The clinimetric properties of aerobic and anaerobic fitness measures in adults with cerebral palsy: A systematic review of the literature.
Use maximal cycle tests for ambulatory adults with CP and ignore the 6-minute walk as a peak measure — there is still no validated test for adults with severe mobility limits.
01Research in Context
What this study did
Lennon et al. (2015) hunted for fitness tests that truly work for ambulatory adults with cerebral palsy. They screened every paper that checked reliability or validity of aerobic or anaerobic tools.
They kept only studies that used gold-standard stats. The final pile held cycle ergometer trials, 6-minute walk tests, and a few other tools.
What they found
Maximal cycle tests earned a solid thumbs-up. Multiple studies showed stable scores and strong links with true oxygen uptake.
The 6-minute walk flunked as a maximal test. Evidence was strong against using it to claim peak aerobic capacity. For adults who cannot walk or pedal, no validated option exists yet.
How this fits with other research
Leung et al. (2017) looked at accelerometers in adults with intellectual disability. They also found a mess: no shared protocol and lots of missing data. Both reviews scream the same warning — pick your tool with care.
Patton et al. (2020) tested the ALPHA-Fit battery in ID. Only half of the subtests gave steady numbers. Their pickiness mirrors Nancy’s crew: some tests look easy but fail under real-world use.
Ferguson et al. (2020) built an equation that turns hip step counts into oxygen use for Down syndrome. It gives you a cheap proxy when cycle tests are impossible, filling the very gap Nancy flagged for more impaired adults.
Why it matters
If you run health programs for adults with CP, stick to maximal cycle ergometry when they can pedal. Skip the 6-minute walk as your peak test. When mobility is limited, borrow the F et al. step-count equation while we wait for better tools. Always report reliability data so teams know scores can be trusted.
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02At a glance
03Original abstract
OBJECTIVE: To analyze the clinimetric properties of maximal aerobic and anaerobic fitness measurement protocols in adults with cerebral palsy (CP). DATA SOURCES: A systematic search through March 2015 of databases PubMed, Embase, SPORTDiscus and PsycINFO was performed with medical subject heading terms for 'cerebral palsy' combined with search terms adults or adolescents and multiple text words for fitness and exercise tests that yielded 864 articles. STUDY SELECTION: Abstracts were screened by two reviewers to identify use of maximal fitness measurements in adolescents (14-18yrs) or adults (>18yrs) with CP of all abilities. Ninety-four articles were reviewed. No studies of adolescent (14-18yrs) qualified. Eight articles reported clinimetric properties for adults with CP who walk or propel a wheelchair independently. Five articles reported on aerobic capacity, one reported on anaerobic capacity and two reported on both. DATA EXTRACTION: Methodological quality of the studies was rated using portions of the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. Quality of the measurement protocols was evaluated based on statistical strength of the clinimetrics. Synthesis of the overall evidence was based on the Cochrane review group guidelines which combine methodological quality and statistical strength. DATA SYNTHESIS: Eight articles reported on 4 aerobic and 1 anaerobic protocols. Overall synthesis revealed that for ambulatory adults with CP there is (i) moderate evidence for good reliability and good construct validity of maximal aerobic and anaerobic cycle tests, (ii) moderate evidence for good criterion validity of sub-maximal aerobic cycle tests, and (iii) strong evidence for poor criterion validity of the six-minute walk test as a maximal aerobic test. And for adults who propel a wheelchair there is limited evidence of good reliability for maximal aerobic wheelchair ergometer tests. CONCLUSIONS: Limited quality research exists on the clinimetric properties of aerobic and anaerobic capacity measures for adults with CP who have independent mobility. Quality aerobic and anaerobic measures for adults with more severe mobility impairments are absent.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2015.08.002