Effect of designed aerobic exercise program on cardiopulmonary fitness in children with hemiparetic cerebral palsy. A randomized controlled trial
DOI:
https://doi.org/10.47197/retos.v78.118796Keywords:
cerebral palsy, hemiparesis, aerobic exercise, cardiopulmonary fitness, VO₂ max, six-minute walk testAbstract
Background: Children with hemiparetic cerebral palsy (CP) often experience reduced cardiopulmonary fitness, limiting functional mobility and participation. Aerobic exercise has been shown to enhance fitness in pediatric CP.
Objective: To investigate the effect of a designed aerobic exercise program on walking energy expenditure, aerobic capacity, and functional walking endurance in children with hemiparetic CP.
Methods: Forty children with hemiparetic CP participated in this randomized controlled study, their age from 7–12 years and GMFCS I–II. They were randomly assigned to a study group (n = 20) and a control group (n = 20). The control group received the conventional physiotherapy program based on the neuro-developmental technique 45 minutes (3 sessions/week), while the study group received the same conventional physiotherapy program provided to control group besides a supervised designed 12-weeks aerobic exercise program for 45 minutes (3 sessions/week). Outcome measures included Energy Expenditure Index (EEI), maximal oxygen uptake (VO₂ max), and the Six-Minute Walk Test (6MWT), assessed pre- and post-intervention. Data was analyzed using mixed-design MANOVA.
Results: There was a significant reduction in EEI (p < 0.001), a significant increase in VO₂ max (p < 0.001), and a significant improvement in 6MWT distance (p < 0.001) in the study group, whereas changes in the control group were not significant.
Conclusion: The study findings support the integration of designed aerobic exercise training into pediatric rehabilitation programs to enhance cardiopulmonary fitness and functional outcomes in hemiparetic CP children.
References
Abd El-Nabie, W. A., & Abd El-Monem, A. M. (2019). Effect of treadmill training on energy cost of walking, functional walking capacity and postural stability in children with cerebral palsy: A randomized controlled trial. International Journal of Physiotherapy, 6(3), 116–122. http://dx.doi.org/10.7243/2055-2386-6-5
Balemans, A. C., Bolster, E. A., Brehm, M. A., & Dallmeijer, A. J. (2017). Physical Strain: A New Perspective on Walking in Cerebral Palsy. Archives of physical medicine and rehabilitation, 98(12), 2507–2513. https://doi.org/10.1016/j.apmr.2017.05.004
Bjornson, K. F., Belza, B., Kartin, D., Logsdon, R., & McLaughlin, J. F. (2007). Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically. Physical therapy, 87(3), 248–257. https://doi.org/10.2522/ptj.20060157
Carlon, S. L., Taylor, N. F., Dodd, K. J., & Shields, N. (2013). Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review. Disability and rehabilitation, 35(8), 647–655. https://doi.org/10.3109/09638288.2012.715721
Chrysagis, N., Skordilis, E. K., Stavrou, N., Grammatopoulou, E., & Koutsouki, D. (2012). The effect of treadmill training on gross motor function and walking speed in ambulatory adolescents with cerebral palsy: a randomized controlled trial. American journal of physical medicine & rehabilitation, 91(9), 747–760. https://doi.org/10.1097/PHM.0b013e3182643eba
Damiano, D. L., & DeJong, S. L. (2009). A systematic review of the effectiveness of treadmill training and body weight support in pediatric rehabilitation. Journal of neurologic physical therapy : JNPT, 33(1), 27–44. https://doi.org/10.1097/NPT.0b013e31819800e2
Dodd, K. J., & Foley, S. (2007). Partial body-weight-supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial. Developmental medicine and child neurology, 49(2), 101–105. https://doi.org/10.1111/j.1469-8749.2007.00101.x
Fowler, E. G., Kolobe, T. H., Damiano, D. L., Thorpe, D. E., Morgan, D. W., Brunstrom, J. E., Coster, W. J., Henderson, R. C., Pitetti, K. H., Rimmer, J. H., Rose, J., Stevenson, R. D., Section on Pediatrics Research Summit Participants, & Section on Pediatrics Research Committee Task Force (2007). Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings. Physical therapy, 87(11), 1495–1510. https://doi.org/10.2522/ptj.20060116
