RESEARCH PAPER Group aquatic training improves gait efficiency in adolescents with cerebral palsy LAURENT BALLAZ 1,2 , SUZANNE PLAMONDON 2 & MARTIN LEMAY 1,2 1 De ´partement de kinanthropologie, Universite ´ du Que ´bec a `, Montre ´al, Que ´bec, Canada and 2 Centre de re ´adaptation Marie Enfant (CHU Sainte Justine), Montre ´al, Quebec, Canada Accepted November 2010 Abstract Purpose. To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system. Method. Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45 min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions’ intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function. Results. Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures. Conclusions. Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity. Keywords: Aquatic training, gait efficiency, muscular strength, adolescent, cerebral palsy Introduction Approximately three-quarters of children and ado- lescents with cerebral palsy (CP) are ambulatory with or without assistive device [1]. They typically walk more slowly and expend a greater amount of energy to walk than their healthy counterparts [2]. Such adaptations lead to poor gait efficiency, defined as energy cost per distance travelled during walking [3]. Poor gait efficiency has a significant impact on the autonomy and quality of life of patients with CP, reducing walking distance travelled and increasing the overall level of fatigue [4]. In CP, gait efficiency mainly depends on adapta- tions of the cardiorespiratory and musculoskeletal systems [2,5–7]. Adequate physical exercise training can attenuate the effects of these adaptations and eventually increases gait efficiency [7]. The cardior- espiratory system can be improved by aerobic training, therefore reducing the proportion of physi- cal capacity required during gait. The musculoske- letal system can also be improved with an appropriate muscle strength training programme and positively impact gait pattern resulting in a more efficient gait [8,9]. Unfortunately, the intensity of spontaneous physical activity is usually too low to significantly improve the cardiorespiratory or mus- culoskeletal systems (i.e. aerobic capacity and muscular strength). People with CP need to be enrolled in a training programme to significantly impact these systems [10]. Adolescents with CP could particularly benefit from an adequate training Correspondence: Laurent Ballaz, PhD, Sainte Justine University Hospital Centre, Montreal, Quebec, Canada. E-mail: laurent.ballaz@gmail.com Disability and Rehabilitation, 2011; 33(17–18): 1616–1624 ISSN 0963-8288 print/ISSN 1464-5165 online ª 2011 Informa UK, Ltd. DOI: 10.3109/09638288.2010.541544 Disabil Rehabil Downloaded from informahealthcare.com by University of Montreal on 08/09/11 For personal use only.