Exercise is safe and useful for people with cerebral palsy (CP), and strength training is part of that. The Australian clinical position is to aim for the same targets as everyone else where possible: aerobic activity plus strengthening, adapted to the person. For trainers, the work is in the adaptation: managing fatigue, choosing equipment that controls movement, and treating the client as the expert in their own body.
This guide covers what the evidence says about dosage, what to program, what to avoid, how to work with a client's allied health team, and where NDIS funding fits. It is written for fitness professionals and gym owners, and it is useful for anyone with CP who wants to know what good training should look like.
TL;DR
- Aim for at least 150 minutes of moderate-intensity aerobic activity a week, plus muscle strengthening on two or more days, scaled to the client's starting point and built up gradually.
- Strength training does not make spasticity worse. Train both sides of a joint, and use machines or adapted equipment where free weights are unsafe.
- Expect faster fatigue, plan rest breaks, and judge sessions by movement quality, not only by task completion.
- Ask about GMFCS level, recent botulinum toxin injections and surgery, and keep the client's physiotherapist or exercise physiologist in the loop.
- Fear of pain or injury is often a bigger barrier than the exercise itself, so familiarity and a collaborative approach matter.
Table of Contents
- What cerebral palsy means for a training session
- How much exercise: the numbers
- What the evidence supports
- Strength training and spasticity
- Fatigue, rest and movement quality
- Know the client: GMFCS and medical history
- Working with an exercise physiologist and the NDIS
- Designing a week: an example
- Fear is a barrier too
- Our perspective
- Build the skills with Inclusive-AF
- A checklist before the first session
- FAQ
- Sources
What cerebral palsy means for a training session
CP is a non-progressive disorder that affects movement and coordination, with many causes and different types of movement disorder, according to the OneAbility handbook from an adapted strength and conditioning program. Non-progressive does not mean unchanging in daily life. Muscle tone, joint range and energy cost shift with growth, age, surgery, injections, temperature and tiredness.
That is why a diagnosis alone tells you very little. Two clients who both say "I have CP" can have completely different goals, movement patterns and capacity. One may walk unaided and want to run a 5 km event. Another may use a power wheelchair and want to build upper-body strength for transfers. Your program starts from the person in front of you.
The umbrella review of systematic reviews notes that CP is the most common childhood disability, affecting 1.5 to 3 per 1000 live births, and that physical exercise has been shown to improve muscle and limb outcomes. Many of your clients with CP will have been active in therapy since childhood. What many have not had is access to a mainstream gym where staff know what to do.
How much exercise: the numbers
The Cerebral Palsy Alliance submission to the NDIA Evidence Advisory Committee says exercise programs for people with CP should include both aerobic and strength training, delivered by qualified professionals. It describes guidance for adults aligned with general population standards where appropriate:
| Component | Target |
|---|---|
| Aerobic activity | At least 150 minutes of moderate intensity per week (or 75 minutes of vigorous intensity) |
| Muscle strengthening | Two or more days per week |
| Structured therapeutic programs | 2 to 3 sessions per week, at least 20 minutes each |
| Program length for functional gains | 12 to 16 consecutive weeks |
The first global physical activity guidelines for people living with disability add an important point for the way you onboard people: start with small amounts and gradually increase frequency, intensity and duration where able. A client who has not exercised in years should not be handed 150 minutes in week one.
For a deeper look at the evidence behind CP-specific recommendations, the Verschuren and colleagues review sets out frequency, intensity and time for continuous and rhythmic exercise involving major muscle groups. It is written for clinicians, but it is readable and worth skimming before you design a block.
Reading the numbers sensibly
These are targets, not entry requirements. A client with significant fatigue might begin with 10 minute bouts, split across the day. Count those minutes. The aim is a sustained habit over 12 to 16 weeks, not a heroic first month.
What the evidence supports
The CPA submission reports that task-oriented training, virtual-reality-assisted training and resistance-based training are among the most effective interventions for limb and gross motor function in people with CP. It cites systematic reviews showing these approaches can safely increase muscle strength, gait speed and functional independence.
Safety data is reassuring. The same submission reports serious adverse events in fewer than 2% of participants in community-based studies, with minor soreness or fatigue the most common responses, usually resolving without medical intervention. A systematic review of community-based physical activity interventions for adolescents and adults with complex CP looked at both implementation strategies and adverse events, which is the right pairing of questions for a gym to ask.
In practice that means:
- Strength training is a core component, not an optional extra.