García, C. C., Alcocer-Gamboa, A., Ruiz, M. P., Caballero, I. M., Faigenbaum, A. D., Esteve-Lanao, J., Saiz, B. M., Lorenzo, T. M., & Lara, S. L. (2016). Metabolic, cardiorespiratory, and neuromuscular fitness performance in children with cerebral palsy: A comparison with healthy youth. Journal of exercise rehabilitation, 12(2), 124–131. https://doi.org/10.12965/jer.1632552.276
Graham, H. K., Rosenbaum, P., Paneth, N., Dan, B., Lin, J. P., Damiano, D. L., Becher, J. G., Gaebler-Spira, D., Colver, A., Reddihough, D. S., Crompton, K. E., & Lieber, R. L. (2016). Cerebral palsy. Nature reviews. Disease primers, 2, 15082. https://doi.org/10.1038/nrdp.2015.82
Himmelmann, K., & Uvebrant, P. (2014). The panorama of cerebral palsy in Sweden. XI. Changing patterns in the birth-year period 2003-2006. Acta paediatrica (Oslo, Norway: 1992), 103(6), 618–624. https://doi.org/10.1111/apa.12614
Hollung, S.J., Hägglund, G., Gaston, M.S., Seid, A.K., Lydersen, S., Alriksson-Schmidt, A.I. and Andersen, G.L. (2021), Point prevalence and motor function of children and adolescents with cerebral palsy in Scandinavia and Scotland: a CP-North study. Dev Med Child Neurol, 63: 721-728. https://doi.org/10.1111/dmcn.14764
Krägeloh-Mann, I., & Cans, C. (2009). Cerebral palsy update. Brain & development, 31(7), 537–544. https://doi.org/10.1016/j.braindev.2009.03.009
Lauglo, R., Vik, T., Lamvik, T., Stensvold, D., Finbråten, A. K., & Moholdt, T. (2016). High-intensity interval training to improve fitness in children with cerebral palsy. BMJ open sport & exercise medicine, 2(1), e000111. https://doi.org/10.1136/bmjsem-2016-000111
Maltais, D. B., Wiart, L., Fowler, E., Verschuren, O., & Damiano, D. L. (2014). Health-related physical fitness for children with cerebral palsy. Journal of child neurology, 29(8), 1091–1100. https://doi.org/10.1177/0883073814533152
Marinov, B., Kostianev, S., & Turnovska, T. (2003). Modified treadmill protocol for evaluation of physical fitness in pediatric age group--comparison with Bruce and Balke protocols. Acta physiologica et pharmacologica Bulgarica, 27(2-3), 47–51.
McIntyre, S., Goldsmith, S., Garcia, A., Badawi, N., & Blair, E. (2022). Global prevalence of cerebral palsy: A systematic analysis. Developmental Medicine & Child Neurology, 64(12), 1494–1506. https://doi.org/10.1111/dmcn.15346
Mendola, N. (2025). Exercise Evolved: Exciting New Updates in ACSM’s Guidelines for Exercise Testing and Prescription, 12th Edition. ACSM’S Health & Fitness Journal, 29(2), 44–47. https://doi.org/10.1249/fit.0000000000001036
Mukherjee, P., Das, P. R., Pradhan, D. K., Sahoo, R., & Mishra, P. (2025). Effectiveness of aerobic training on cardiopulmonary function and quality of life in children with cerebral palsy: A single-blinded randomized trial. J Clin Biomed Sci, 15(3), 163–171. https://doi.org/10.58739/jcbs/v15i3.24.221
Nsenga Leunkeu, A., Shephard, R. J., & Ahmaidi, S. (2012). Six-minute walk test in children with cerebral palsy gross motor function classification system levels I and II: reproducibility, validity, and training effects. Archives of physical medicine and rehabilitation, 93(12), 2333–2339. https://doi.org/10.1016/j.apmr.2012.06.005
Oskoui, M., Coutinho, F., Dykeman, J., Jetté, N., & Pringsheim, T. (2013). An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Developmental medicine and child neurology, 55(6), 509–519. https://doi.org/10.1111/dmcn.12080
Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental medicine and child neurology, 39(4), 214–223. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
Reedman, S., Boyd, R. N., & Sakzewski, L. (2017). The efficacy of interventions to increase physical activity participation of children with cerebral palsy: a systematic review and meta-analysis. Developmental medicine and child neurology, 59(10), 1011–1018. https://doi.org/10.1111/dmcn.13413
Reedman, S. E., Sakzewski, L., McNamara, L., Sherrington, C., Beckman, E., West, K., Trost, S. G., Thomas, R., Chatfield, M. D., Dutia, I., Gennen, A., Dodds, B., Cotton, Z., & Boyd, R. N. (2022). Study protocol for Running for health (Run4Health CP): a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care. BMJ Open, 12(6). https://doi.org/10.1136/bmjopen-2021-057668
