None listed
Conditions
Brief summary
It is known that moderate-intensity physical activity enhances health, fitness and functioning in people with cerebral palsy (CP). Anecdotal evidence indicates high training loads designed to develop Paralympic swimmers may elicit excellent clinical outcomes. The primary aim of the program of research will be to evaluate the therapeutic benefit of a performance-focused swimming intervention for people with cerebral palsy who have high support needs. We hypothesise that outcomes of the study will substantiate the anecdotal evidence. Specifically, that high training loads will improve health, fitness and functioning in people with cerebral palsy who have high support needs. 3 young people with moderate to severe cerebral palsy who are insufficiently active for health, but are interested in participating in competitive sport, will be recruited. The study will adopt a concurrent multiple baseline design with 5 phases: A1-B1-A2-B2-A3. The first phase is a baseline testing phase (A1) for participants 1, 2 and 3 lasting 10 weeks, 16 weeks and 22 weeks respectively. There will be 5, 8 and 11 baseline data points for participants 1, 2 and 3 respectively. The intervention will then be introduced to participants in a staggered sequence. The first part of the intervention is a 16 week performance-focused swimming training phase (B1) during which there will be 8 data collection points. The training program will comprise of moderate to high intensity swimming, aerobic, strength, neuromotor and flexibility training which is individually tailored to optimise swimming performance. The intensity and duration of training sessions will vary but will be steadily increased throughout the phase. This phase will be followed by a 5-week maintenance phase (A2), in which there will be no training. There will be 5 data collection points in this phase. Participants will then undergo the second part of the intervention - a further 16 week training phase (B2), which will mirror phase B1. There will be 8 data collection points in this phase. Finally, participants will undergo a further 5 week maintenance phase in which there will be no training. There will be 5 data collection points in this phase, which will mirror phase A2. Outcomes will relate to health, fitness and functioning, and findings are expected to provide an indication of the therapeutic value of sports participation for the population of interest. The study is expected to have implications for neurological rehabilitation.
Interventions
Following a familiarisation phase and baseline testing, each participant will complete a 16-week period of performance-focused swimming training which will be delivered by a multi-professional team of qualified swim coaches, physiotherapists and exercise physiologists. The term “performance-focused” refers to the fact that the sole aim of all strategies employed in this intervention will be to permit and then improve competitive swimming performance. In general, the program will comprise a combi
Following a familiarisation phase and baseline testing, each participant will complete a 16-week period of performance-focused swimming training which will be delivered by a multi-professional team of qualified swim coaches, physiotherapists and exercise physiologists. The term “performance-focused” refers to the fact that the sole aim of all strategies employed in this intervention will be to permit and then improve competitive swimming performance. In general, the program will comprise a combination of low to high intensity aerobic, strength, neuromotor and flexibility training which will be individually tailored to optimise swimming performance. This will involve a combination of gym-based training and pool-based training sessions. Within the gym-based sessions, a combination of land-based aerobic training, resistance training and stretching exercises will be carried out. Balance, proprioception and motor control training will also be included in the program. Swimming training in this phase will aim to improve swimming technique, aerobic and anaerobic endurance, speed and in-water power, race starts and the ability to maintain maximal pace. The frequency and duration of training sessions will vary, but will aim to gradually increase over the course of the phase. Training will be carried out in a combination of group and one-on-one sessions, and participants will be paired with a non-disabled volunteer training buddy who will complete exercise sessions with them, providing motivational support and exercise assistance (e.g., equipment access, exercise positioning, and in-water support). Participants will also receive advice from undergraduate dietetics students and postgraduate sports psychology students at the University of Queensland. This element of the intervention will be primarily educational, and will be included to support the participants in the transition into sports participation. The support from dietetics students will aim to enhance the participant’s understanding of healthy dietary behaviours, and sports psychology students will utilise techniques known to enhance motivational readiness such as goal setting and self-monitoring while training. In the final 2 weeks of the 16-week period participants will taper – that is, training volume will be reduced in a systematic, non-linear fashion with the aim of facilitating recovery and optimising peak performance at a competitive event. Participants who are able to complete 50 metres of continuous swimming will be entered into a local competition conducted by an accredited swimming club. If participants are unable safely to complete 50 metres – the minimum distance for an official competition – a competitive event will be tailored for them in which they will compete against other invited swimmers in a competition which conforms as closely with para swimming rules as possible. Following the first performance-focused training period and time trial, there will be a 5-week ‘maintenance’ phase during which training will be withdrawn. This phase will act as a recovery period for participants, however testing will continue. Following the maintenance phase, the participants will train for a further 16 weeks. This will once again be a performance-focused cycle of training which aims to increase independent swim distance and enhance swimming speed. The same principles of training used in training period 1 will be applied in training period 2: a combination of low to high intensity aerobic, strength, neuromotor and flexibility training which is designed to optimise swimming performance. Participants will continue to train in groups and one-on-one with their training buddies, and will continue to receive advice from undergraduate dietetics students and postgraduate sports psychology students at the University of Queensland. Once again, participants will complete a timed maximal swim over a distance suited to their ability in the final weeks of the 16-week training period. Following completion of the MBD, the study will continue for a further a 4-year period. The participants will continue the same training program for 4 further seasons, aligned with the competitive swimming season in Queensland, Australia. Withdrawal phases will be incorporated within and between seasons to facilitate recovery. (UQ ethical approval #2018001472).
Sponsors
University of Queensland
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
15 Years to 30 Years
Healthy volunteers
No
Inclusion criteria
a) Cerebral palsy, GMFCS III IV or V; b) Aged greater than or equal to 15 years and less than 35 years; c) Insufficiently active for health (i.e. not consistently meeting national physical activity guidelines); d) have not participated in a performance focused swimming training program in the past five years; e) high water confidence; f) can be safely supervised in the water by a single qualified instructor and able to safely disengage for at least three seconds; g) Medically fit to participate in a graduated swim for fitness program including: i. Water Immersion: no medical contraindications to water immersion (i.e., ability to safely swallow thin fluids and a strong effective cough); and ii. Seizure Disorder: no seizure disorder or, affected by a seizure disorder which did not increase in severity or frequency with exertion and for which there was a management plan could be executed by a single qualified instructor h) Intellectually able to understand and engage in supervised exercise; and i) Have sufficient time and/or family support to commit to the intervention.
Exclusion criteria
a) Recent serious musculoskeletal injury or illness; b) Major surgery in the last six months or currently scheduled; c) High Cardiovascular Risk; d) Compromised skin integrity that is contagious, severe or ongoing; e) Pain levels which affect ability to engage in exercise; f) Significant intellectual impairment which affects ability to follow instructions; and g) Significant dysphagia or oromotor dysfunction with an associated increase in the risk of aspiration.
Outcome results
None listed