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Rochette E, Saidi O, Merlin É, Duché P. Physical activity as a promising alternative for young people with juvenile idiopathic arthritis: Towards an evidence-based prescription. Front Immunol 2023; 14:1119930. [PMID: 36860845 PMCID: PMC9969142 DOI: 10.3389/fimmu.2023.1119930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in young people. Although biologics now enable most children and adolescents with JIA to enjoy clinical remission, patients present lower physical activity and spend more time in sedentary behavior than their healthy counterparts. This impairment probably results from a physical deconditioning spiral initiated by joint pain, sustained by apprehension on the part of both the child and the child's parents, and entrenched by lowered physical capacities. This in turn may exacerbate disease activity and lead to unfavorable health outcomes including increased risks of metabolic and mental comorbidities. Over the past few decades, there has been growing interest in the health benefits of increased overall physical activity as well as exercise interventions in young people with JIA. However, we are still far from evidence-based physical activity and / or exercise prescription for this population. In this review, we give an overview of the available data supporting physical activity and / or exercise as a behavioral, non-pharmacological alternative to attenuate inflammation while also improving metabolism, disease symptoms, poor sleep, synchronization of circadian rhythms, mental health, and quality of life in JIA. Finally, we discuss clinical implications, identify gaps in knowledge, and outline a future research agenda.
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Affiliation(s)
- Emmanuelle Rochette
- Department of Pediatrics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France,Clermont Auvergne University, INSERM, CIC 1405, CRECHE unit, Clermont-Ferrand, France,Toulon University, Laboratory “Impact of Physical Activity on Health” (IAPS), Toulon, France,*Correspondence: Emmanuelle Rochette,
| | - Oussama Saidi
- Toulon University, Laboratory “Impact of Physical Activity on Health” (IAPS), Toulon, France
| | - Étienne Merlin
- Department of Pediatrics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France,Clermont Auvergne University, INSERM, CIC 1405, CRECHE unit, Clermont-Ferrand, France
| | - Pascale Duché
- Toulon University, Laboratory “Impact of Physical Activity on Health” (IAPS), Toulon, France
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Balan S, Chickermane P, Panjikaran N. Role of rehabilitation in comprehensive management of juvenile idiopathic arthritis: When and how? INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_55_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nørgaard M, Herlin T. Specific Sports Habits, Leisure-Time Physical Activity, and School-Educational Physical Activity in Children With Juvenile Idiopathic Arthritis: Patterns and Barriers. Arthritis Care Res (Hoboken) 2019; 71:271-280. [PMID: 30354015 DOI: 10.1002/acr.23795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/16/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) may cause functional impairment and reduced time engaged in physical activity. The aim of this study was to investigate the habits of patients with JIA regarding participation in club sports, leisure-time physical activity, and school-educational physical activity and relate this to objectively measured physical activity using accelerometry and to compare the findings with those in healthy controls. METHODS Consecutive patients from the Aarhus University Hospital outpatient clinic were included. Clinical characteristics, functional ability, and exploration of specific habits in club sports, leisure-time physical activity, and school-educational physical activity (based on a standardized questionnaire) in patients were recorded and compared with those in healthy controls. The intensity and frequency of physical activity were measured by accelerometer monitoring, using ActiGraph GT1M. RESULTS Sixty-eight patients with JIA and 118 healthy control subjects were included. Despite having low disease activity, children with JIA had significantly lower accelerometry-monitored physical activity levels compared with healthy controls. The distribution of specific club sport activities was the same among patients and controls. However, the proportion of patients spending >3 hours/week participating in club sports was significantly lower than the proportion of controls, whereas no difference in time spent engaging in physical activity during leisure-time was observed. Participation in compulsory school-educational physical activity was equally high in patients and controls, although participation by patients was significantly less consistent than that by controls. Patient reports of time spent with club sport and leisure-time physical activity was significantly related to accelerometry measures, whereas this was not observed for school-educational physical activity. CONCLUSION The results of this study indicate the need for structured guidance for all patients with JIA (including those with minimal disease activity) in both understanding and coping with the consequences of a low level of physical activity.