- Task-specific practice matters. If the client wants to get up from a chair or climb stairs more easily, train movements that look like that.
- Aerobic work matters for heart and lung health. The research behind the Insights above notes that adults with CP are at significantly higher risk of cardiovascular and respiratory disease than the general population.
Strength training and spasticity
The most common myth we hear from trainers is that lifting makes spasticity worse. The OneAbility handbook addresses this directly: clinical evidence shows strength training is safe and necessary. Drop the worry and focus on programming.
Some principles from that handbook:
- Train both sides of the joint. If you train the knee flexors, train the knee extensors too, to keep balance around the joint.
- Choose equipment that controls the movement. Primitive reflexes can make free weights dangerous for some clients. Machines or adapted equipment can give a safer path of movement.
- Do not abandon an exercise because of grip. If spasticity makes gripping hard, try grip aids. They can often be adjusted to suit the plane of movement and the load.
- Do not use non-adapted exercises unmodified. Modify first, then progress.
The handbook also notes that people with CP often show a high capacity for load management. Do not under-load. Progress gradually, watch movement quality and let the client's feedback guide you.
Fatigue, rest and movement quality
Movement often costs more energy for people with CP, so fatigue can arrive earlier. The handbook explains that fatigue can be greater during submaximal tasks, because the person may be unable to compensate neurophysiologically as exhaustion builds. A systematic review of fatigue in people with CP compared self-reported and objectively measured fatigue, which tells you something useful: what the client says about how they feel is real data.
How to build this into a session:
- Plan frequent rest breaks from the start, and say so. Rest is part of the program, not a failure.
- Ask about fatigue before and after each session, not only during.
- Judge a set by movement quality. If the pattern is breaking down, the set is finished, even if the rep target is not met.
- Track the day-after response over a few weeks. Minor soreness is common. Persistent or escalating pain is a reason to talk to the client's health team.
Know the client: GMFCS and medical history
The Gross Motor Function Classification System (GMFCS) is used by clinicians in Australia to classify motor ability, as described in the CPA submission. Many adults with CP know their level. It is reasonable to ask, politely and privately, because it helps set realistic goals and match intensity. If they do not know, do not push.
Also ask about:
- Recent botulinum toxin injections. They change muscle tone for a period.
- Orthopedic surgery. It can change range of motion and loading restrictions.
- Temperature. Spasticity can increase in the cold, so warm-ups and room temperature matter.
- Current therapy. Ask who their physiotherapist, occupational therapist or exercise physiologist is, and with the client's consent, keep in touch.
The handbook frames success as a collaborative approach that treats the client as the expert in their own body, with close communication with the medical team. Ask: "What helps you? What should I never do?" Then believe the answer.
Working with an exercise physiologist and the NDIS
In Australia, Accredited Exercise Physiologists (AEPs) hold a four-year tertiary qualification in exercise science and physiology and are accredited by Exercise & Sports Science Australia, per the CPA submission. They are the allied health professionals best placed to assess and design programs for people with CP under the NDIS.
NDIS participants can access these services under Capacity Building funding for Improved Health and Wellbeing, which can cover assessment, tailored programs and training for support workers or carers. Funding rules depend on each participant's plan, so the participant or their plan manager is the right person to confirm what is covered.
What does this mean for a trainer or gym owner?
- You are not replacing the AEP. You are the day-to-day environment where the program is practiced.
- A client may arrive with a written program. Learn it, and ask the AEP what you can safely progress.
- If a client has no allied health input and complex needs, suggest they speak with their GP or a physiotherapist or AEP before you start a heavy block. Do it as a collaboration, not a gatekeeping step.
Designing a week: an example
This is an illustration of structure, not a prescription. Always adapt to the person, their GMFCS level and their health team's advice.
Client A: ambulant adult, wants general fitness (hypothetical).
- Day 1: machine-based lower body strength (leg press, seated row), including both knee flexors and extensors, with rest breaks every few sets. 30 to 40 minutes.
- Day 2: aerobic work such as a cycle ergometer or walking at a moderate effort, in bouts the client can sustain.
- Day 3: upper body and trunk strength using machines, cables with grip aids if needed, and task-specific practice such as sit-to-stand.
- Weekend: a pool or home session of the client's choice.
Client B: wheelchair user, wants stronger transfers (hypothetical).
- Two strength days focusing on pushing, pulling and shoulder stability, using machines or adapted equipment, with attention to the shoulders because of daily load.
