title: A lifestyle intervention improves fatigue, mental health and social support among adolescents and young adults with cerebral palsy: focus on mediating effects.
abstract: OBJECTIVE
  To evaluate the effect of a lifestyle intervention on fatigue, participation, quality of life, gross motor functioning, motivation, self-efficacy and social support, and to explore mediating effects of physical behavior and physical fitness.
  
  
  METHODS
  A randomized controlled trial with intention to treat analysis.
  
  
  METHODS
  Rehabilitation centers in university hospitals in the Netherlands.
  
  
  METHODS
  Adolescents and young adults with spastic cerebral palsy.
  
  
  METHODS
  A six-month lifestyle intervention that consisted of physical fitness training combined with counseling sessions focused on physical behavior and sports participation.
  
  
  METHODS
  Fatigue, social participation, quality of life and gross motor functioning.
  
  
  RESULTS
  The lifestyle intervention was effective in decreasing fatigue severity during the intervention (difference = -6.72, p = 0.02) and in increasing health-related quality of life with respect to bodily pain (difference = 15.14, p = 0.01) and mental health (difference = 8.80, p = 0.03) during follow-up. Furthermore, the domain participation and involvement of the social support increased during both the intervention (difference = 5.38, p = 0.04) and follow-up (difference = 4.52, p = 0.03) period. Physical behavior or physical fitness explained the observed effects for 22.6%, 9.7% and 28.1% of improvements on fatigue, bodily pain and mental health, but had little effect on social support (2.6%).
  
  
  CONCLUSIONS
  Fatigue, bodily pain, mental health and social support can be improved using a lifestyle intervention among adolescents and young adults with cerebral palsy. Furthermore, substantial mediating effects were found for physical behavior and physical fitness on fatigue, bodily pain and mental health.
authors.affiliation: Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands Rijndam Rehabilitation Center, Rotterdam, The Netherlands j.slaman@erasmusmc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Slaman
authors.affiliation: Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: H J G
authors.initials: HJ
authors.lastname: van den Berg-Emons
authors.affiliation: Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Meeteren
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Twisk
authors.affiliation: Sophia Rehabilitation, The Hague, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Markus
authors.affiliation: Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Stam
authors.affiliation: Rijndam Rehabilitation Center, Rotterdam, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: van der Slot
authors.affiliation: Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Roebroeck
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005221:Fatigue / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008603:Mental Health; D009048:Motor Skills; D009426:Netherlands; D010809:Physical Fitness; D011788:Quality of Life; D020377:Self Efficacy; D058992:Social Participation; D012944:Social Support; D013177:Sports / Q000502:physiology / Q000523:psychology; D055815:Young Adult
keywords: Participation (WHO ICF); cerebral palsy; fatigue; motor performance; quality of life