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Feldman BM. Exercise as Medicine for Children with Arthritis. J Rheumatol 2017; 44:1103-1105. [PMID: 28765342 DOI: 10.3899/jrheum.170461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Brian M Feldman
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
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Cavallo S, Brosseau L, Toupin-April K, Wells GA, Smith CA, Pugh AG, Stinson J, Thomas R, Ahmed S, Duffy CM, Rahman P, Àlvarez-Gallardo IC, Loew L, De Angelis G, Feldman DE, Majnemer A, Gagnon IJ, Maltais D, Mathieu MÈ, Kenny GP, Tupper S, Whitney-Mahoney K, Bigford S. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis. Arch Phys Med Rehabil 2017; 98:1018-1041. [DOI: 10.1016/j.apmr.2016.09.135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/15/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022]
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Cavallo S, Majnemer A, Mazer B, Chilingaryan G, Ehrmann Feldman D. Participation in Leisure Activities among Canadian Children with Arthritis: Results from a National Representative Sample. J Rheumatol 2015; 42:1002-10. [PMID: 25979718 DOI: 10.3899/jrheum.131377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the level of participation in leisure activities among children and youth with arthritis, as well as to identify the sociodemographic (age, sex, family income), disease-related (functional limitations, disease duration, pain, medication use, child's need for assistance), and contextual factors (use of rehabilitation services, proximity of local recreation facilities, cost of activities) that may be associated. METHODS Data from the Participation and Activity Limitation Survey (PALS) 2006, a Canadian postcensus survey, was analyzed. Bivariate and multivariable linear regression analyses were applied to examine the associations between the sample's level of participation in leisure activities, and sociodemographic, disease-related, and contextual characteristics. RESULTS In Canada in 2006, an estimated 4350 children ranging in age from 5 to 14 years were living with arthritis. Fifty-six percent of parents reported that arthritis restricted their child's participation in leisure activities. Bivariate analysis showed that the availability of local recreational facilities, the affordability of activities, and the child not requiring any assistance were all associated (modified Bonferroni correction α < 0.005) with greater participation in various types of leisure activities. Multiple linear regressions showed that higher family income (β 0.47, 95% CI 0.09, 0.85) and greater perceived pain (β 0.59, 95% CI 0.07, 1.10) were positively associated with involvement in informal leisure. CONCLUSION Our findings underline the importance of considering contextual factors in developing treatment plans aimed at improving participation in leisure activities among children with arthritis. Future longitudinal studies targeting children living with arthritis could provide pertinent information on participation over fluctuations in disease status.
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Affiliation(s)
- Sabrina Cavallo
- From the Département de Médecine Sociale et Préventive, École de Santé Publique, and the École de Réadaptation, Faculté de Médecine, Université de Montréal; The Montreal Children's Hospital; McGill University Health Center; The Institut de Recherche en Santé Publique Université de Montréal; The Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal; The School of Physical and Occupational Therapy, McGill University; The Public Health Department, Montréal; The Jewish Rehabilitation Hospital, Laval, Québec, Canada.S. Cavallo, MSc, BSc(OT), Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal Children's Hospital, McGill University Health Center, Institut de Recherche en Santé Publique Université de Montréal, and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, and the Institut de Réadaptation de Montréal; A. Majnemer, PhD, OT, School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, and McGill University Health Center; B. Mazer, PhD, BSc(OT), Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, School of Physical and Occupational Therapy, McGill University, and Jewish Rehabilitation Hospital; G. Chilingaryan, DMD, MPH, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, and Jewish Rehabilitation Hospital; D. Ehrmann Feldman, PhD, PT, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Institut de Recherche en Santé Publique Université de Montréal, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal Children's Hospital, and t
| | - Annette Majnemer
