Physical health in individuals with cerebral palsy: from understanding cardiovascular disease to prevention of multimorbidity

Abstract

Cerebral palsy (CP) is no longer just a childhood disability. Children with CP grow up and become adolescents and eventually adults. However their risk of cardiovascular disease (CVD) and multimorbidity, defined as the presence of at least two chronic conditions, is poorly understood. This thesis sought to investigate CVD risk in individuals with CP and identify important health variables to understand and prevent multimorbidity development in this population. First, we discovered that adults with CP have an increased prevalence of CVD and an increased risk of death due to CVD compared to the general population, which raises concerns about CVD in people with CP and warrants further study. We investigated differences in cardiovascular health and moderate-to-vigorous physical activity (MVPA) in ambulatory adolescents and adults with CP between Gross Motor Function Classification System (GMFCS) levels I and II. Our findings suggest individuals who are GMFCS level II may be at increased risk for CVD in comparison to individuals who are GMFCS level I. We then evaluated longitudinal changes in risk factors of CVD in a cohort of individuals with CP. After a time interval of 4.0 ± 1.2 years, we found decreased absolute and relative brachial artery flow mediated dilation as measures of endothelial function, while carotid artery intima media thickness increased. We also discovered that 75% of participants with CP reported poor sleep quality, 80% engaged in less than the recommended 150 minutes of MVPA per week and 14% had poor eating behaviours. Taken together, this research suggests that individuals with CP experience accelerated aging for disease progression, specifically CVD, and that physical activity, sleep, and nutrition, together, could provide a framework for a lifestyle intervention to reduce and prevent multimorbidity risk in individuals with CP.