LONG-TERM SPORT OR EXERCISE COMMENCED BEFORE 16 YEARS OF AGE REDUCES ADVERSE BODY COMPOSITION OUTCOMES IN CEREBRAL PALSY

Abstract

Bone mineral density (BMD) and appendicular lean mass (ALM) deficits are common in people with cerebral palsy (CP), increasing sarcopenia and osteoporosis risk, while sport/exercise participation before age 16 improves adult peak bone mass accretion. This study investigated the effects of high-level sport/exercise participation commenced before 16 years of age on body composition in ambulatory adults with CP. Body composition was measured via dual-energy X-ray absorptiometry in a cross-sectional observational pilot study of 26 adults (m=19; f=7; GMFCS I-III) grouped via self-reported activity level into Low (<150 minutes moderate-vigorous activity weekly; n=10), Post-16 (active but commenced participation after 16; n=6), and Pre-16 (active and commenced participation before 16; n=10). Between-group Z-score differences were assessed via Kruskal-Wallis one-way ANOVA, with post-hoc comparisons via Mann-Whitney U-test. Whole body, spine and hip BMD Z-scores were significantly higher in Pre-16 (1.020 (0.639), 1.210 (1.102), and 0.450 (1.325), respectively) versus Low (-0.500 (0.715), -0.840 (0.957), and -1.020 (1.059), respectively) (p<0.001-0.008). Thirteen participants, including four competitive athletes, had low BMD, and 15, including eight athletes, had moderate-significant ALM deficits, versus age- and sex-specific reference populations. Ambulatory adults with CP who exceed physical activity guidelines and commenced participation before 16 years of age have higher BMD than those who are sedentary or commenced participation after 16 years. Sport and exercise across the lifespan are critical to ameliorate adverse body composition outcomes common in CP, however, some athletes remain at-risk and require targeted combined resistance training and dietary interventions in addition to sport training to address low ALM and BMD.