PHYSICAL ACTIVITY AND VASCULAR HEALTH IN ADULTS WITH CP

RELATIONSHIPS BETWEEN MOTOR CLASSIFICATION, PHYSICAL ACTIVITY AND CARDIOVASCULAR HEALTH IN ADULTS WITH CEREBRAL PALSY

By

PATRICK MCPHEE, BSc.

A Thesis Submitted to the School of Graduate Studies

in Partial Fulfillment of the Requirements for

the Degree Masters of Science in Kinesiology

McMaster University MASTER OF SCIENCE (2014)

Hamilton, Ontario (Kinesiology)

TITLE: Relationships between motor classification, physical activity and cardiovascular health in adults with cerebral palsy

AUTHOR: Patrick McPhee, BSc. (McMaster University)

SUPERVISOR: Dr. Maureen MacDonald

SUPERVISORY COMMITTEE:Dr. Brian Timmons

Dr. Jan Willem Gorter

NUMBER OF PAGES: xv, 110

ABSTRACT

Cerebral palsy (CP) is a disability that impacts a person throughout their lifespan and may place adults with the condition at an increased risk of physical inactivity and cardiovascular disease. Cardiovascular structure and function in adults with CP has not been comprehensively investigated previously. In the current cross-sectional, observational study, endothelial function, carotid distensibility, and arterial stiffness were assessed using flow-mediated dilation (FMD), B-mode ultrasound, and pulse wave velocity (PWV), respectively, in forty adults with CP (age 33.7 12.7 years). The study sample was separated based on whether subjects were community ambulant or community non-ambulant using the Gross Motor Function Classification System (GMFCS). Those in GMFCS I-II were labeled community ambulant (age 31.7 10.4 years) while those in GMFCS III-V were community non-ambulant (age 34.8 13.6 years). Resting arterial stiffness was examined through assessment of central and upper and lower limb peripheral PWV (cPWV, uPWV, lPWV). Carotid intima-media thickness (IMT), a measure of vascular structure, was also quantified using B-mode ultrasound images and a semi-automated edge detection software program. cPWV was calculated using the distance (carotid to femoral using the subtraction method) and time delay between the foot of the carotid waveform and the foot of the femoral waveform. uPWV was calculated from the carotid to radial artery distance (subtracting the distance from the carotid to sternal notch from the carotid to radial distance) and the time delay between the arrival of the foot of each corresponding waveform. lPWV was calculated from the femoral to posterior tibialis artery using the distance between each site and time delay between the arrival of the foot of each corresponding waveform. Physical activity (PA) levels were assessed using Actigraph accelerometry with cut points that had been previously determined in normal adults. Cardiometabolic markers of fasting serum interleukin-6, insulin, glucose, and a lipid panel were analyzed. The non-ambulant group had an increased uPWV (10.2 m/s 1.9) compared to the ambulant group (8.28 m/s 1.6) (p0.05) in absolute, relative or normalized FMD responses. Both groups also had similar values of carotid IMT and carotid distensibility. No group differences were found in any of the cardiometabolic or inflammatory markers. Moderate-to-vigorous PA (MVPA) levels were greater in the ambulant group (2.4 mins 2.1 per hour) compared to the non-ambulant group (0.3 mins 0.6 per hour) (p