Rimmer, J. A., & Rowland, J. L. (2008). Physical activity for youth with disabilities: a critical need in an underserved population. Developmental neurorehabilitation, 11(2), 141–148. https://doi.org/10.1080/17518420701688649
Rogers, A., Furler, B. L., Brinks, S., & Darrah, J. (2008). A systematic review of the effectiveness of aerobic exercise interventions for children with cerebral palsy: an AACPDM evidence report. Developmental medicine and child neurology, 50(11), 808–814. https://doi.org/10.1111/j.1469-8749.2008.03134.x
Romeo, D. M., Venezia, I., De Biase, M., Sini, F., Velli, C., Mercuri, E., & Brogna, C. (2022). The Use of the 6MWT for Rehabilitation in Children with Cerebral Palsy: A Narrative Review. Journal of personalized medicine, 13(1), 28. https://doi.org/10.3390/jpm13010028
Santos, K. P., Silva, V. M., Reis, I. F., Aquino, M. R., Lana, M. R., & Teixeira, M. F. (2023). Physical conditioning in children and adolescents with cerebral palsy: Systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2023.04.036
Scholtes, V. A., Becher, J. G., Janssen-Potten, Y. J., Dekkers, H., Smallenbroek, L., & Dallmeijer, A. J. (2012). Effectiveness of functional progressive resistance exercise training on walking ability in children with cerebral palsy: a randomized controlled trial. Research in developmental disabilities, 33(1), 181–188. https://doi.org/10.1016/j.ridd.2011.08.026
Shikako-Thomas, K., Majnemer, A., Law, M., & Lach, L. (2008). Determinants of participation in leisure activities in children and youth with cerebral palsy: systematic review. Physical & occupational therapy in pediatrics, 28(2), 155–169. https://doi.org/10.1080/01942630802031834
Slaman, J., Bussmann, J., van der Slot, W. M., Stam, H. J., Roebroeck, M. E., van den Berg-Emons, R. J., & Transition and Lifespan Research Group South West Netherlands (2013). Physical strain of walking relates to activity level in adults with cerebral palsy. Archives of physical medicine and rehabilitation, 94(5), 896–901. https://doi.org/10.1016/j.apmr.2012.11.005
Soares, E. G., Gusmão, C. H. V., & Souto, D. O. (2023). Efficacy of aerobic exercise on the functioning and quality of life of children and adolescents with cerebral palsy: A systematic review and meta-analysis. Developmental medicine and child neurology, 65(10), 1292–1307. https://doi.org/10.1111/dmcn.15570
Tauro, R., Ganesh, S., & Vincent, J. G. (2024). Effect of Cardiovascular Endurance Training on the Exercise Capacity and Endurance in Children With Cerebral Palsy. Cureus, 16(6), e61595. https://doi.org/10.7759/cureus.61595
Verschuren, O., & Takken, T. (2010). Aerobic capacity in children and adolescents with cerebral palsy. Research in developmental disabilities, 31(6), 1352–1357. https://doi.org/10.1016/j.ridd.2010.07.005
Verschuren, O., Peterson, M. D., Balemans, A. C., & Hurvitz, E. A. (2016). Exercise and physical activity recommendations for people with cerebral palsy. Developmental medicine and child neurology, 58(8), 798–808. https://doi.org/10.1111/dmcn.13053
Verschuren, O., Takken, T., Ketelaar, M., Gorter, J. W., & Helders, P. J. (2006). Reliability and validity of data for 2 newly developed shuttle run tests in children with cerebral palsy. Physical therapy, 86(8), 1107–1117. https://doi.org/10.1093/ptj/86.8.1107
Verschuren, O., Wiart, L., Hermans, D., & Ketelaar, M. (2012). Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy. The Journal of pediatrics, 161(3), 488–494. https://doi.org/10.1016/j.jpeds.2012.02.042
Wasserman, K., Hansen, James, Sue, D.Y., Stringer, William, Sietsema, Kathy, Sun, Xing-Guo & Whipp, B.J. (2012). Principles of exercise testing and interpretation: Including pathophysiology and clinical applications: Fifth edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Wijnhoud, L., Takken, T., & Verschuren, O. (2024). Aerobic fitness in children with cerebral palsy compared to typically developing peers: A systematic review and meta-analysis. Revista Brasileira De Fisioterapia. https://doi.org/10.1016/j.bjpt.2024.101142
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Hamada S Ayoub, Emad M Taha, Rania M Tawfik, Shereen Mohamed Said, Sara Rabie El-Hadad, Dany Alphonse Anwar Habib, Doaa A Sanad

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.