
==== Front
Sci Rep
Sci Rep
Scientific Reports
2045-2322
Nature Publishing Group UK London

39251832
71967
10.1038/s41598-024-71967-2
Article
Physical performance and technical specific skills of women football players with cerebral palsy
Henríquez Matías 1
Cornejo María Isabel mcornejo20@santotomas.cl

23
Albaladejo-García Carlos 4
Messiaen Charlotte 4
Roldan Alba 4
Yanci Javier 5
Reina Raul 4
1 https://ror.org/04jrwm652 grid.442215.4 0000 0001 2227 4297 Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Providencia, Chile
2 https://ror.org/02vbtzd72 grid.441783.d 0000 0004 0487 9411 Escuela de Kinesiología, Universidad Santo Tomas, 8320000 Santiago, Chile
3 https://ror.org/02vbtzd72 grid.441783.d 0000 0004 0487 9411 Magíster en Ciencias de la Actividad Física y del Deporte Aplicadas al Entrenamiento, Rehabilitación y Reintegro Deportivo, Universidad Santo Tomas, 8320000 Santiago, Chile
4 https://ror.org/01azzms13 grid.26811.3c 0000 0001 0586 4893 Department of Sport Sciences, Sports Research Centre, Miguel Hernández University, Elche, Spain
5 grid.11480.3c 0000000121671098 Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
6 9 2024
6 9 2024
2024
14 208315 1 2024
2 9 2024
© The Author(s) 2024
2024
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This study aimed to determine the physical performance profile (ability to change direction, vertical and horizontal jump, sprint ability, and dribbling-specific skills) of the first women football players with cerebral palsy (CP) who participated in an international CP football competition, accounting for their sport classes. We also examined the relationships between the different physical performance variables. Forty-five female players with CP (24.9 ± 7.5 years) were categorised into three sport classes based on their impairment severity: 19 were FT1 (severe impairments); 21 FT2; and 5 FT3 (mild impairments). Various physical performance tests were conducted, including the 505 change of direction test; vertical and horizontal jumps; 10 m sprint test; and the dribbling speed test. Significant correlations were observed between the change of direction ability, sprint (r = 0.89; p < 0.01), and dribbling tests (r = 0.71; p < 0.01), as well as between horizontal jump and sprint time (r =  − 0.74; p < 0.01). FT1 players demonstrated poorer performance compared to FT3 in the 505 test and standing broad jump (p < 0.05; dg = −1.79 and 1.22 respectively), but also lower vertical jump heights (p < 0.05; dg = −0.91 to −1.57) and increased time required for sprint (p < 0.05; dg = 0.88 to 1.16) and dribbling tests (p < 0.05; dg = 0.85 to 1.44) compared to both FT2 and FT3 players. These findings offer valuable insights into the physical performance characteristics of female footballers with CP, which can guide training and sport enhancement programs for this unique para-sport population.

Subject terms

Environmental social sciences
Psychology and behaviour
issue-copyright-statement© Springer Nature Limited 2024
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pmcIntroduction

According to data from the Féderation International de Football Association (FIFA), 13.36 million girls and women worldwide actively participate in organised football, and they described increasing interest in participation and competitive opportunities at different levels of society1. This popularity also applies to football for para-athletes with disabilities, particularly in the case of cerebral palsy (CP) football, which is an adapted sport that brings competitive opportunities for both women and men with physical impairments of spastic hypertonia, motor ataxia, or dyskinesia. The first international football competition for women para-athletes with CP was sanctioned in 2022, reflecting the first steps towards professionalising the discipline and raising the competitive standards similar to men CP footballers and able-bodied counterparts. CP is a non-progressive group of development disorders affecting movement and posture often accompanied by disturbances in sensation, perception, epilepsy, and secondary musculoskeletal problems2. Compared to men’s CP football, the women’s sport has modifications related to the field dimensions (40 × 27 m for women vs 70 × 50 m for men); the number of players (five-a-side for women vs seven-a-side for men); and the length of the game (two halves of 25 min for women vs two halves of 30 min each for men)3. In addition, they share some rules and adaptations such as a throw-in with only one hand; the absence of the offside rule; and a classification system that categorises players according to the impact of their impairment on several football skills4. The classification system uses the same criteria for each sex, dividing players by impairment severity into the three sport classes FT1, FT2, and FT3 by considering impairment based on bilateral spasticity, athetosis/ataxia, and unilateral spasticity.

