Impact of Cerebral Palsy on Health-Related Physical Fitness in Adults: Systematic Review

Hombergen SP, Huisstede BM, Streur MF, Stain Hi, Slaman J. Bussmann JB, van den Berg-Emons RJ. Impact of cerebral palsy on health-related physical fitness in adults: systematic review. Arch Phys Med Rehabil 2012;93:871-81. Objective: To conduct a systematic review of the impact of cerebral palsy (CP) on the level of health-related physical fitness (body composition, cardiorespiratory endurance, flexibility, muscular endurance, and strength) in adults with CP compared with able-bodied adults. Data Sources: The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PEDro were searched up to December 2010 for relevant comparative studies. Study Selection: Two reviewers independently applied the inclusion criteria (adults, comparative design, components of physical fitness) to select potential relevant studies. Data Extraction: Two reviewers independently extracted the data and assessed the methodological quality. A consensus method was used to solve disagreements. Data Synthesis: Pooling data was not possible, but a best-evidence synthesis was conducted. Also, a description of the level of health-related physical fitness in CP was given (expressed as a percentage of able-bodied controls). Nine case-control studies were included (average age +/- SD of subjects with CP, 21 +/- 3y): 3 investigated body composition; 5, cardiorespiratory endurance; 3, muscular strength; and 1, muscular endurance. Two of the studies investigated multiple fitness components. No studies on flexibility were found. Muscular strength (34%-60%), muscular endurance (27%-52%), and cardiorespiratory endurance (14%) showed significantly lower values in adults with CP compared with able-bodied controls. Studies on body composition reported conflicting results on the impact of CP. Conclusions: The results of this review point to a reduction in 3 components of health-related physical fitness in young adults with CP compared with controls: muscular strength, muscular endurance, and cardiorespiratory endurance. However, the level of evidence varies from moderate (muscular strength) to limited (muscular endurance and cardiorespiratory endurance). Additional studies of high methodological quality are recommended before firm conclusions can be made.