Effectiveness of Functional Exercise Training on Aerobic Capacity

Effectiveness of Functional Exercise Training on Aerobic Capacity Among Spastic Cerebral Palsy Children


Objectives: Cerebral palsy is primarily a disorder of movement and posture. Most of the cerebral palsy children struggle to do ac-tivities of daily life due to lack of cardiovascular endurance. Functional exercise training is a structured physical activity which uses more energy and is more intense than activities, which are part of daily living. The Study aims to show the effectiveness of functional exercise training on aerobic capacity among spastic cerebral palsy children.

Methods: Ten spastic cerebral palsy children were selected consecutively for the study and treated with functional exercise training for a period of 3 months, weekly two sessions of each 45 minutes. By step test VO2 maximum was assessed before and after the end of 3 months to evaluate the aerobic capacity.

Results: The obtained data’s were statistically analysed by paired ‘t’ test at 0.005 level of significance and found that there was sig-nificant improvement in aerobic capacity following functional exercise training in spastic cerebral palsy children.

Conclusion: There was significant improvement in aerobic capacity following functional exercise training in spastic cerebral palsy children.


Cerebral palsy (CP) is primarily a disorder of movement and posture. It is defined as “A group of non-progressive, but changing mo-tor impairment syndromes secondary to lesion or anomalies of the brain arising in the early stages of its development [1]. Incidence of cerebral palsy is 2 to 2.5 per 1000 live births [2]. Spastic cerebral palsy is more (77.4%) common among all the types of cerebral palsy’s. Most children identified with cerebral palsy are boys [3].

Cerebral palsy is not a curable disease. Early physical therapy and proper rehabilitation will reduce the disabilities of cerebral palsy children. A multidisciplinary approach is necessary to rehabilitate a cerebral palsy child and among that physical therapy plays an impor-tant role in managing gross motor dysfunction. Physical therapy can be started as soon as the condition is diagnosed. The goals of physical therapy includes to foster independence by improving functional mobility, strengthen and encourage the growth of muscles, improve the ability to move all parts of the body and prevent joints from becoming tight or contracted.

Positioning, adaptive devices, splints, casts and braces are used to support the limbs and minimise uncontrolled movements. Exercises help to improve the functional activities and make the child near normal. Scooters, wheelchairs and other devices are advised to increase mobility. The various techniques that are used to treat cerebral palsy children are proprioceptive neuromuscular facilitation, stretching, hydrotherapy, neuro developmental therapy, roots approach, sensory integration, ROM exercise, constrained induced movement therapy and myofascial release [4].

Aerobic capacity is also known as maximal oxygen uptake or maximum oxygen consumption (VO2 max). The maximum ability of a person to transport oxygen and utilize during physical activities is called VO2 max. Physical fitness is directly related to the VO2 max of the children [5]. Peak oxygen uptake is strongly associated with health and disease in adulthood. Moreover, it is a strong indicator of func-tional capacity and mortality in adulthood [6].

Maintaining an appropriate level of aerobic fitness reduces the risk of disease and injury and increases the ability to work efficiently and to participate in and enjoy physical activity (sports, recreation, and leisure) [7]. Research consistently has shown that children with cerebral palsy have low V̇ O2 peak values [8]. These low levels of V̇ O2 peak affect both daily and rec-reational activities and could have significant implications for health in people with CP [9].

Functional exercise training is structured physical activity which uses more energy and is more intense than activities, which are part of daily living. Three areas of physical fitness are important for children, adolescents and adults with and without cerebral palsy. The first is aerobic fitness, the efficiency of the body to work for prolonged periods of time using oxygen as the fuel. Aerobic activities include walk-ing, running and swimming.

The second is anaerobic fitness, or the efficiency of the body to complete more strenuous activities that are much shorter in duration less than 15 seconds. These are the main forms of activity for children and include climbing stairs and games such as hide and go seek and tag. The third aspect of physical fitness is muscle strength. Increasing muscle strength aims to assist walking and improve the efficiency of doing other exercise [10].