Change of direction ability has been identified as a relevant performance parameter in multidirectional sports such as football due to the number of turning actions involved in actions with and without the ball during matches5,6. Moreover, vertical jump performance has been shown to be a valuable indicator of the neuromuscular status of football players due to the association of height performance with force production and the musculoskeletal system7. In addition, horizontal muscle strength plays a crucial role in football, and early studies have highlighted the relationship between horizontal jump assessment and sprint performance in non-impaired players8,9. Applied to CP football, prior research suggests that male players exhibit impaired fitness in relevant aspects that contribute to sports performance, such as aerobic and anaerobic capacity10,11; ability to change direction12; balance13; jump performance14; and sprint15. These impaired fitness capacities are also evident in small-sided game formats16,17 as well as during the competition18, demonstrating that CP football requires intermittent and high-intensity actions, and they can be used to differentiate between sports classes or different levels of impairments. Sports-specific research studies have reported the utility of different specific physical tests including sprint, change of direction, vertical and horizontal jump, balance, and dribbling, to discriminate between sports classes using key determinants of football performance14,19. However, despite this body of relevant literature on the physical capacities of male football players with CP, there is a gap in understanding the performance characteristics of women footballers with motor impairments that could influence their football skills.

Therefore, this study aims to (1) determine the associations between the tests that the literature has shown to be valid and reliable for assessing sports performance of (male) CP football, and (2) to determine the physical performance capacity (i.e., change of direction ability, vertical and horizontal jump, sprint ability, and dribbling-specific skills) of international-level female CP football players while considering their sport classes. Based on early studies with male footballers with CP, it was hypothesized that performance results would show significant associations between the various tests applied and differences between sport classes due to the impact of the players´ impairment.

Material and methods

Participants

Forty-five female CP football players (24.9 ± 7.5 years; 59.9 ± 13.3 kg; 163.7 ± 6.8 cm) participated in this study (confidence level = 99%, sampling error = 0%, 100% of the population). All players competed in the 2022 Women’s World Cup in Salou, Spain. The participants belonged to five national teams from four continents and were described according to the classification rules of the International Federation of Cerebral Palsy Football (IFCPF) in compliance with the requirements of the minimal impairment criteria for hypertonia, ataxia, and dyskinesia20. Participants were categorised into severe impairment (FT1; n = 19), moderate impairment (FT2; n = 21), and mild impairment (FT3; n = 5). In addition, participants were categorised according to different impairment profiles including bilateral spasticity (n = 9), dyskinesia including ataxia or athetosis (n = 10), and unilateral spasticity (n = 26). The players participated in one to seven weekly training sessions (2.6 ± 1.6 per week) and had 4.4 ± 3.9 years of CP football experience. Their playing positions were goalkeeper (n = 6), defender (n = 13), midfielder (n = 12), and attacker (n = 14). The inclusion criterion was those with a valid IFCPF license. Players with any musculoskeletal injury that limited their performance in the tests were excluded. All participants were informed of the protocols involved in the study and were familiarised with the test setup. The participants provided written informed consent after receiving a detailed written and oral explanation of the study details in accordance with the Declaration of Helsinki (2013). This study was approved by the ethics committee of Miguel Hernandez University (DPS.RRV.03.17).

