Can a lifestyle intervention improve physical fitness in adolescents and young adults with spastic cerebral palsy? A randomized controlled trial

OBJECTIVE

To evaluate both the short- and long-term effectiveness of a lifestyle intervention on physical fitness in adolescents and young adults with cerebral palsy (CP).

DESIGN

Single-blind, randomized controlled trial.

SETTING

University hospitals and rehabilitation clinics.

PARTICIPANTS

Adolescents and young adults (N=57) with spastic CP classified in Gross Motor Function Classification System levels I through IV; of these, 42 completed the study.

INTERVENTION

A 6-month lifestyle intervention consisting of physical fitness training combined with counseling sessions focused on physical behavior and sports participation.

MAIN OUTCOME MEASURES

Physical fitness, including measures of cardiopulmonary fitness, muscle strength, and body composition.

RESULTS

Favorable short- and medium-term effects were found for peak oxygen consumption, oxygen consumption, and load on the anaerobic threshold and waist circumference. Favorable long-term effects were found for sum of skinfolds, systolic blood pressure, and total cholesterol.

CONCLUSIONS

This exploratory study showed that the lifestyle intervention was effective in improving cardiopulmonary fitness and body composition. Effects of body composition were maintained in the long term. However, the intervention needs to be optimized to increase muscle strength and for long-term retention of effects on aerobic capacity.

A comparison of amodiaquine and sulfadoxine-pyrimethamine as first-line treatment of falciparum malaria in Kenya

A randomized 14-day study in vivo compared the response of Plasmodium falciparum malaria to amodiaquine (35 mg/kg) and sulfadoxine-pyrimethamine (sulfadoxine, 25 mg/kg) in symptomatic outpatients at 2 sites in northern and western Kenya during 1993. Of the 239 patients recruited, 181 (76%) completed the study [84 (46%) on amodiaquine and 97 (54%) on sulfadoxine-pyrimethamine]. There were no significant differences in the parasitological, clinical or haematological responses between the 2 drug groups in both areas, with 18.5% resistance to amodiaquine versus 9.5% for sulfadoxine-pyrimethamine in the north and 35.1% against amodiaquine versus 34.5% for sulfadoxine-pyrimethamine in the west. In both sites defervescence was significantly more rapid with amodiaquine (P < 0.05) and true clinical failure (symptomatic illness with recurrent parasitaemia) was unusual (9%). As high-level resistance to chloroquine is widespread, both drugs are valuable alternatives. However, the significantly higher levels of resistance in the west may be a sign of the increased drug pressure in this holoendemic area and send an important warning concerning resistance to sulfadoxine-pyrimethamine.