Effects of treadmill training on cardiorespiratory endurance and constipation in children with cerebral palsy: a randomized clinical trial

Background: Children with cerebral palsy (CP) commonly experience reduced cardiorespiratory endurance due to limited mobility and sedentary lifestyle. Constipation is also a frequent comorbidity affecting their health and quality of life. Treadmill training has been suggested as an effective intervention to improve physical fitness and functional mobility in children with CP. Objective: To evaluate the effects of treadmill training on cardiorespiratory endurance and constipation in children with spastic diplegic cerebral palsy. Methodology: A randomized clinical trial was conducted from January to May 2024 at Rahman Medical Institute and Akbar Kare Institute, Peshawar. Thirty-six children with spastic diplegic CP (aged 4–10 years; GMFCS levels I–II) were randomly assigned to treadmill training plus conventional physical therapy (TT, n=18) or conventional physical therapy alone (CPT, n=18). The intervention lasted 12 weeks with progressive exercise intensity. Cardiorespiratory endurance was assessed using the 6-Minute Walk Test (6MWT), while constipation severity was measured using the Constipation Assessment Scale (CAS). Data were analyzed using MANOVA, independent t-test, and repeated-measures ANOVA (α≤0.05). Results: MANOVA showed a significant overall effect of intervention on combined outcomes (Pillai's Trace=0.338, p=0.002). The TT group demonstrated significantly greater improvement in 6MWT distance compared with the CPT group (p<0.001). However, no significant between-group differences were observed for CAS scores (p=0.444), although both groups showed within-group improvement over time. Conclusion: Treadmill training significantly improves cardiorespiratory endurance in children with spastic diplegic cerebral palsy but does not provide additional benefits for constipation compared with conventional therapy alone.