Procedures

A descriptive and cross-sectional design was used to determine the change of direction ability, vertical and horizontal jump ability, sprint ability, and dribbling skills in women’s players with CP. The battery of tests administered consisted of the change of direction 505 test to evaluate ability to change direction; the countermovement jump (CMJ) to assess vertical jump; standing broad jump (SBJ) to evaluate horizontal jump performance; a 10 m sprint test; and a dribbling speed test to assess football-specific skills. All participants were instructed to complete the test battery, although six players did not complete all of the tests due to the severity of their impairments and their impact on their mobility (i.e., four players did not complete the SBJ test, nor the dribbling test; and two players did not complete the sprint and the change of direction tests). The assessments were conducted with a minimum of 72 h before official competition matches. Before the procedures, all participants were instructed to perform a 10-min standardised warm-up including similar movements to those in the tests, such as jogging, progressive sprints, vertical and horizontal jumps, dribbling with the ball, and turning movements. The tests were conducted on a synthetic grass pitch, and the vertical jump test took place in a specific room with a stable and levelled surface with an ambient temperature between 20° and 22 °C. For all activity limitation assessments, two attempts were performed, with 2-min rest periods provided between each trial and 3-to-5-min rest intervals between the tests. The best attempt of each test was used for data analysis. Verbal encouragement was consistently provided throughout the tests to ensure that the players exerted maximal effort.

Measurements

Change of direction: 505 test

The ability to change direction was assessed using the 505 test, which has been utilised in previous studies of male CP footballers15,21. Participants were instructed to sprint towards a line with timing gates placed at 10 m, then continue sprinting forward to a line 5 m ahead and perform a 180° turn before sprinting back 5 m to the finish line, placed at the 10 m line in front of where the test started. Participants performed the turning movement with two repetitions on both sides, and the best attempt was recorded. The players completed the trials of the 505-test using a single-time gate (Witty System; Microgate, Bolzano, Italy) positioned over the start/finish lines. The shortest time (s) to complete the distance was used for the subsequent analysis.

Vertical jump: countermovement jump (CMJ)

To assess the CMJ, a jump mat (Globus, Ergotester, Italy) was used following the procedures described in previous studies with male footballers with CP14,22. The participants started in a standing position with their hands on their hips, maintaining this position throughout the jump execution without using an arm swing. All participants performed a fast downward flexion–extension movement to reach approximately 90° of knee flexion, followed by a maximum vertical jump23. Athletes performed two trials, and the highest jump height reached in cm was recorded for analysis. Participants who presented high spasticity levels and a hemiplegic pattern with difficulties maintaining their hands on their hips were allowed to keep their hands on one side of their bodies11.

Horizontal jump: standing broad jump (SBJ)

For the SBJ test, participants were instructed to attempt to cover the greatest horizontal distance possible with a jump that started by propelling both legs together, with bilateral take-off and landing. The shortest distance from the landing heel to the starting point was measured in cm, allowing the use of arms to increase jump distance and using the furthest distance covered for analysis. Participants performed two trials, and the best result was used for data analyses14.

Sprint: 10 m sprint test

Sprinting performance was measured by recording the time taken to perform a 10 m linear sprint using two pairs of time gates (Witty System; Microgate, Bolzano, Italy). Participants were instructed to exert maximum effort during the entire distance and started in a standing position placed 0.5 m before the first timing gate24. The fastest time (s) out of two trials was used for analysis.

Football skill test: dribbling speed test

To assess the change of direction ability with the ball, the dribbling speed test was utilised per previous studies19. Four cones were placed to create a 9 m × 9 m square; an additional cone was placed between those cones, at 4.5 m, on the starting line. Participants were instructed to start the test 0.5 m behind the starting line with a ball. Players started the test by moving the ball with their feet, going around the cones to the finish line. Both the player and the ball should have circled the cones without dropping the cones. The shortest time taken to complete the test out of two trials was used for analysis.

Statistical analysis

Data are presented as mean ± standard deviation (SD). The distribution and homogeneity of variance of each variable were checked using the Shapiro–Wilk normality and Levene’s tests. To examine differences between players’ sport classes, a one-way analysis of variance (ANOVA) and Bonferroni post-hoc comparisons were performed. To calculate the effect size of within-group differences, Hedges’ g index was used. This index was chosen to account for the potential bias introduced by small sample sizes, using a 95% confidence interval [CI] 25. Hedge’s g (dg) was interpreted according to the following values: < 0.25 = trivial; 0.25–0.5 = small; 0.5–0.8 = moderate; and > 0.8 = large26. The Pearson correlation coefficient (r) was used to assess the strength of association between the different physical performance variables. The interpretations employed were trivial (r < 0.1), small (r = 0.1– 0.3), moderate (r = 0.3–0.5), large (r = 0.5–0.7), very large (r = 0.7–0.9) and nearly perfect (r =  > 0.9)27. Data analysis was performed using Statistical Package for Social Sciences (version 26.0; SPSS Inc., Chicago, IL, USA). Statistical significance was set at p < 0.05.