- From the Département de Médecine Sociale et Préventive, École de Santé Publique, and the École de Réadaptation, Faculté de Médecine, Université de Montréal; The Montreal Children's Hospital; McGill University Health Center; The Institut de Recherche en Santé Publique Université de Montréal; The Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal; The School of Physical and Occupational Therapy, McGill University; The Public Health Department, Montréal; The Jewish Rehabilitation Hospital, Laval, Québec, Canada.S. Cavallo, MSc, BSc(OT), Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal Children's Hospital, McGill University Health Center, Institut de Recherche en Santé Publique Université de Montréal, and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, and the Institut de Réadaptation de Montréal; A. Majnemer, PhD, OT, School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, and McGill University Health Center; B. Mazer, PhD, BSc(OT), Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, School of Physical and Occupational Therapy, McGill University, and Jewish Rehabilitation Hospital; G. Chilingaryan, DMD, MPH, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, and Jewish Rehabilitation Hospital; D. Ehrmann Feldman, PhD, PT, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Institut de Recherche en Santé Publique Université de Montréal, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal Children's Hospital, and t
| | - Barbara Mazer
- From the Département de Médecine Sociale et Préventive, École de Santé Publique, and the École de Réadaptation, Faculté de Médecine, Université de Montréal; The Montreal Children's Hospital; McGill University Health Center; The Institut de Recherche en Santé Publique Université de Montréal; The Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal; The School of Physical and Occupational Therapy, McGill University; The Public Health Department, Montréal; The Jewish Rehabilitation Hospital, Laval, Québec, Canada.S. Cavallo, MSc, BSc(OT), Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal Children's Hospital, McGill University Health Center, Institut de Recherche en Santé Publique Université de Montréal, and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, and the Institut de Réadaptation de Montréal; A. Majnemer, PhD, OT, School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, and McGill University Health Center; B. Mazer, PhD, BSc(OT), Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, School of Physical and Occupational Therapy, McGill University, and Jewish Rehabilitation Hospital; G. Chilingaryan, DMD, MPH, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, and Jewish Rehabilitation Hospital; D. Ehrmann Feldman, PhD, PT, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Institut de Recherche en Santé Publique Université de Montréal, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal Children's Hospital, and t
| | - Gevorg Chilingaryan
- From the Département de Médecine Sociale et Préventive, École de Santé Publique, and the École de Réadaptation, Faculté de Médecine, Université de Montréal; The Montreal Children's Hospital; McGill University Health Center; The Institut de Recherche en Santé Publique Université de Montréal; The Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal; The School of Physical and Occupational Therapy, McGill University; The Public Health Department, Montréal; The Jewish Rehabilitation Hospital, Laval, Québec, Canada.S. Cavallo, MSc, BSc(OT), Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal Children's Hospital, McGill University Health Center, Institut de Recherche en Santé Publique Université de Montréal, and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, and the Institut de Réadaptation de Montréal; A. Majnemer, PhD, OT, School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, and McGill University Health Center; B. Mazer, PhD, BSc(OT), Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, School of Physical and Occupational Therapy, McGill University, and Jewish Rehabilitation Hospital; G. Chilingaryan, DMD, MPH, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, and Jewish Rehabilitation Hospital; D. Ehrmann Feldman, PhD, PT, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Institut de Recherche en Santé Publique Université de Montréal, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal Children's Hospital, and t
| | - Debbie Ehrmann Feldman
