A Synopsis: Evidence-Based Physical Activity Guidelines
for Individuals with Cerebral Palsy through Supported Standing
Presented by Britta Schwartzhoff, PT, DPT, ATP/SMS RESNA-certified Assistive Technology Professional and Seating and Mobility Specialist in her role as Clinical Education Specialist with Altimate Medical 8/14/2025.
Cerebral Palsy (CP) is a group of movement disorders caused by an early brain injury, impacting the sensorimotor areas responsible for movement, coordination, and posture. Affecting approximately 17 million people globally, CP is the most common lifelong physical disability. Adults with CP are more susceptible to a wide range of chronic conditions, including Type 2 diabetes, heart disease, and hypertension, often due to lower levels of health-related fitness and physical activity. These factors increase their risk for cardiometabolic issues, such as high blood pressure and cholesterol.
Physical Activity (PA) Guidelines from the World Health Organization (WHO)
For children aged 5-17, it is recommended they get an average of at least 60 minutes per day of moderate-to-vigorous physical activity, mostly aerobic, throughout the week. This should also include vigorous exercises that strengthen muscles and bones at least three days a week.
For adults, the recommendation is to engage in 150-300 minutes of moderate-intensity aerobic activity or 75-150 minutes of vigorous-intensity aerobic activity per week. Additionally, they should perform muscle-strengthening activities at least two times a week.
If an individual has a neurologic condition such as CP, the WHO makes the following
Good Practice Recommendations
• PA recommendations remain consistent
• Doing some PA is better than none
• Even if not meeting these recommendations, doing some PA will provide benefits
• Start by doing small amounts of PA and increase slowly over time
• No major risks with engaging in PA when appropriate to current activity level, health status, and physical function (benefits vs risks assessment)
• May need to consult health professional to determine best type and amount
• Limit sedentary time
Despite these recommendations, according to research, individuals with CP are often sedentary for 76-99% of their waking hours. Those with more severe physical involvement tend to be less active, which puts them at a greater risk for additional health problems. The most common barriers to physical activity for people with CP include limited motor function, lack of accessible facilities, financial constraints, and insufficient time or assistance.
The Role of Supported Standing
The numerous benefits of supported standing, such as improving bone mineral density, reducing spasticity, and enhancing overall quality of life, are widely recognized. However, it's less commonly known that for individuals with CP, especially those classified at Gross Motor Function Classification System (GMFCS) levels IV or V, supported standing is not a passive activity. Research shows that standing increases energy expenditure to over 1.5 Metabolic Equivalent of Task (METs) for all GMFCS levels, meaning that simply changing an individual's position to standing can significantly contribute to their accumulation of light physical activity and reduce the time they spend being sedentary.
Any activity that is added to the position of supported standing will raise the individual’s exertion rate increasing METs.
Exercise Suggestions during Supported Standing
For Adults
- Arm Bike
- Boxing
- Use of Glider feature when available
- Cordless jump rope
- Weighted ball toss
- Weighted ropes
- Core strengthening activities
- Theraband strengthening activities
- Zoom Ball (with partner)
- Partial Range lower extremity strengthening
For Children
- Arts and Crafts: Drawing, painting, or working with playdough can be enhanced by the stability provided by the stander, allowing for better hand and arm control.
- Building: Activities like using blocks, stacking cups, or constructing with magnetic tiles can improve hand-eye coordination and spatial reasoning.
- Sensory Play: Activities like playing with kinetic sand, water beads, or textured materials can provide sensory stimulation and fine motor practice.
- Puzzles: Simple puzzles with large pieces or adapted puzzles can be engaging and help with problem-solving skills.
- Fine Motor Games: Using tongs to pick up small objects or playing with toys that require fine motor skills can be incorporated.
- Catch and Throw: Using soft, lightweight balls or beanbags to play catch can improve hand-eye coordination and spatial awareness.
- Reaching and Grasping: Positioning objects like bubbles or toys just out of reach encourages reaching and grasping, promoting midline crossing.
- Weight Shifting: Encouraging weight shifting from side to side while standing can improve balance and coordination.
- Cooking and Meal Prep: Assisting with age-appropriate tasks like washing vegetables or stirring ingredients can be incorporated into standing time.
- Social Games: Playing simple games like "Simon Says" or engaging in role-playing with family members can promote social interaction and communication.
- Music and Movement: Dancing or singing while standing can improve coordination and provide a fun way to move.
- Household Chores: Activities like folding laundry or dusting can be adapted for standing and can promote participation in daily routines.
Physical activity offers essential benefits for individuals with Cerebral Palsy (CP) throughout their lives. Supported standing is an effective intervention that promotes regular physical activity for these individuals. It not only helps them reduce sedentary time but also creates opportunities for additional activities, which in return enhances their health and functional abilities.
Resources
https://altimatemedical.com/education/ Evidence-Based Physical Activity Guidelines for Individuals with Cerebral Palsy through Supported Standing Presented by Britta Schwartzhoff, PT, DPT, ATP/SMS RESNA-certified Assistive Technology Professional and Seating and Mobility Specialist in her role as Clinical Education Specialist with Altimate Medical on 8/14/2025.
To view full resouces list, download this resource pdf.
