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Progressive resistance training for adolescents with cerebral palsy: the STAR randomized controlled trial

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Jennifer M. Ryan, Grace Lavelle, Nicola Theis, Marika Noorkoiv, Cherry Kilbride, Thomas Korff, Vasilios Baltzopoulos, Adam Shortland, Wendy Levin

Original languageEnglish
Pages (from-to)1283-1293
Number of pages11
JournalDevelopmental Medicine and Child Neurology
Issue number11
Accepted/In press1 Jan 2020
Published1 Nov 2020

King's Authors


Aim: To evaluate the effect of progressive resistance training of the ankle plantarflexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). Method: Sixty-four adolescents (10–19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I–III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net nondimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention-to-treat. Results: Median attendance at the 10 supervised sessions was 80% (range 40–100%). There was no between-group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI] –0.07 to 0.11, p=0.696) or 22 weeks (mean difference: –0.08, 95% CI –0.18 to 0.03, p=0.158). There was also no evidence of between-group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group. Interpretation: We found that 10 supervised sessions and 20 home sessions of progressive resistance training of the ankle plantarflexors did not improve gait efficiency, muscle strength, activity, participation, or any biomechanical outcome among adolescents with CP. What this paper adds: Thirty sessions of progressive resistance training of the ankle plantarflexors over 10 weeks did not improve gait efficiency among ambulatory adolescents with cerebral palsy. Resistance training did not improve muscle strength, activity, or participation. Ninety percent of participants experienced an adverse event. Most adverse events were expected and no serious adverse events were reported.

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