- From the Département de Médecine Sociale et Préventive, École de Santé Publique, and the École de Réadaptation, Faculté de Médecine, Université de Montréal; The Montreal Children's Hospital; McGill University Health Center; The Institut de Recherche en Santé Publique Université de Montréal; The Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal; The School of Physical and Occupational Therapy, McGill University; The Public Health Department, Montréal; The Jewish Rehabilitation Hospital, Laval, Québec, Canada.S. Cavallo, MSc, BSc(OT), Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal Children's Hospital, McGill University Health Center, Institut de Recherche en Santé Publique Université de Montréal, and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, and the Institut de Réadaptation de Montréal; A. Majnemer, PhD, OT, School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, and McGill University Health Center; B. Mazer, PhD, BSc(OT), Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, School of Physical and Occupational Therapy, McGill University, and Jewish Rehabilitation Hospital; G. Chilingaryan, DMD, MPH, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, and Jewish Rehabilitation Hospital; D. Ehrmann Feldman, PhD, PT, Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Institut de Recherche en Santé Publique Université de Montréal, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal Children's Hospital, and t
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Juvenile idiopathic arthritis and physical activity: possible inflammatory and immune modulation and tracks for interventions in young populations. Autoimmun Rev 2015; 14:726-34. [PMID: 25936296 DOI: 10.1016/j.autrev.2015.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/12/2015] [Indexed: 12/26/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by persistent joint inflammation that manifests as joint pain and swelling and limited range of joint motion. In healthy subjects, the literature reports that physical activity has an anti-inflammatory effect. In JIA patients, exercise could be used as a therapeutic tool to counteract disease-related inflammation and thereby improve clinical symptoms, although transient flare of pain could be the price to pay. Indeed, in patients with a chronic inflammatory disease, physical activity is prone to exacerbate underlying inflammatory stress. Physical activity improves quality of life and symptoms in JIA patients, but the mechanisms of action remain unclear. This review focuses on the mechanisms underlying exercise-induced immune and hormonal changes. Data on the impact of acute and chronic physical activities on the secretion of hormones and other molecules such as miRNA or peptides involved in the inflammatory process in JIA was compiled and summarized, and the key role of the biological effect of muscle-derived interleukin 6 in the exercise-induced modulation of pro/anti-inflammatory balance is addressed. We also go on to review the effect of training and type of exercise on cytokine response. This review highlights the beneficial effect of physical exercise in children with JIA and potential effect of exercise on the balance between pro- and anti-inflammatory response.
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Cavallo S, Feldman D. Rehabilitation and psychosocial issues in juvenile idiopathic arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cavallo S, April KT, Grandpierre V, Majnemer A, Feldman DE. Leisure in children and adolescents with juvenile idiopathic arthritis: a systematic review. PLoS One 2014; 9:e104642. [PMID: 25329390 PMCID: PMC4203655 DOI: 10.1371/journal.pone.0104642] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/10/2014] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED The aim of this systematic review is to describe participation in social and physical leisure activities among children and adolescents with JIA, as well as identify potential determinants of leisure participation. METHODS Electronic databases were systematically searched for articles published up until June 2013 pertaining to participation in leisure activities among youth with JIA and other rheumatic diseases. Studies were included if they measured involvement in either social or physical leisure activities. Selection and quality appraisal of articles were completed independently by two authors. RESULTS Eight hundred and ninety-three articles were found through electronic and reference search. One hundred and nine full articles were reviewed to assess for eligibility. Twelve articles met inclusion criteria and findings were reviewed. Most focused on describing participation in physical rather than social activities. Results suggest that youth with JIA participated less in both social and physical leisure activities as compared to healthy peers, and those with JIA did not meet national recommendations for physical activity. Potential determinants of leisure participation were socio-demographic (age, sex), anthropometric (height, weight) and disease-related (JIA subtype, disease duration, pain, number of swollen or painful joints, stiffness, fatigue, well-being) factors. CONCLUSION Characterization of leisure activity remains limited and mostly focused on physical activity in JIA. Assessment of more comprehensive outcome measures is warranted to obtain a better description of leisure in this population. Evidence of the influence of contextual factors as potential determinants of involvement in leisure among children with pediatric rheumatologic diseases is needed.
