Determining Physical Activity Levels and Cardiovascular Health in Adults with Cerebral Palsy (Stay-FIT 20-40 years study)

In Brief © Jan Willem Gorter and Patrick McPhee, 2012

In this In Brief communication we want to share our study protocol to understand the health impact of physical activity in adults with Cerebral Palsy (CP).

Why are we doing this study?

  • In the Stay-FIT pilot study, it was determined that the physical activity level of adolescents with CP (mean age 13.5 years) was lower than that of their healthy peers (Gorter et al. 2012). However, the vessel health was not statistically different (Martin et al. 2012).
  • In general, inactivity can bring cardiovascular disease and diabetes over time.
  • Vessel health may be compromised in adults with CP aged 20-40 years, particularly in those with lower physical activity levels or greater amounts of sedentary time.
  • Simply put, it is possible that adolescents with CP who are inactive can develop health problems in adulthood that is potentially preventable.

What do we know about physical activity in adults with CP?

  • Adults with bilateral spastic CP, especially those with low-level gross motor functioning, are at risk for an inactive lifestyle (Nieuwenhuijsen et al 2009).
  • Adults with unilateral spastic CP (hemiplegia) did not differ from healthy subjects on the level of physical activity endured on a daily basis (van der Slot et al., 2007).
  • Adults with CP who were physically active experienced greater levels of fatigue than their able-bodied peers. (Nieuwenhuijsen et al., 2009).
  • Severity of fatigue was found to be associated with depressive symptoms in adults with CP (Van der Slot et al 2012)
  • Promoting physical activity that has vascular health benefits and results in limited fatigue is of future interest.

How do we measure cardiovascular health in adults with CP?

  • Anthropometric Measurements - sitting and if possible standing height (cm) will be measured to the nearest mm without shoes. Body mass will be measured to the nearest 0.1 kg using a digital scale. Body Mass Index will also be determined from the respective measures above.
  • Continuous heart rate will be recorded via an electrocardiograph (ECG). Blood pressure will also be measured and recorded.
  • Carotid distensibility, the measurement of an artery's ability to increase in diameter with an increase in pressure, will be measured non-invasively via ultrasonography (Martin et al., 2012).

How do we measure physical activity in adults with CP?

  • Physical activity in participants will be monitored and recorded for seven consecutive days using an Actigraph accelerometer with a sampling interval of three seconds.
  • Inclusive with the accelerometer will be a log-book in which to record when the accelerometer was attached and removed (e.g., bed-time).
  • A standardized self-report activity measure (PARA-SCI) and a fatigue self-assessment tool (FISSA) will be used to measure physical activity and fatigue levels, respectively (Ginis et al., 2005, Brunton & Bartlett, 2012).


  • A participant pool of fifty adults with CP (aged 20-40 years) will be invited to participate in the study.
  • Individuals with CP in south-western Ontario will be invited to a half day assessment at McMaster University in Hamilton.
  • We hope to recruit ten participants per GMFCS level I to V, i.e. individuals who are able to walk with and without an aid as well as individuals who use a wheelchair to get around.

What's next?

  • We will begin recruiting participants by presenting the study at the annual Ontario Federation of Cerebral Palsy (OFCP) conference in September, 2012.
  • Every participant to the study will receive an individualized report with results of the assessment.

Want to know more? Contact:


This project is funded by the Ontario Federation for Cerebral Palsy. Investigators of this project are Jan Willem Gorter (PI), Maureen MacDonald and Brian Timmons. The following members of the Stay-FIT study Group participate in the research program: Robert Palisano, Peter Rosenbaum, Virginia Wright. Karen Henderson is research assistant to the project.

  • Click here for list of references

    Brunton & Bartett (2012). Fatigue impact and severity self-assessment. Personal Communication.

    Ginis, K. A., Latimer, A. E., Hicks, A. L., Craven, B. C. (2005). Development and evaluation of an activity measure for people with spinal cord injury. Medical Science of Sports and Exercise, 37(7), 1099-1110.

    Gorter JW. Rehabilitative therapies for the child with cerebral palsy: focus on Family, Function & Fitness. Minerva Pediatrica; Aug 2009, (4):425-40.

    Gorter JW, Noorduyn SG, Obeid J, Timmons BW. Accelerometry: A Feasible Method to Quantify Physical Activity in Ambulatory and Nonambulatory Adolescents with Cerebral Palsy. Int J Pediatr. 2012;2012:329284. Epub 2012 Jun 26.

    Martin, A. A., Cotie, L. M., Timmons, B. W., Gorter, J. W., MacDonald, M. J. (2012). Arterial structure and function in ambulatory adolescents with cerebral palsy are not different from healthy controls. International Journal of Pediatrics, 2012, 1-8.

    Nieuwenhuijsen, C., van der Slot, W. M. A., Dallmeijer, A. J., Janssens, P. J., Stam, H. J., Roebroeck, M. E., van den Berg-Emons, H. J. G. (2009). Physical fitness, everyday physical activity, and fatigue in ambulatory adults with bilateral spastic cerebral palsy. Scand J Med Sci Sports, 21, 535-542.

    Rimmer, J. H. (2001). Physical fitness levels of persons with cerebral palsy. Dev Med Child Neurol, 43(3), 208-212.

    Van der Slot, W., Roebroeck, M., Landkroon, A., Terburg, M., Berg-Emons, R. J. G., van den Stam, H. (2007). Everyday physical activity and community participation of adults with hemiplegic Cerebral Palsy. Disability and Rehabilitation, 29(3), 179-189.