Results

Association between tests

Regarding the internal consistency of the tests performed by the female CP footballers, moderate to large correlations were found between CMJ performance with the sprint test (r =  − 0.47; p = 0.001; Fig. 1A) and the change of direction assessment (r =  − 0.50; p = 0.001; Fig. 1B). In addition, there was a large to very large correlation between horizontal jump and sprint performance (r =  − 0.74; p < 0.001; Fig. 1C) and with 505 test performance (r =  − 0.68; p < 0.001; Fig. 1D). A significant correlation was also found between CMJ and SBJ (r = 0.67, large; p = 0.001) and between the 505 test and sprint performance (r = 0.89, very large; p < 0.001). Regarding the dribbling speed test results, moderate to very large correlations were found with CMJ (r =  − 0.40; p = 0.009; Fig. 2A), SBJ (r =  − 0.59; p < 0.001; Fig. 2B), change of direction (r = 0.71; p = 0.001; Fig. 2C), and 10 m sprint test (r = 0.67; p < 0.001; Fig. 2D).Fig. 1 Correlation between the countermovement jump with the sprint test (A) and with the change of direction test (B), and horizontal jump ability with sprint test (C) and with the change of direction test (D) by women footballers with cerebral palsy. 10-m sprint 10-m test, CMJ countermovement jump test, 505 505 change of direction test, SBJ standing broad jump.

Fig. 2 Correlation between the dribbling speed test with the countermovement jump test (A), with horizontal jump ability (B), with the change of direction test (C), and with the 10-m sprint test (D) by women footballers with cerebral palsy. 10-m sprint 10-m test, CMJ countermovement jump test, 505 505 change of direction test, SBJ standing broad jump.

Comparison between sport class groups

Table 1 shows the results of the physical performance tests by the group and subgroups of sport classes. The demographic characteristics of the participants in each group were FT1 (26.0 ± 9.7 years; 55.4 ± 9.7 kg; 162.5 ± 6.7 cm; 20.8 ± 2.55 kg/m2), FT2 (23.4 ± 6.3 years; 62.4 ± 14.9 kg; 164.0 ± 6.8 cm; 23.0 ± 4.7 kg/m2) and FT3 (26.6 ± 4.0 years; 65.8 ± 15.2 kg; 163.6 ± 7.3 cm; 23.6 ± 3.9 kg/m2). The ANOVA showed significant differences among the classes for the 505 test results [F(2,40) = 4.46; p = 0.018], CMJ [F(2,42) = 5.95; p = 0.005], SBJ [F(2,38) = 6.74; p = 0.003], 10 m sprint [F(2,40) = 6.08; p = 0.005], and dribbling speed test [F(2,38) = 7.43; p = 0.002]. In the pairwise comparison between players' sport classes, significant differences were found for the results of the 505 test and the SBJ between FT1 and FT3 (p < 0.05; dg = -1.79 to 1.22, large). Regarding the performance in the vertical jump assessment, players with more impairment reached significantly lower jump heights per the pairwise comparison between FT1 and FT2 (p = 0.012; dg =  − 0.91, large) and FT1 and FT3 (p = 0.040; dg =  − 1.57, large). Players with the more functional profiles had the shortest times in the sprint test when comparing FT1 versus FT2 (p = 0.022; dg =  − 0.88, large) and FT1 versus FT3 (p = 0.017; dg = 1.16, large). Lastly, players from the FT1 sport class had the slowest dribbling times compared to the FT2 (p = 0.026; dg = 0.85, large) and FT3 players (p = 0.003; dg = 1.44, large). However, no significant differences were found when comparing players in the classes FT2 and FT3, although moderate to large effect sizes were found for the 505, SBJ, sprint, and dribbling speed tests (p > 0.05; dg = 0.61 to 1.18). Table 1 Descriptive results for 505 test, countermovement jump, standing broad jump, sprint test and dribbling speed tests for all women’s players with cerebral palsy and pairwise comparison according to sport class