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Affiliation(s)
- Sabrina Cavallo
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
- Montreal Children's Hospital, McGill University Health Center, Montréal, Québec, Canada
- Institut de Recherche en Santé Publique Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, Montréal, Québec, Canada
| | - Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Grandpierre
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Annette Majnemer
- Montreal Children's Hospital, McGill University Health Center, Montréal, Québec, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Debbie Ehrmann Feldman
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
- Institut de Recherche en Santé Publique Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, Montréal, Québec, Canada
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Direction de Santé Publique de Montréal, Montréal, Québec, Canada
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Van Oort C, Tupper SM, Rosenberg AM, Farthing JP, Baxter-Jones AD. Safety and feasibility of a home-based six week resistance training program in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013; 11:46. [PMID: 24359015 PMCID: PMC3878188 DOI: 10.1186/1546-0096-11-46] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA), among the most common chronic diseases of childhood, can be associated with attenuated physical activity levels, reduced fitness, decreased functionality and pain. This pilot study aimed to determine the safety, feasibility and effect of a six week resistance training program in children with JIA. METHODS Youth (8-18 years) with JIA participated in a home-based resistance training program. Participants reported pain on an electronic diary once a day for one week prior to training, then once a day on non-exercise days and three times a day (before-exercise, after-exercise, and end-of-day) on exercise days for the subsequent six weeks of training. Secondary outcome measures included inflammation (assessed by ultrasound), muscle size (assessed by ultrasound), muscle strength (assessed by dynamometer) and functional ability (assessed by childhood health assessment questionnaire), measured at baseline and post-training. Participants were also instructed to wear an accelerometer one week prior to training to estimate baseline physical activity levels. Statistical analyses included safety (pain changes and any adverse events), feasibility (adherence to program and modifications made to exercises) and effect of program (differences in secondary measures pre and post training). An alpha level of p < 0.05 was accepted as significant. RESULTS Seven participants completed an average of 12.7 ± 3.4 (range 8-17) exercise sessions out of a possible 18 (70.6%). No adverse events were reported and pain did not increase over the seven weeks. Secondary measures revealed a significant increase in vastus lateralis thickness from pre to post training (p < 0.05). End-of-day pain intensity was correlated to end-of-day stiffness, fatigue and mood (r = .864, r = .581, r = -.637, respectively, p < 0.001). Pain intensity was also correlated with ratings of perceived exertion of the exercise (r = 0.324, p < 0.01). Only two children met the recommended 60 minutes of moderate to vigorous physical activity per day. CONCLUSIONS A six week home-based resistance training program is both safe (absence of pain changes or adverse events over the six weeks) and feasible (comparable adherence rates to other exercise studies involving JIA and individually modifiable) in children with JIA.
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Affiliation(s)
- Cameron Van Oort
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Susan M Tupper
- Saskatoon Health Region, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Alan M Rosenberg
- Department of Pediatrics, College of Medicine, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Jonathan P Farthing
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Adam D Baxter-Jones
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada.
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Carle AC, Dewitt EM, Seid M. Measures of health status and quality of life in juvenile rheumatoid arthritis: Pediatric Quality of Life Inventory (PedsQL) Rheumatology Module 3.0, Juvenile Arthritis Quality of Life Questionnaire (JAQQ), Paediatric Rheumatology Quality of Life Scale (PRQL), and Childhood Arthritis Health Profile (CAHP). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S438-45. [PMID: 22588764 DOI: 10.1002/acr.20560] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A C Carle
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Feldman D, Cavallo S. Rehabilitation and psychosocial issues in juvenile idiopathic arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The presence of certain medical or orthopedic conditions need not preclude adolescents from being physically active and participating in sports. The benefits of continued physical activity far outweigh any concerns for potential complications for most such conditions. This article reviews sport participation guidelines for adolescents with conditions that include juvenile chronic arthritis, eye injures, solitary kidney, skin conditions, scoliosis, and spondylolysis.
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Affiliation(s)
- Eugene Diokno
- Arnold Palmer Sports Health Center, Union Memorial Hospital, Baltimore, MD 21218, USA.
