Evaluating exercise interventions to improve activity, participation and quality of life for those living with complex forms of cerebral palsy

This doctoral thesis aims to evaluate the effect of exercise, and more broadly physical activity, on adults with cerebral palsy (CP), particularly individuals who use wheelchairs to access the community. There are few studies that provide uncertain evidence to guide exercise and physical activity interventions for adults with CP. Adults with CP often face greater health challenges compared to their non-disabled peers, making it difficult to achieve the potentially life-enhancing and risk-reducing benefits of physical activity. This issue is worsened for adults with CP living in regional and remote areas, where both health specialists and opportunities for community-based physical activity are often limited. To address the research question, this thesis explores three identified research gaps: 1) the lack of research on adults with CP, particularly individuals who use wheelchairs in the community, 2) the uncertain effects or guidance for implementing exercise and physical activity interventions that focus on quality of life and participation – attendance and involve, and the feasibility of implementing an evidence based strategy (FitSkills) in a regional setting. The doctoral project involved conducting a systematic review (study 1) to understand the current literature on exercise for adults with CP to improve quality of life and participation. Additionally, the project included speaking directly with adults with CP who use wheelchairs, about their wants and needs regarding physical activity participation. Based on the findings from these studies, the thesis proposes the adaptation of an existing community-based exercise gym intervention (FitSkills), using the guidance from the initial research phases. The aim is to determine whether a peer-mentored gym-based intervention is feasible in a regional setting and has the potential to improve quality of life and participation for adults with CP. The implications of this research are: 1) for future research, it provides a foundation to further explore the sustainability of community based program in regional communities; 2) for practice, it encourages councils and local service providers to develop the confidence, skills, and tools to implement community based physical activity programs such as a peer-mentored gym intervention; 3) and for individuals with CP, it offers opportunities to take part in authentic physical activity within their communities, in environments that support autonomy, individuality, and positive social attitudes.