Variables	FT1 (n = 15–19)	FT2 (n = 20–21)	FT3 (n = 5)	Overall (n = 41–45)		Pairwise comparisons	
FT1 vs. FT2	FT1 vs. FT3	FT2 vs. FT3	
M ± SD	M ± SD	M ± SD	M ± SD	p	dg (LCI–UCI)	dg (LCI–UCI)	dg (LCI–UCI)	
505 (s)	3.52 ± 0.51 (n = 17)	3.18 ± 0.44 (n = 21)	2.92 ± 0.25 (n = 5)	3.29 ± 0.49 (n = 43)	0.018	0.70 (0.06 to 1.34)	1.22 (0.18 to 2.27)*	0.61 (−0.38 to 1.60)	
CMJ (cm)	14.65 ± 4.40 (n = 19)	19.65 ± 6.17 (n = 21)	21.20 ± 1.60 (n = 5)	17.71 ± 5.72 (n = 45)	0.005	−0.91 (−1.56 to −0.26)*	−1.57 (−2.65 to −0.49)*	−0.26 (−1.24 to 0.71)	
SBJ (cm)	102.69 ± 32.89 (n = 16)	125.65 ± 32.86 (n = 20)	161.40 ± 25.65 (n = 5)	121.05 ± 36.51 (n = 41)	0.003	−0.68 (−1.32 to −0.05)	−1.79 (−2.90 to −0.68)**	−1.09 (−2.11 to −0.07)	
Sprint 10-m (s)	2.63 ± 0.44 (n = 17)	2.32 ± 0.23 (n = 21)	2.14 ± 0.20 (n = 5)	2.42 ± 0.37 (n = 43)	0.005	0.88 (0.23 to 1.53)*	1.16 (0.12 to 2.20)*	0.77 (−0.22 to 1.77)	
DST (s)	22.86 ± 5.92 (n = 15)	18.73 ± 3.44 (n = 21)	14.82 ± 1.66 (n = 5)	19.76 ± 5.07 (n = 41)	0.002	0.85 (0.20 to 1.49)*	1.44 (0.37 to 2.50)**	1.18 (0.15 to 2.21)	
M  mean, SD standard deviation, dg g index effect size, 505  505 change of direction test, CMJ  countermovement jump, SBJ  standing broad jump, DST  dribbling speed test, LCI  lower interval of confidence, UCI  upper interval of confidence.

ANOVA post-hoc comparison of significant differences between groups: * p < 0.05 and ** p < 0.01

Discussion

This study aimed to determine the physical characteristics of international-level women footballers with CP in the different activity limitation tests which are employed during the sport classification process. These tests include change of direction ability, vertical and horizontal jump performance, sprint ability, and dribbling-specific skills. Although this has been studied in male footballers with CP, no previous studies have investigated women footballers’ physical performance, to the best of our knowledge. The novelty of the present study is in the identification of physical performance parameters used as activity limitation tests during the classification process regarding the different sport classes. Overall, players from the FT3 class showed the best performance across all physical tests compared to the more impaired footballers. Moreover, players in the FT2 class jumped higher, sprinted, and dribbled the ball faster compared to FT1 players. However, no significant differences were found between FT2 and FT3 players.