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The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol 2010; 22:213-7. [DOI: 10.1097/bor.0b013e328335d1a2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hackett J, Johnson B. Physiotherapy and occupational therapy for children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2010. [DOI: 10.1016/b978-0-443-06934-5.00022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Six-minute walking test in children with ESRD: discrimination validity and construct validity. Pediatr Nephrol 2009; 24:2217-23. [PMID: 19633871 PMCID: PMC2753769 DOI: 10.1007/s00467-009-1259-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/25/2009] [Accepted: 06/15/2009] [Indexed: 11/19/2022]
Abstract
The six-minute walking test (6MWT) may be a practical test for the evaluation functional exercise capacity in children with end-stage renal disease (ESRD). The aim of this study was to investigate the 6MWT performance in children with ESRD compared to reference values obtained in healthy children and, secondly, to study the relationship between 6MWT performance with anthropometric variables, clinical parameters, aerobic capacity and muscle strength. Twenty patients (13 boys and seven girls; mean age 14.1 +/- 3.4 years) on dialysis participated in this study. Anthropometrics were taken in a standardized manner. The 6MWT was performed in a 20-m-long track in a straight hallway. Aerobic fitness was measured using a cycle ergometer test to determine peak oxygen uptake (V O(2peak)), peak rate (W(peak)) and ventilatory threshold (VT). Muscle strength was measured using hand-held myometry. Children with ESRD showed a reduced 6MWT performance (83% of predicted, p < 0.0001), irrespective of the reference values used. The strongest predictors of 6MWT performance were haematocrit and height. Regression models explained 59% (haematocrit and height) to 60% (haematocrit) of the variance in 6MWT performance. 6MWT performance was not associated with V O(2peak), strength, or other anthropometric variables, but it was significantly associated with haematocrit and height. Children with ESRD scored lower on the 6MWT than healthy children. Based on these results, the 6MWT may be a useful instrument for monitoring clinical status in children with ESRD, however it cannot substitute for other fitness tests, such as a progressive exercise test to measure V O(2peak) or muscle strength tests.
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Hutzal CE, Wright FV, Stephens S, Schneiderman-Walker J, Feldman BM. A qualitative study of fitness instructors' experiences leading an exercise program for children with juvenile idiopathic arthritis. Phys Occup Ther Pediatr 2009; 29:409-25. [PMID: 19916825 DOI: 10.3109/01942630903245309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Children with arthritis face challenges when they try to increase their physical activity. The study's objective was to identify elements of a successful community-based exercise program for children with arthritis by investigating the perspectives of fitness instructors who led the program. This qualitative study used a phenomenological approach. Four fitness instructors participated in individual interviews. Themes were developed through inductive analytic methods. Three main themes were identified: (a) children with arthritis require encouragement and guidance throughout the program from fitness instructors who understand their arthritis, and support from parents and peers; (b) children need help to overcome their negative perceptions about exercise; and (c) exercise program participation can launch the adoption of a more active lifestyle. Pediatric physiotherapists can encourage the establishment of successful exercise programs for children with arthritis in nonmedical or community environments through the formation of supportive, education-based partnerships with community-based fitness instructors.
