2, 95% CI 1.1 to 4.4), but not at 12 months. No significant intervention effect was demonstrated for mobility capacity (Table 4), attitude towards sports (Table 5) and the other secondary outcomes (Tables 6 and 7) at 4 months, 6 months or 12 months. (See eAddenda for Tables 6 and 7.) A positive trend was found for the GMFM-66 at 6 months (mean Modulators between-group difference 2.8, 95% CI 0.2 to 5.4), but not at 12 months, and for the 1-minute walk test at 4 months (mean between-group difference 5 m, 95% CI 0 to 9), but not at 6 months or 12 months. For attitude towards sports, when compared to the control group, Hydroxychloroquine mouse there was also a trend for

reporting greater agreement with possible advantages of sports at 12 months (p = 0.04) but not at 6 months, and a borderline significant greater disagreement with possible disadvantages of sports at 6 months (p = 0.02) but not at 12 months. There was no significant effect of the intervention on ABT 888 physical activity, so the hypothesis that counselling, home-based physiotherapy and fitness training would work synergistically to improve physical activity could not be confirmed. This was against our expectations, previous studies in cerebral palsy showed (non-significant) positive trends towards improving physical activity in children and adolescents with cerebral palsy

after either counselling,11 or fitness training only.9 Nevertheless, the present findings are in agreement with research involving typically developing children where evidence is equivocal. No evidence has been found for the effectiveness of family-based and community-based physical activity interventions that combine exercise programs with the provision of information.29 Another review has pointed out that physical activity among typically developing children can be increased by means of school-based interventions.30 The authors of that review indicated that the highest-quality studies with positive effects on physical not activity were characterised by a multicomponent intervention (education, focus on behavioural change and involvement of parents) and a minimum intervention

duration of one school year. Therefore, it is possible that our 6-month program was too short to elicit changes in such a complex behaviour as physical activity. Whether a longer counselling period, with periodical attention to physical activity, may be needed to improve physical activity in children with cerebral palsy should be examined in further research. Another explanation for the intervention’s lack of effect on physical activity might be insufficient contrast between groups, which could arise from three possible sources. First, the families who chose to participate in the study were likely to be more interested in (increasing) physical activity than those who refused to participate, as illustrated by the parents’ already very positive attitude towards sports in both groups.