When examining the relationship between the different physical performance variables of the study, significant associations were found between all of the physical tests employed, which confirmed the hypothesis of the study. Similar results have been reported in studies of non-impaired women participants, which also identified the associations of sprint performance with horizontal jump distance8; vertical jump ability28; and change of direction performance29. Considering that sprint and change of direction capacities have been identified as relevant physical skills in women’s football performance, the findings of this study suggest that these parameters are possibly influenced by lower limb power production, which is reflected in vertical and horizontal jump outcomes29. Given the similarities of the different parameters evaluated in women footballers with CP, stretch–shortening cycle-based assessments are likely to be appropriate due to the motor requirements for football (e.g., jumping, sprinting, change of direction). In addition, physical determinants showed a significant association with specific ball dribbling skills, suggesting multifactorial causation of this parameter. These results are concordant with a report on non-impaired women footballers which showed associations between direction change capacity and ball and sprint, distinguishing the requirements of acceleration and deceleration for optimal performance30. From a strength point of view, those players with deficits affecting their vertical/horizontal jump ability could have greater limitations of specific football skills, thereby affecting player performance.

Performance variation considering sport classes

When exploring the performance for each test and comparing between sport classes, women’s players with mild impairments from the FT3 sport class showed a greater change of direction ability in the 505 test compared to FT1 players, partially confirming the study's hypothesis. These results are concordant with those reported by Peña-González et al.4, which found that male CP footballers with severe impairments also exhibited lower performance. The ability to change direction is fundamental to responding to the sudden variation in directional movements frequently encountered during football matches31. According to Preissler et al.30, non-impaired women’s football players with better change-of-direction abilities tend to possess superior dribbling capacities at high intensities, which is a football-specific skill that can precede a goal or a crucial moment of the match32. The differences between 505 test profiles of female CP footballers are possibly due to the impact of their impairment severities. Factors such as stride length, impaired balance, dynamic balance issues, and asymmetries can create challenges during pivoting, based on the unique characteristics of each profile of players with CP18,32. It should be noted that no significant differences, but moderate effect sizes, were found when comparing FT2 players and other sports classes. Moreover, when change of direction is assessed in women players with CP, the specific characteristics of their impairments; motor control factors; technical proficiency; and different performance contributors must be considered29. Further studies should continue exploring ability to change direction in order to discriminate between impairment profiles (i.e., type of impairment) and sport classes (i.e., level of the impairment), considering potential impairment-specific relationships between eligible impairments and activity limitations when performing a test that requires lower limb power, inter-limb coordination, and balance4.

In addition to the ability to change direction, vertical jump testing has been reported as an adequate tool for assessing male para-athletes with CP to estimate their neuromuscular status11,23; to determine the effects of strength training protocols34 and to support the process of class allocation14. In addition, the CMJ has been suggested as a measure to differentiate between competitive construct levels and positional roles in non-impaired women footballers35–37. We found that women players with the most severe impairments had the lowest jump performance: as such, CMJ could be an alternative to distinguish between sport classes. This can be explained by the structural and functional properties of spastic muscle that impact on the efficient use of the stretch–shortening cycle. This would affect players with higher levels of impairment more, resulting in lower jump heights22. Furthermore, coordination problems and motor control functions also affect CMJ outcomes, resulting in ineffective translation of momentum between jump phases.

Significant differences in horizontal jump test performance were found only between FT1 and FT3, while the other pairwise comparisons had moderate to large effect sizes but no significant difference. Horizontal jumping requires intersegmental coordination and stability, as well as muscle strength and power. Kugler and Janshen38 proposed that horizontal forces play a crucial role in acceleration, so the optimization of forward propulsion requires a precise application of force8,9. As such, these elements closely align with the demands of sprinting, possibly having a great transfer to this performance component due to the similarity of both activities8,39.

According to Bishop et al. 40, inter-limb asymmetries in horizontal jump performance in non-impaired youth women’s football players have been associated with slower sprint times. It has been suggested that horizontal jump test results are used for class allocation in CP football due to the coordination requirement and the relevance of this physical parameter to the sport14. However, it should be noted that this study only included the SBJ and not unipodal tests because, in most cases, the demand for the task exceeded the physical capacities of the participants. It would be beneficial for future studies to explore this variable in women players with CP, who often exhibit asymmetrical patterns as a result of their neurological health condition. In addition, classifiers should use jump performance outcomes and the observed qualitative motor strategies during the task as reference values to better allocate the sport class for women footballers with CP.