- One aerobic day with an arm ergometer or similar, built from short bouts upward.
The CPA submission also describes an integrated model combining land-based strength training, hydrotherapy in temperature-controlled pools around 32 to 34°C, and home-based practice. If your facility has a warm pool or a relationship with one, that is a real advantage for clients whose spasticity increases in the cold.
Fear is a barrier too
Don't assume the physical side is the main obstacle. Experts note that fear of injury or increased pain often stops people with CP from being active more than the physiological response does. Familiar surroundings, safety-conscious programming and a person-centered, active-support approach help break that cycle.
Practical ways to do it:
- Offer a quiet first visit to see the space and try equipment before any program begins.
- Explain each exercise, and agree on a signal to pause.
- Start well within capacity and let the client set the pace of progress.
- Talk to the client, not their support worker, unless the client asks otherwise.
- Skip the pity and the praise for ordinary effort. Use the same professional language you would with anyone.
Our perspective
We built Inclusive-AF because too much disability training for fitness professionals talks down to the people it is supposed to serve. Trainers don't need to be told to be kind. They need to know what to do on Tuesday morning when a client with CP walks in: how to adjust a machine, what to ask, which myths to drop and when to call the physio.
Our view on cerebral palsy exercise is simple. Take the evidence seriously: strength and aerobic work are valuable and safe when programmed well. Take the person seriously: the client knows their body better than any textbook. And take the environment seriously: a gym that is physically accessible but culturally awkward still shuts people out. Our training is co-designed with people with disabilities, and that shapes what we teach and how we say it.
If you are unsure, ask the client, ask their health team, adjust, and try again. Most mistakes are fixed by listening.
— Tommy
Build the skills with Inclusive-AF
If you want structured, practical training rather than a patchwork of PDFs, start with our free introductory crash course, Crash Course: Train Clients With Disability. Our modules on the History of Disability in Australia (20 AUD) and The Social Model of Disability (40 AUD) give you the context behind why so many gyms are not built for these clients. Our courses are CPD accredited. If you manage a team, group and team enrolment lets you train your whole staff together. For a personal look at the systems many of our clients navigate, see the blog post My Experience with Disability Employment Services.
A checklist before the first session
- Ask about goals first, then about GMFCS level, if the client is comfortable sharing.
- Ask about recent injections, surgery and current therapy, and get consent to contact the health team.
- Check the room temperature and plan a longer warm-up.
- Choose machines or adapted equipment where free weights are risky, and have grip aids ready.
- Build in rest, and agree on how the client will tell you to slow down.
- Plan both sides of each joint.
- Review after two to three weeks, then adjust, aiming for 12 to 16 weeks of consistent work.
FAQ
What is the best exercise for cerebral palsy?
There is no single best exercise. The evidence supports a mix of aerobic training and strength training, with task-specific practice for the movements the person wants to improve. Resistance-based, task-oriented and virtual-reality-assisted training have all shown benefits for limb and gross motor function in the CPA submission. An exercise physiologist can tailor the mix.
Can cerebral palsy get better with exercise?
CP itself is non-progressive, and exercise does not cure it. Structured programs can, however, improve muscle strength, gait speed and functional independence, according to the systematic reviews cited by Cerebral Palsy Alliance. Gains usually need consistent training, with programs of 12 to 16 weeks commonly studied.
Is strength training safe for people with spasticity?
Yes. Clinical evidence shows that strength training does not worsen spasticity, and the OneAbility handbook calls it safe and necessary. Train both sides of each joint, use machines or adapted equipment when free weights are unsafe, and keep the client's health team informed about changes.
How should I start training a client with cerebral palsy?
Begin with a conversation about their goals, their experience and what helps them. Ask about GMFCS level, recent injections or surgery and their allied health team. Start with small amounts, build gradually and review often. Our free crash course is a practical place to build these skills.
Sources
- Cerebral Palsy Alliance submission to the NDIA Evidence Advisory Committee (2026)
- OneAbility handbook (PISE)
- Community-based physical activity interventions for adolescents and adults with complex CP (Developmental Medicine & Child Neurology)
- Exercise and physical activity recommendations for people with cerebral palsy (PMC)
- The first global physical activity and sedentary behavior guidelines for people living with disability
- Umbrella review of physical activity and exercise in cerebral palsy (PubMed)
- Systematic review of fatigue in individuals with cerebral palsy (PMC)
- NDIS Capacity Building: Improved Health and Wellbeing