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Takken T, van Brussel M, Engelbert RHH, Van der Net J, Kuis W, Helders PJM. Exercise therapy in juvenile idiopathic arthritis. Cochrane Database Syst Rev 2008; 2008:CD005954. [PMID: 18425929 PMCID: PMC8903819 DOI: 10.1002/14651858.cd005954.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Exercise therapy is considered an important component of the treatment of arthritis. The efficacy of exercise therapy has been reviewed in adults with rheumatoid arthritis but not in children with juvenile idiopathic arthritis (JIA). OBJECTIVES To assess the effects of exercise therapy on functional ability, quality of life and aerobic capacity in children with JIA. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE (January 1966 to April 2007), CINAHL (January 1982 to April 2007), EMBASE (January 1966 to October 2007), PEDro (January 1966 to October 2007), SportDiscus (January 1966 to October 2007), Google Scholar (to October 2007), AMED (Allied and Alternative Medicine) (January 1985 to October 2007), Health Technologies Assessment database (January 1988 to October 2007), ISI Web Science Index to Scientific and Technical Proceedings (January 1966 to October 2007) and the Chartered Society of Physiotherapy website (http://www.cps.uk.org) were searched and references tracked. SELECTION CRITERIA Randomised controlled trials (RCTs) of exercise treatment in JIA. DATA COLLECTION AND ANALYSIS Potentially relevant references were evaluated and all data were extracted by two review authors working independently. MAIN RESULTS Three out of 16 identified studies met the inclusion criteria, with a total of 212 participants. All the included studies fulfilled at least seven of 10 methodological criteria. The outcome data of the following measures were homogenous and were pooled in a meta-analysis: functional ability (n = 198; WMD -0.07, 95% CI -0.22 to 0.08), quality of life (CHQ-PhS: n = 115; WMD -3.96, 95% CI -8.91 to 1.00) and aerobic capacity (n = 124; WMD 0.04, 95% CI -0.11 to 0.19). The results suggest that the outcome measures all favoured the exercise therapy but none were statistically significant. None of the studies reported negative effects of the exercise therapy. AUTHORS' CONCLUSIONS Overall, based on 'silver-level' evidence (www.cochranemsk.org) there was no clinically important or statistically significant evidence that exercise therapy can improve functional ability, quality of life, aerobic capacity or pain. The low number of available RCTs limits the generalisability. The included and excluded studies were all consistent about the adverse effects of exercise therapy; no short-term detrimental effects of exercise therapy were found in any study. Both included and excluded studies showed that exercise does not exacerbate arthritis. The large heterogeneity in outcome measures, as seen in this review, emphasises the need for a standardised assessment or a core set of functional and physical outcome measurements suited for health research to generate evidence about the possible benefits of exercise therapy for patients with JIA. Although the short-term effects look promising, the long-term effect of exercise therapy remains unclear.
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Affiliation(s)
- T Takken
- University Medical Center Utrecht, Department of Pediatric Physical Therapy & Exercise Physiology, Room Kb 02.056.0, POBox 85090, Utrecht, Netherlands, 3508 AB.
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Singh-Grewal D, Schneiderman-Walker J, Wright V, Bar-Or O, Beyene J, Selvadurai H, Cameron B, Laxer RM, Schneider R, Silverman ED, Spiegel L, Tse S, Leblanc C, Wong J, Stephens S, Feldman BM. The effects of vigorous exercise training on physical function in children with arthritis: A randomized, controlled, SINGLE-BLINDED trial. ACTA ACUST UNITED AC 2007; 57:1202-10. [PMID: 17907238 DOI: 10.1002/art.23008] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion, peak oxygen uptake, peak power, and self-reported physical function in children with juvenile idiopathic arthritis (JIA). METHODS Eighty children with JIA, ages 8-16 years, were enrolled in a randomized, single-blind controlled trial. Both groups participated in a 12-week, 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group. Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour (VO(2submax)) as the primary outcome, maximal oxygen uptake, and peak power at the beginning and end of the program. Physical function was measured using the Child Health Assessment Questionnaire (C-HAQ). RESULTS The exercise program was well tolerated in both groups. There was no difference in VO(2submax) or any other exercise testing measures between the groups through the study period and no indication of improvement. Both groups showed significant improvements in C-HAQ with no difference between the groups. Adherence was higher in the control group than the experimental group. CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function. The intensity of aerobic training did not seem to provide any additional benefits, but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with, and provide a degree of benefit equivalent to more intensive programs.
