Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?


      • This is the first prospective randomized study of high-intensity circuit training for children with cerebral palsy.
      • Home-based training is an effective extension to institutional training in children with cerebral palsy.
      • High-intensity and progressive resistance strength trainings improved specific functional parameters.
      • There was no improvement for other measures of function or participation measures.
      • Only high-intensity circuit training enhanced total muscle strength.



      Does home-based progressive resistance or high-intensity circuit training improve strength, function, activity, or participation in children with cerebral palsy (CP)?


      This was the first study on high-intensity circuit training for children with CP. This study was conducted as a randomized prospective controlled pilot study.


      Evaluation took place at the gait laboratory of the university hospital, training sessions were performed at home.


      Children (N=22) with CP (average age: 12y, 10mo, 19 Gross Motor Function Classification System level I, 3 level II) were randomly assigned either to progressive resistance training (PRT) or high-intensity circuit training (HICT).


      The PRT group trained with progressive overload, while the HICT group performed as many repetitions as possible within 30-second intervals (8wk, 3 times weekly in both groups).

      Main Outcome Measures

      Outcome measures stretched over all domains of the International Classification of Functioning, Disability and Health and included muscle strength, muscle power sprint test (MPST), timed stairs test (TST), 6-minute walking test, Gait Profile Score (GPS), timed Up and Go test (TUGT) and participation questionnaires.


      Only the HICT group was able to improve strength. Furthermore, the HICT group scored better in the MPST, while PRT participants improved in the TST and TUGT. The HICT-group was able to show improvement in the subscores of the parent-reported participation questionnaire. Other measures of mobility or participation did not change.


      Both programs improved function specific to intervention. However, only the HICT group showed significant strength and participation improvements. Compliance was decent in both groups, but the average training unit was shorter in the HICT group. Both exercise programs showed functional benefits, but HICT might be the preferable option for strengthening in highly functional children with CP.


      List of abbreviations:

