SHORT ANSWER
Advances and Answers in Pediatric Health
Walking the Walk
ORTHOPEDICS
For most adults , increased physical activity lowers the risk of cardiovascular disease , or CVD . That ’ s not always true for individuals with physical disabilities . In the case of cerebral palsy , the combination of increased activity with poor gait biomechanics can in fact lead to pain , chronic fatigue and subsequently decreased activity , resulting in a net negative impact on the risk of CVD .
It ’ s a serious long-term concern as young people with cerebral palsy make the transition from pediatric to adult care , and it ’ s the focus of the Cerebral Palsy Adult Transition Study , led by James Carollo , PhD .
One of the first of its kind , the study looked at the relationship between walking ability , as measured by the gross motor function classification system , or GMFCS , and markers of metabolic syndrome , generally considered a prelude for CVD . Carollo and his team looked at age , waist-to-hip ratio , blood pressure , blood glucose , cholesterol , insulin , triglycerides , and high- and lowdensity lipoprotein in 70 young adults with cerebral palsy who ’ d previously had their ambulatory ability assessed at Children ’ s Colorado ’ s Center for Gait and Movement Analysis .
The team then compared those subjects ’ data to age-matched populations from the National Health and Nutrition Examination Survey registry , a long-running CDC study that collects data on the prevalence of chronic conditions in the population at large , and used a tool called the Framingham Heart Study , or FHS , to estimate subjects ’ 30-year risk of CVD .
Ultimately , the study identified metabolic syndrome in 17.1 % of the cerebral palsy cohort , versus 10 % in the general population , and their FHS factor showed an increased risk of 20 to 40 %. As suspected , participants with greater walking impairment also had elevated markers of metabolic syndrome .
“ So that shows you these markers should be included in their standard of care ,” says Dr . Carollo . “ There ’ s a lot we don ’ t understand about these risk factors in this population , but we do know that quality of care in childhood is going to have deep implications for their long-term health and quality of life .”
The study is an influential step in that direction . Published in Developmental Medicine & Child Neurology in 2019 ( 1 ), it influenced new recommendations for patients with cerebral palsy issued by the American Heart Association this year . •
1 . Heyn PC , Tagawa A , Pan Z , Thomas S , Carollo JJ . Prevalence of metabolic syndrome and cardiovascular disease risk factors in adults with cerebral palsy . Dev Med Child Neurol . 2019 Apr ; 61 ( 4 ): 477-483 .
JAMES CAROLLO , PHD , PE
Director , Musculoskeletal Research Center Director , Center for Gait and Movement Analysis Children ’ s Hospital Colorado
Associate professor , Physical Medicine & Rehabilitation , University of Colorado School of Medicine
PATRICIA HEYN , PHD , FGSA , FACRM
Deputy Director , Cochrane US University of Colorado Affiliated Center
Associate professor , Physical Medicine & Rehabilitation University of Colorado School of Medicine
Research Associate , Center for Gait and Movement Analysis ( CGMA ) Children ’ s Hospital Colorado
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