Introduction:Low bone mineral density (BMD) predisposes children with cerebral palsy (CP) to increased risk of fractures. Effectiveness of weight-bearing on BMDis still ambiguousespecially in mild to moderately affected CP children.Westudied effectiveness of structured weight-bearing exercise program (SWBEP) on BMD in this subgroup.

Methods: Forty-threeCP children  with Gross motor function classification system I-IV levels were enrolled on outpatient basis between 2016-2017.Whole-body DEXA scan and blood investigations [Calcium, Phosphate, Vitamin-D and Alkaline Phosphatase(ALP)] were done. Caregivers were taught  personalised SWBEP and maintenance of  compliance diary. They continued exercises at home and visited the institute every fortnightly. Repeat investigations were done at 6-9months in children fulfilling the required compliance(80%)-

Results:Thirty fourchildren followed with required compliance [mean age 7 years (5-9 years) 70% boys]. Significant percentage change were noted in BMD at lumbar spine [median increase (IQR): 3.61%(2.77-13.37%);p=0.0098)]and BMD at pelvis [median increase(IQR):2.67% (0-8.25%);p=0.0414]. There was significant decrease in ALP [median decrease (IQR):51U/L(3-316U/l);p=0.0018].BMDwas lower when compared to cohort of normal childrentaken from a previous study[mean difference -0.085 (SE 0.013) P <0.05].

Conclusion:Weight bearing exercises lead to significant increase in BMD  in children with mild to moderate CP.Community based weight bearingprogrammes may help improving bone health in this vulnerable group.Role of ALP in bone mineral health needs further exploration.