
体能下降、早期疲劳和低体力活动水平（PAL）的恶性循环被认为会影响脑瘫（CP）儿童。然而，体能变化与PAL及疲劳变化之间的关系尚不清楚。
本研究的目的是调查CP儿童体能变化、与步行相关的PAL和疲劳之间的关联。
本研究是一项随机对照试验的二次分析，在基线、6个月（干预期后）和12个月时进行测量。
24名7至13岁的双侧痉挛型CP儿童和22名单侧痉挛型CP儿童，均能行走，参与了本研究。体能通过有氧能力、无氧阈值、无氧能力以及等长和功能性肌肉力量进行测量。使用脚踝佩戴的活动监测器测量与步行相关的PAL，为期1周。疲劳通过儿童生活质量（PedsQL）多维疲劳量表进行测定。通过随机系数回归分析纵向关联。
在双侧CP儿童中，所有体能参数均与与步行相关的PAL呈显著正相关，而在单侧CP儿童中未发现体能与与步行相关的PAL之间存在关联。未发现体能与疲劳之间存在临床相关关联。
尽管随机系数回归分析可用于研究参数之间的纵向关联，但无法确定因果关系。因此，体能与与步行相关的PAL之间关联的实际方向仍不确定。
双侧痉挛型CP儿童可能会从改善体能中受益，以提高其PAL，反之亦然，尽管单侧CP儿童并非如此。CP儿童的体能与自我报告的疲劳之间似乎没有关系。针对改善PAL的干预措施可能因双侧或单侧CP儿童而有所不同。
