Energetics of walking in individuals with cerebral palsy and typical development, across severity and age: A systematic review and meta-analysis

Mauro Nardon, Federico Ruzzante, Leslie O'Donnell, Alessandra Adami, Sudarshan Dayanidhi, Matteo Bertucco*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


Background: Individuals with cerebral palsy (CP) report physical fatigue as a main cause of limitation, deterioration and eventually cessation of their walking ability. A consequence of higher level of fatigue in individuals with CP leads to a less efficient and long-distance walking ability. Research question: This systematic review investigates the difference in 1) walking energy expenditure between individuals with CP and age-matched typically developing (TD) individuals; and 2) energetics of walking across Gross Motor Function Classification System (GMFCS) levels and age. Methods: Five electronic databases (PubMed, Web of Science, CINAHL, ScienceDirect and Scopus) were searched using search terms related to CP and energetics of walking. Results: Forty-one studies met inclusion criteria. Thirty-one studies compared energy expenditure between CP and age-matched controls. Twelve studies correlated energy expenditure and oxygen cost across GMFCS levels. Three studies investigated the walking efficiency across different ages or over a time period. A significant increase of energy expenditure and oxygen cost was found in individuals with CP compared to TD age-matched individuals, with a strong relationship across GMFCS levels. Significance: Despite significant differences between individuals with CP compared to TD peers, variability in methods and testing protocols may play a confounding role. Analysis suggests oxygen cost being the preferred/unbiased physiological parameter to assess walking efficacy in CP. To date, there is a knowledge gap on age-related changes of walking efficiency across GMFCS levels and wider span of age ranges. Further systematic research looking at longitudinal age-related changes of energetics of walking in this population is warranted.

Original languageEnglish (US)
Pages (from-to)388-407
Number of pages20
JournalGait and Posture
StatePublished - Oct 2021


  • Cerebral palsy
  • Energetics
  • Oxygen consumption
  • Oxygen cost
  • Walking

ASJC Scopus subject areas

  • Biophysics
  • Rehabilitation
  • Orthopedics and Sports Medicine


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