Effects of eccentric strength training in improving motor functions in people with cerebral palsy: a systematic review

Objective(s): To determine the effectiveness of eccentric strength training (ECC) in improving motor functions in people with cerebral palsy (CP).

Data Sources: A systematic search of randomized and non-randomized controlled clinical trials, and quasi-experimental trials, was made in MEDLINE, Web of Science, Rehabilitation & Sports Medicine, Cochrane Library, PEDro and OTSeeker databases. The search considered the date since opening date of the database until March 2023. The search strategy included terms related to population(cerebral palsy) and intervention (eccentric strength training), in human studies, without language restrictions.

Study Selection: The inclusion criteria were trials with CP participants with a prescription of ECC (e.g., going down hills), compared with other exercise mode (e.g., concentric training) or rehabilitation. The outcome were muscle strength, neuromuscular activation, muscle mass, balance, gait velocity, gross motor skills, and adverse events. Two authors independently selected titles and abstracts of retrieved studies using the software Abstrackr. A third reviewer resolved discrepancies. A proportion of 4/426 articles met the selection criteria.

Data Extraction: The data extracted included characteristics of study population, intervention, comparator, methodology, results, adverse events, and information to assess the risk of bias. One author extracted the data, and the second author checked the information. Disagreements were resolved by discussion and then by the third author. The risk of bias was assessed with Cochrane tools (RoB 2.0 and Robins-I).

Data Synthesis: Four articles with fourty-six participants were included. The qualitative synthesis revealed that ECC seems to improve muscle strength, balance, muscle volume, gait speed, GMFM score, and decreased the neuromuscular activity. No significant adverse events were reported. The risk of bias of articles ranged from some concern to high.

Conclusions: The evidence of ECC in CP is limited, the scant literature seems to suggest that ECC could improve motor functions in individuals with CP and appears to be safe. However, the limited number of studies and the risk of bias still result in low certainty of the evidence.

Author(s) Disclosures: All authors do not have any conflict of interest to declare.