Purpose of the Study

The purpose of the study is to find out the effectiveness of functional exercise training on aerobic capacity in children with cerebral palsy. The aerobic capacity of children was measured with VO2 max by step test [11]. We hypothesized that functional exercise as a safe and beneficial intervention option for children with cerebral palsy.

Materials and Methods

Review Board of RVS College of Physiotherapy affiliated to the, The Tamil Nadu Dr MGR Medical University approved this single group pre and post-test experimental study and a written consent was obtained from the participants parents after giving clear instructions regarding the treatment procedure and its implications. The study was conducted in RVS Collage of Physiotherapy, Coimbatore. Ten clini-cally diagnosed spastic cerebral palsy children, classified under level I or II on the Gross Motor Function Classification System (GMFCS), who can able to follow simple verbal commands were consecutively selected for the study. Children treated Surgically and with neurotox-ins were excluded from the study.

Functional exercise training was given for all the children, weekly two sessions each session lasted for 45 minutes and the same was continued for three months. The training program includes 3 phases warm up phase training phase and cool down phase. Training phase consist of 8 standardized task specific aerobic exercises.

Functional exercise training

Aerobic capacity of all the children were measured byVO2 max using step test [12], at zero level and end of third moth of the study.


Step test scores were analysed with paired ‘t’ test and found significant at 0.005 level.

Mean value, mean difference, standard deviation and paired ‘t’ value between pre-test and post-test score of step test.

Hence the calculated paired ‘t’ value 11.54 is more that ‘t’ table value 3.250 at 0.005 level. It is concluded that there is significant differ-ence in aerobic capacity following functional exercise training in children with spastic cerebral palsy. That is there is significant difference in aerobic capacity following functional exercise training among children with spastic cerebral palsy.

Graphical representation of pre-test, post-test and mean value of step test.


The major findings was that the functional exercise training programme increases aerobic capacity in children with spastic cerebral palsy. The positive effect was maintained for a period of one month following cessation of training. but the follow up results were not discussed in the present study. The study has limited to small sample size of single experimental group but the findings are in agreement with other studies which have shown that functional exercise training programme in cerebral palsy is associated with improvements in aerobic capacity.

Olaf., et al. (2007) conducted a study on adolescents and children with cerebral palsy to evaluate the aerobic and an-aerobic capacity following 8-week training program. Seven to eighteen years old 86 cerebral palsy children participated in the study. It was concluded that anaerobic capacity (P = .004) and aerobic (P < .001) showed significant training effect. A significant effect was also found for athletic competence (P = .005), muscle strength (P < .001and agility (P < .001). When added to standard care physical therapy exercises improve fitness, involvement level, and excellence of life in children with cerebral palsy [13].


Functional exercise training program is effective in improving aerobic capacity among children with spastic cerebral palsy.


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  7. Carnethon MR., et al. “Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults”. Journal of the American Medical Association 294.23 (2005): 2981-2988.
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  9. Fernhall B and Pitetti KH. “Limitations to work capacity in individuals with intellectual disabilities”. Clinical Exercise Physiology 3.4 (2001): 176-185.
  10. Thomas D O’Brien., et al. “Systematic review of physical activity and exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs”. BMJ Open Sport and Exercise Medicine 2.1 (2016): e000109.
  11. Duygu Turker., et al. “The effects of goal directed therapy on gross motor function and functional status of children with cerebral palsy” (2015).
  12. Payam Heydari., et al. “Step Test: a method for evaluating maximum oxygen consumption to determine the ability kind of work among students of medical emergencies”. Electron Physician 9.3 (2017): 4020-4026.
  13. Olaf Verschuren., et al. “Exercise Training Program in Children and Adolescents With Cerebral Palsy: A Randomized Controlled Trial”. JAMA Pediatrics 161.11 (2007): 1075-1081.

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