The Ultimate Guide to Cerebral Palsy and Exercise
Strategies to Improve Quality of Life—with Clinical Insight on How I Tailor Exercise Plans Based on Functional Thresholds
Table of Contents
Introduction
Cerebral palsy (CP) brings a range of challenges—tight muscles, fatigue, coordination issues, and sometimes pain or difficulty with walking. But here’s the good news: exercise, when done the right way, can make a huge difference.
Whether you're aiming for better posture, easier transfers, or more comfort in daily movement, physical activity can unlock potential in ways that go far beyond the gym. And when it’s adapted to the person’s current ability and energy level, exercise becomes empowering.
As an exercise physiologist, I’ve worked with people across the full CP spectrum—from young kids to adults, from walkers to wheelchair users. One of the most important things I’ve learned is this: the best results come when we adjust the plan session by session, based on what the body is ready for on that day.
What Is Cerebral Palsy?
Cerebral palsy is a group of conditions that affect how muscles work. It’s caused by damage to the developing brain—usually before or during birth. People with CP might have stiff muscles, poor coordination, or difficulty with balance and movement. These challenges vary from person to person.
The brain injury doesn’t get worse over time, but the effects on the body can—especially if muscles tighten from lack of use or joints lose mobility. That’s where exercise comes in.
More Information (CDC):
What Is the GMFCS—and Why Does It Matter?
To make sure exercise is safe and effective, we use a tool called the Gross Motor Function Classification System (GMFCS). It helps us understand a person's current movement level.
Here’s a quick breakdown:
Level I:
Walks independently. May have some balance or coordination challenges.
Level II:
Walks in most settings but may need help with uneven ground or long distances.
Level III:
Uses walking aids (like a walker or crutches). May use a wheelchair for longer distances.
Level IV:
Mostly uses a wheelchair. May stand or take a few steps with support.
Level V:
Needs full physical support for movement and positioning.
This system helps us match the right type and intensity of exercise to the person’s needs and goals.
More Information: CanChild
How I Titrate Exercise: Adjusting Based on Daily Function
1. The Functional Readiness Scan
Before each session, I quickly check:
Tone: Are their muscles tighter than usual? Any sudden increases in stiffness?
Fatigue: Did they sleep well? Do they seem low on energy today?
Coordination: Are movements smooth or jerky?
Focus: Are they alert and engaged, or distracted and overwhelmed?
If someone’s tight or tired, we go gentler: maybe stretching, breath work, or pool movement. If they’re focused and their body feels good, we ramp up to strength or balance work.
2. Short Movement Blocks > Long Workouts
Long workouts can lead to mental or physical fatigue. Instead, I use short, focused blocks:
10 minutes of movement (like reaching, standing, or assisted walking)
3–5 minutes of rest, play, or sensory activity
10 minutes of strength work (like sit-to-stand or resistance band drills)
Cool-down with stretching or breathing
This keeps energy up, helps focus, and allows us to adapt mid-session.
3. Tools and Therapies I Often Use
Depending on the person’s needs, I often mix in:
Aquatic therapy: Warm water reduces spasticity and makes movement easier.
Passive range of motion (PROM): Gently moving a limb to keep joints flexible, especially for people who can’t do it themselves.
Treadmill or gait training: Often with harnesses or supports, to practice walking patterns safely.
Physical Benefits of Exercise for People With CP
1. Cardiovascular Fitness (Aerobic Exercise)
Think swimming, cycling, or dancing.
These activities:
Improve heart and lung health
Boost energy and endurance
Help with sleep and mood
Aerobic exercise improves endurance and day-to-day function in people with CP (PubMed).
2. Strength Training
Even gentle resistance work—like pushing against a band or practicing sit-to-stand—can:
Reduce fatigue
Improve posture
Make daily activities easier (like getting off the toilet or climbing stairs)
Research shows that resistance training does not increase spasticity, and can improve function (PubMed).
3. Balance & Flexibility Work
We often underestimate how much balance impacts confidence. Balance training and gentle stretching can:
Help with standing, transfers, and fall prevention
Improve comfort
Reduce joint stiffness
Great options include seated yoga, Tai Chi, aquatic movement, or games that encourage shifting weight and reaching.
Mental Health and Social Benefits
Exercise isn’t just physical—it boosts mood, motivation, and social connection.
Mood: Movement increases brain chemicals like serotonin, which helps regulate mood and reduce anxiety.
Confidence: Meeting even small movement goals builds a strong sense of independence.
Connection: Group classes or sports (like wheelchair basketball or adaptive dance) can reduce isolation and increase joy.
A 2022 review showed that physical activity improves mood, attention, and self-esteem in youth with CP (PubMed).
Preventing Contractures: My Go-To Basics
Contractures happen when muscles or tendons get too tight, limiting joint movement. These are common in CP, especially if a joint isn’t moved regularly.
Here’s how we can help prevent them:
Key Exercises
Hamstring and calf stretches: Crucial for kids who walk on their toes or have tight knees.
Hip flexor stretching: Helps reduce forward-tilted pelvis and supports upright posture.
Daily PROM: Especially for those in GMFCS IV–V.
Functional strength: Sit-to-stand, side leg lifts, and reaching exercises help build active range of motion.
Supportive Tools
Orthotics (like AFOs) to keep ankles aligned
Standing frames to bear weight through the legs
Wedges or positioning aids to support good posture at rest
Pool therapy to reduce gravity’s load on joints
Stretching works best when combined with strength training in the opposing muscles.
Final Thoughts
Every Body Moves Differently—and That’s the Point
Exercise for someone with cerebral palsy isn’t about chasing Olympic-level performance. It’s about unlocking what’s possible for them, today. With the right structure, patience, and creativity, movement becomes a source of:
Confidence
Independence
Joy
When we meet people where they are—physically, emotionally, and functionally—we turn exercise into empowerment.
