Associations of Sedentary Behaviour, Physical Activity, Blood Pressure and Anthropometric Measures with Cardiorespiratory Fitness in Children with Cerebral Palsy

Background Children with cerebral palsy (CP) have poor cardiorespiratory fitness in comparison to their peers with typical development, which may be due to low levels of physical activity. Poor cardiorespiratory fitness may contribute to increased cardiometabolic risk. Purpose The aim of this study was to determine the association between sedentary behaviour, physical activity and cardiorespiratory fitness in children with CP. An objective was to determine the association between cardiorespiratory fitness, anthropometric measures and blood pressure in children with CP. Methods This study included 55 ambulatory children with CP [mean (SD) age 11.3 (0.2) yr, range 6-17 yr; Gross Motor Function Classification System (GMFCS) levels I and II]. Anthropometric measures (BMI, waist circumference and waist-height ratio) and blood pressure were taken. Cardiorespiratory fitness was measured using a 10 m shuttle run test. Children were classified as low, middle and high fitness according to level achieved on the test using reference curves. Physical activity was measured by accelerometry over 7 days. In addition to total activity, time in sedentary behaviour and light, moderate, vigorous, and sustained moderate-to-vigorous activity (>= 10 min bouts) were calculated. Results Multiple regression analyses revealed that vigorous activity (beta = 0.339, p < 0.01), sustained moderate-to-vigorous activity (beta = 0.250, p < 0.05) and total activity (beta = 0.238, p < 0.05) were associated with level achieved on the shuttle run test after adjustment for age, sex and GMFCS level. Children with high fitness spent more time in vigorous activity than children with middle fitness (p < 0.05). Shuttle run test level was negatively associated with BMI (r(2) = -0.451, p < 0.01), waist circumference (r(2) = -0.560, p < 0.001), waist-height ratio (r(2) = -0.560, p < 0.001) and systolic blood pressure (r(2) = -0.306, p < 0.05) after adjustment for age, sex and GMFCS level. Conclusions Participation in physical activity, particularly at a vigorous intensity, is associated with high cardiorespiratory fitness in children with CP. Low cardiorespiratory fitness is associated with increased cardiometabolic risk.