Acceleration and sprint are widely recognised key determinants of match performance in non-impaired women footballers41. Although match running performance in women’s CP football has not been previously studied, the sport shares similar characteristics to regular football in that it requires intermittent high-intensity actions such as acceleration and sprinting for different technical and tactical skills during the game. Again, women players with severe impairments (FT1) had slower sprint times compared to the FT2 and FT3 sports classes. These findings are concordant with previous reports indicating that sprint ability discriminates between profiles of mild and severe impairments33. The differences between FT1 and FT2 profiles suggest the utility of the 10 m sprint test in differentiating between sport classes. Athletes with CP generally exhibit lower sprint speeds than their non-impaired counterparts33, possibly due to increased ground contact time, reduced stride length, and reduced flight time42. These mechanical characteristics are likely to influence the sprint performance by severity of the impairment and specific profiles of women footballers with CP. Finally, regarding dribbling ability, Peña-González et al.19 reported the validity of the dribbling speed test for use in classifying men’s footballers with CP to assess change of direction ability and dribbling skills. In line with their results, women players from the FT3 and FT2 sport classes had significantly greater dribbling skill proficiencies compared to those in FT1, and there were large effect sizes between FT2 and FT319. Preissler et al.30 suggest that a change of direction circuit involving a ball requires more adaptations of locomotor functions, resulting in complex-coordination skill requirements that may explain these differences between the CP football classes.

Limitations, considerations and future studies

This study has limitations. First, although the work takes an ecological approach and includes a representative sample of the participants competing at the first women’s World Cup for footballers with CP. When considering sport classes, the subgroups are small and unequal in size, despite of the CP football rules of the game that establishes that teams must play with a minimum of one FT1 and a maximum of one FT3 players. This study has a sample distribution of 42.2% of FT1, 46.7% of FT2, and 11.1% of FT3 footballers, constraining cut-off boundaries for null hypothesis rejection, despite the adequate statistical power of the sample. Second, it should be noted that this sport modality is still under development, and, in some cases, women’s players’ physical performance is limited by the lack of resources, relatively few training hours, and less competitive experience, resulting in a greater impact of their impairment on football-specific activity limitation test performance. Nevertheless, this study brings novel insights to understand the complexity of para-athlete development in sport-specific contexts such as classification in women’s sports for people with CP.

Strength and conditioning coaches should also consider specific player characteristics to plan adequate training to meet the physical demands of the para-sport. Further studies could also explore the on-field physical demands of the sport; physiological characteristics; sex differences; the influence of hormonal factors; and the risk of injuries for women footballers with CP.

Conclusions

This is the first study to report on the performance of women footballers with CP in a number of activity limitation tests related to football-specific skills, such as change of direction ability, sprint, vertical and horizontal jump, and dribbling. The associations found in this study are similar to those reported in studies carried out on footballers without motor impairments and on CP male footballers, reinforcing the significance of physical testing in this specific population and improving understanding of the relationship between physical test outputs and football performance. In line with previous evidence in (male) CP footballers, significant differences were also observed between sport classes, underscoring the relevance of the use of these assessments during the classification process. These results support the use of physical testing to identify the appropriate sport class of women footballers with CP. In addition, our results describe the sport-specific performance of international-level women´s CP footballers, helping coaches to monitor the physical performance of this novel group of para-athletes.

Acknowledgements

The authors would like to thank to the teams who participated in the study and the support of the International Federation of Cerebral Palsy Football.

Author contributions

MH, MIC and RR conceived the study. AR, MH, RR and JY contributed to the design of the study. MH, MIC, CAG, and CM directed the study and managed data acquisition. MH, RR, JY had full access to data and takes responsibility for the integrity of the data. RR and MH provided expert advice and performed statistical analysis. MH, RR, MIC, AR, CM, CAG and JY drafted the manuscript. All authors reviewed the manuscript.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare no competing interests.

Ethical declarations

This study was approved by the ethics committee of Miguel Hernandez University (DPS.RRV.03.17).

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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