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Cerebral palsy: can exercises that strengthen calf muscles make walking easier for teenagers?

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What did the project achieve?

“Although we didn’t find evidence that performing strength exercises made walking easier for young people with cerebral palsy, they did perceive other benefits beyond the physical measurements that we took,” says Dr Jennifer Ryan of Brunel University London.

Cerebral palsy is the most common serious physical disability in children, affecting around 2,000 babies born in the UK each year.1-2 A child with the condition will experience lifelong difficulties with their movement and coordination, which may affect their ability to walk.

Sadly, these difficulties often worsen as teenagers with cerebral palsy become young adults – and so we set out to investigate if performing strengthening exercises made walking easier,” says Dr Ryan.

A total of 64 young people aged between 10 and 19 with cerebral palsy from across England took part in the study. The participants were randomly split into two groups, with half taking part in a 10-week strengthening programme with a physiotherapist – and the others continuing to receive their usual care. The team carried out a series of assessments at enrolment, 10 weeks later – and another 12 weeks after that.

“After the programme, when we looked at all adolescents together, we did not identify any differences between the two groups in the amount of energy they used to walk, muscle strength, muscle size, ability to perform activities, or participation in physical activities,” says Dr Ryan. “But when we looked only at those who were affected on both sides of their body, we did find that adolescents in the exercise group used less energy when walking.”

The participants also reported experiencing a range of physical and psychological benefits from taking part in the strengthening programme.

“These included feeling stronger, being able to keep up with their peers, and improved balance,” says Dr Ryan. “They felt a sense of achievement and pride when their bodies could do more than they expected, which motivated them to continue.”


  1. Wimalasundera, N. & Stevenson, V.L., Cerebral palsy. BMJ Practical Neurology 2016; 16:184-194.
  2. Office for National Statistics. Vital statistics in the UK: births, deaths and marriages – 2018 update. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/vitalstatisticspopulationandhealthreferencetables [website accessed 23 July 2019]

This research was completed on

Estimates suggest around one in every 400 children has cerebral palsy in the UK.1 They will experience lifelong problems with movement and coordination, which vary greatly from one child to another. If children learn to walk, it’s important to help them maintain this ability for as long as possible. Dr Jennifer Ryan, of Brunel University London, is investigating whether teenagers who perform exercises that strengthen calf muscles find walking easier. She believes this could help teenagers with cerebral palsy to stay fit and healthy, and improve their overall wellbeing.

Action Medical Research and the Chartered Society of Physiotherapy Charitable Trust are jointly funding this study

How are children’s lives affected now?

Every year in the UK, around 2,000 babies are diagnosed with cerebral palsy, the commonest physical disability of childhood.1-4 Parents often ask whether their child will learn to walk independently.

“A lot of teenagers with cerebral palsy can walk without any kind of walking aid,” says Dr Ryan “However, they tend to walk more slowly than other teenagers and walking takes more effort. They may find they can’t keep up with their friends, or tire more quickly, meaning they take part in fewer day-to-day activities, including sports.”

“Sadly, walking difficulties often become worse as teenagers become young adults,” continues Dr Ryan. “Associated reductions in levels of activity may put people with cerebral palsy at increased risk of getting heart disease and type 2 diabetes at a young age.”

We urgently need ways to help teenagers with cerebral palsy to keep walking as well as possible for as long as possible.

How could this research help?

“We’re investigating whether an exercise programme that’s designed to strengthen calf muscles benefits teenagers with cerebral palsy by improving their walking,” says Dr Ryan.

The team hopes to find answers to several important questions:

  • Do teenagers find the exercise programme acceptable? Does it fit well into day-to-day life?
  • Do the exercises make walking easier, reducing the effort required? Do they increase teenagers’ physical activity levels and help them participate more fully in everyday life?
  • How do the exercises improve walking? What effects do they have on the different muscles and tendons in the leg?

“If the exercise programme proves beneficial, it could lead to improvements in the physiotherapy that’s offered to teenagers with cerebral palsy and provide them with a programme that they can continue to perform independently in their local gym,” says Dr Ryan. “In the long run, we hope our work will enable people with cerebral palsy to stay fit and healthy for as long as possible, and improve their general level of wellbeing.”


1. NHS Choices. Cerebral palsy. http://www.nhs.uk/conditions/cerebral-palsy/pages/introduction.aspx Website accessed 30 December 2014.

2. ISD Scotland. Births in Scottish Hospitals. Year ending 31st March 2013. Publication date – 26th August 2014. http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publicatio... Website accessed 19 January 2015.

3. Northern Ireland Statistics and Research Agency. Births. Live Births, 1887 to 2013 (Excel). http://www.nisra.gov.uk/demography/default.asp8.htm Website accessed 19 January 2015.

4. Office for National Statistics. Births in England and Wales 2013. http://www.ons.gov.uk/ons/rel/vsob1/birth-summary-tables--england-and-wa... Website accessed 19 January 2015.





Project Leader Dr Jennifer M Ryan BSc PG Dip PhD
Project Team Dr Thomas Korff BSc PhDProfessor V Bill Baltzopoulos BSc MPhil PhDDr Cherry Kilbride MSc PhDDr Adam P Shortland BSc PhDMs Wendy Levin GradDip Phys
Project Location Centre for Research in Rehabilitation, Brunel University London
Project Location Other Centre for Sports Medicine and Human Performance, Brunel University LondonOne Small Step Gait Laboratory, Guy's Hospital, LondonSwiss Cottage School Development and Research Centre, Royal Free London NHS Foundation Trust
Project duration 3 years
Date awarded 24 November 2014
Project start date 2 August 2015
Project end date 1 August 2018
Grant amount £249,847
Grant code GN2340
Acknowledgements This project is supported by a generous grant from The Henry Smith Charity


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