Accelerometer-measured physical activity, sedentary behavior, and sleep in children with cerebral palsy and their adherence to the 24-hour activity guidelines

Raquel Y Hulst, Jan Willem Gorter, Joyce Obeid, Jeanine M Voorman, Ilse M van Rijssen, Anke Gerritsen, Johanna M A Visser-Meily, Sigrid Pillen, Olaf Verschuren, Raquel Y Hulst, Jan Willem Gorter, Joyce Obeid, Jeanine M Voorman, Ilse M van Rijssen, Anke Gerritsen, Johanna M A Visser-Meily, Sigrid Pillen, Olaf Verschuren

Abstract

Aim: To measure and describe the 24-hour activities (i.e. physical activity, sedentary behavior, and sleep) and to examine adherence to the 24-hour activity guidelines among children with cerebral palsy (CP) using actigraphy.

Method: Children's 24-hour activities were recorded over 7 days using hip- and wrist-worn ActiGraph wGT3X-BT accelerometers.

Results: In total, 362 days and 340 nights from 54 children with CP (Gross Motor Function Classification System [GMFCS] levels I-III; 44% females; median age [range] 6 years 6 months [3-12 years]) were included. Mean (SD) daily wear time was 746.2 (48.9) minutes, of which children spent on average 33.8% in light physical activity (251.6 [58.7] minutes per day), 5.2% in moderate-to-vigorous physical activity (38.5 [20.1] minutes per day), and the remaining 61.1% being sedentary (456.1 [80.4] minutes per day). Physical activity decreased while sedentary behavior increased with increasing GMFCS level. In total, 13% of all children met the physical activity recommendations, and 35% met the age-appropriate sleep duration recommendation. The proportion of children meeting the combined 24-hour guidelines for physical activity and sleep was low (5.9%), especially in those classified in GMFCS level III (0%).

Interpretation: The observed low 24-hour guideline adherence rates emphasize the importance of considering the entire continuum of movement behaviors in the care of children with CP, in efforts to promote healthy lifestyle behaviors and prevent negative health outcomes.

© 2022 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Figures

FIGURE 1
FIGURE 1
The ActiGraph wGT3X‐BT triaxial accelerometers (upper left) worn around a child's wrist using a watch strap during the night (upper right), and worn around the hip using an elastic belt (lower left) covered by clothing (lower right) during the day.
FIGURE 2
FIGURE 2
Normalized wear time spent in sedentary behavior, light physical activity, and moderate‐to‐vigorous physical activity for (a) all individual participants clustered by Gross Motor Function Classification System (GMFCS) level and sorted from highest to lowest sedentary behavior, and subgroup data across (b) GMFCS level and (c) age group.
FIGURE 3
FIGURE 3
Total time in bed (hours) spent in sleep onset latency (SOL), total sleep time (TST), and wakefulness after sleep onset (WASO) for (a) all individual participants sorted by age group, and subgroup data across (b) Gross Motor Function Classification System (GMFCS) level and (c) age group.
FIGURE 4
FIGURE 4
Adherence to individual components of the 24‐hour activity guidelines and adherence to the combined 24‐hour activity guidelines for children with cerebral palsy for (a) all children and by Gross Motor Function Classification System (GMFCS) level and (b) by age group.

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