Physiological determinants of endurance capacity in individuals with cerebral palsy: a narrative review

OBJECTIVE: To synthesize evidence on the physiological determinants of endurance capacity in individuals with cerebral palsy. DESIGN: Narrative review. SUBJECTS/PATIENTS: Children and adults with cerebral palsy across the spectrum of motor function (Gross Motor Function Classification System I-V). METHODS: Relevant literature on cardiovascular, pulmonary, haematological, and musculoskeletal determinants of endurance capacity in individuals with cerebral palsy was identified and synthesized. RESULTS: Reduced cardiorespiratory fitness is common, with autonomic dysregulation potentially constraining heart rate responses during exercise, while lower oxygen pulse suggests limitations in stroke volume and peripheral oxygen extraction. Restrictive ventilatory patterns, including reduced functional lung volumes, may further impair exercise capacity. High energetic demands during basic movements exacerbate fatigue and reduce engagement in physical activity. Skeletal muscle also exhibits structural and metabolic alterations, including reduced muscle volume, capillary density, and mitochondrial function, impairing oxygen utilization and energy production. CONCLUSION: Despite methodological heterogeneity, evidence consistently indicates that integrated central and peripheral factors constrain endurance capacity, with impairments more pronounced in individuals with greater functional limitations. Adapted training modalities, such as Frame Running, show promise in improving these outcomes. Understanding these physiological determinants is essential for developing individualized interventions to improve function, participation, health, and quality of life in individuals with cerebral palsy.