      ASKp (Activity Scale for Kids Performance version), CP (cerebral palsy), GPS (Gait Profile Score), HICT (high-intensity circuit training), ICF (International Classification of Functioning, Disability and Health), MPST (muscle power sprint test), PODCI (Pediatric Outcome Data Collection Instrument), PRT (progressive resistance training), TST (timed stairs test), TUGT (timed Up and Go test)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mutch L.
        • Alberman E.
        • Hagberg B.
        • Kodama K.
        • Perat M.V.
        Cerebral palsy epidemiology: where are we now and where are we going?.
        Dev Med Child Neurol. 1992; 34: 547-551
        • Damiano D.L.
        • Vaughan C.L.
        • Abel M.F.
        Muscle response to heavy resistance exercise in children with spastic cerebral palsy.
        Dev Med Child Neurol. 1995; 37: 731-739
        • Scholtes V a
        • Becher J.G.
        • Comuth A.
        • Dekkers H.
        • Van Dijk L.
        • Dallmeijer A.J.
        Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial.
        Dev Med Child Neurol. 2010; 52: e107-e113
        • Taylor N.F.
        • Dodd K.J.
        • Baker R.J.
        • Willoughby K.
        • Thomason P.
        • Graham H.K.
        Progressive resistance training and mobility-related function in young people with cerebral palsy: a randomized controlled trial.
        Dev Med Child Neurol. 2013; 55: 806-812
        • Damiano D.L.
        • Abel M.F.
        Functional outcomes of strength training in spastic cerebral palsy.
        Arch Phys Med Rehabil. 1998; 79: 119-125
        • Ross S.A.
        • Engsberg J.R.
        Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy.
        Arch Phys Med Rehabil. 2007; 88: 1114-1120
        • Damiano D.L.
        Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy.
        Phys Ther. 2006; 86: 1534-1540
        • Scholtes V.A.
        • Dallmeijer A.J.
        • Rameckers E.A.
        • et al.
        Lower limb strength training in children with cerebral palsy—a randomized controlled trial protocol for functional strength training based on progressive resistance exercise principles.
        BMC Pediatr. 2008; 8: 41
        • Dodd K.J.
        • Taylor N.F.
        • Damiano D.L.
        A systematic review of the effectiveness of strength-training programs for people with cerebral palsy.
        Arch Phys Med Rehabil. 2002; 83: 1157-1164
        • Moreau N.G.
        • Falvo M.
        • Damiano D.L.
        Rapid force generation is impaired in cerebral palsy and is related to decreased muscle size and functional mobility.
        Gait Posture. 2013; 35: 154-158
        • Sperlich B.
        • Zinner C.
        • Heilemann I.
        • Kjendlie P.-L.
        • Holmberg H.-C.
        • Mester J.
        High-intensity interval training improves VO(2peak), maximal lactate accumulation, time trial and competition performance in 9-11-year-old swimmers.
        Eur J Appl Physiol. 2010; 110: 1029-1036
        • Tabata I.
        • Nishimura K.
        • Kouzaki M.
        • et al.
        Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max.
        Med Sci Sports Exerc. 1996; 28: 1327-1330
        • Lauglo R.
        • Vik T.
        • Lamvik T.
        • Stensvold D.
        • Finbraten A.-K.
        • Moholdt T.
        High-intensity interval training to improve fitness in children with cerebral palsy.
        BMJ Open Sport Exerc Med. 2016; 2e000111
        • Dodd K.J.
        • Taylor N.F.
        • Graham H.K.
        A randomized clinical trial of strength training in young people with cerebral palsy.
        Dev Med Child Neurol. 2003; 45: 652-657
        • Damiano D.L.
        • Alter K.E.
        • Chambers H.
        New clinical and research trends in lower extremity management for ambulatory children with cerebral palsy.
        Phys Med Rehabil Clin N Am. 2010; 20: 469-491
        • Verschuren O.
        • Ketelaar M.
        • Takken T.
        • Van Brussel M.
        • Helders P.J.M.
        • Gorter J.W.
        Reliability of hand-held dynamometry and functional strength tests for the lower extremity in children with cerebral palsy.
        Disabil Rehabil. 2008; 30: 1358-1366
        • Nicolini-Panisson R.D.
        • Donadio M.V.F.
        Timed “Up & Go” test in children and adolescents.
        Rev Paul Pediatr. 2013; 31: 377-383
        • Nsenga Leunkeu A.
        • Shephard R.J.
        • Ahmaidi S.
        Six-minute walk test in children with cerebral palsy gross motor function classification system levels I and II: reproducibility, validity, and training effects.
        Arch Phys Med Rehabil. 2012; 93: 2333-2339
        • Waters R.L.
        • Mulroy S.
        The energy expenditure of normal and pathologic gait.
        Gait Posture. 1999; 9: 207-231
        • Baker R.
        • McGinley J.L.
        • Schwartz M.H.
        • et al.
        The gait profile score and movement analysis profile.
        Gait Posture. 2009; 30: 265-269
        • Verschuren O.
        • Takken T.
        • Ketelaar M.
        • Gorter J.W.
        • Helders P.J.M.
        Reliability for running tests for measuring agility and anaerobic muscle power in children and adolescents with cerebral palsy.
        Pediatr Phys Ther. 2007; 19: 108-115
        • Capio C.M.
        • Sit C.H.P.
        • Abernethy B.
        • Rotor E.R.
        Physical activity measurement instruments for children with cerebral palsy: a systematic review.
        Dev Med Child Neurol. 2010; 52: 908-916
        • Allen D.D.
        • Gorton G.E.
        • Oeffinger D.J.
        • Tylkowski C.
        • Tucker C.A.
        • Haley S.M.
        Analysis of the Pediatric Outcomes Data Collection Instrument (PODCI) in ambulatory children with cerebral palsy using confirmatory factor analysis and item response theory methods.
        J Pediatr. 2008; 28: 192-198
        • Boyd R.N.
        Functional progressive resistance training improves muscle strength but not walking ability in children with cerebral palsy.
        J Physiother. 2012; 58: 197
        • Romeiser Logan L.
        Children with cerebral palsy are just like everyone else: what you train is what you get.
        Dev Med Child Neurol. 2013; 55: 777
        • Bar-Or O.
        Role of exercise in the assessment and management of neuromuscular disease in children.
        Med Sci Sports Exerc. 1996; 28: 421-427
        • van Vulpen L.F.
        • de Groot S.
        • Rameckers E.
        • Becher J.G.
        • Dallmeijer A.J.
        Improved walking capacity and muscle strength after functional power-training in young children with cerebral palsy.
        Neurorehabil Neural Repair. 2017; 31: 827-841