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Feldman DE, De Civita M, Dobkin PL, Malleson PN, Meshefedjian G, Duffy CM. Effects of adherence to treatment on short-term outcomes in children with juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2007; 57:905-12. [PMID: 17665485 DOI: 10.1002/art.22907] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the impact of adherence to treatment (medication and prescribed exercise) on outcomes in children with juvenile idiopathic arthritis (JIA). METHODS In this longitudinal study, we studied parents of patients with JIA at the Montreal Children's Hospital and British Columbia Children's Hospital in Vancouver. Adherence was evaluated on a visual analog scale in the Parent Adherence Report Questionnaire. Outcomes of interest were active joint count, pain, child functional score on the Child Health Assessment Questionnaire, quality of life score on the Juvenile Arthritis Quality of Life Questionnaire, and parental global impression of overall well-being. The association between adherence to treatment and subsequent outcomes was evaluated using generalized estimating equations and logistic regression. RESULTS Mean age and disease duration of our sample of 175 children were 10.2 and 4.1 years, respectively. Moderate adherence to medication was associated with lower active joint count (odds ratio [OR] 0.47, 95% confidence interval [95% CI] 0.22-0.99). Moderate adherence to exercise was associated with better functional score (OR 0.13, 95% CI 0.03-0.54), and lower pain during the last week (OR 0.14, 95% CI 0.04-0.50). Both high and moderate adherence to exercise were associated with parental perception of global improvement. CONCLUSION Improved outcomes in patients who adhered to treatment underscores the need for clinicians to address adherence issues with their patients. Sustaining adherence, particularly to the more time-consuming treatment of exercise, is a challenge.
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Takken T, van den Eijkhof F, Hoijtink H, Helders PJM, van der Net J. Examining the psychometric characteristics of the Dutch childhood health assessment questionnaire: room for improvement? Rheumatol Int 2006; 26:979-83. [PMID: 16468046 DOI: 10.1007/s00296-006-0108-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 12/25/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to examine the psychometric characteristics of the childhood health assessment questionnaire-disability index (CHAQ-DI). Seventy-six patients with juvenile idiopathic arthritis (JIA), age range 4.8-15.8 years, completed a CHAQ questionnaire one or more times. In total, 321 CHAQ questionnaires were available for analysis. Factor analysis and correlation were used to analyse the data. The analysis indicated that 12 items could be removed from the original 30 items of the CHAQ-DI. Also the addition of "aids and assistance" to the overall scoring method of the CHAQ-DI did not contribute to the overall measuring concept of the CHAQ-DI. The psychometric characteristics of the CHAQ-DI could be improved by removing 12 items from the original 30 items. Moreover, a simple scoring method, without the addition of aids and assistance to the total CHAQ-DI improves sensitivity to change of the CHAQ-DI.
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Affiliation(s)
- T Takken
- Department of Pediatric Physical Therapy & Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KB2.056.0, PO Box 85090, 3508, AB Utrecht, The Netherlands.
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Paap E, van der Net J, Helders PJM, Takken T. Physiologic response of the six-minute walk test in children with juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2005; 53:351-6. [PMID: 15934128 DOI: 10.1002/art.21175] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the physiologic response of the 6-minute walk test (6-mwt) in children with juvenile idiopathic arthritis (JIA). METHODS Eighteen children with JIA (age 7-17 years; 6 boys, 12 girls) performed a 6-mwt and a maximal exercise test. RESULTS The physiologic response of the 6-mwt was on average between 80% and 85% of the peak values of heart rate and oxygen uptake (VO2peak) during the maximal exercise test, except for the minute ventilation, which had a mean percentage of 68.5%. Backward regression analysis showed that height and distance walked were the best predictors of VO2peak during cycling (R2 = 0.883, P < 0.001). During the 6-mwt, the difference between the first and second minute was significant in every variable, except for heart rate. The range of walking distance of children with JIA was comparable with that of healthy elderly people. CONCLUSION The physiologic response of the 6-mwt is at a submaximal, intense level of exercise. The course of the responses during the 6-mwt was normal. The 6-mwt can be regarded as a good test for measuring functional exercise capacity.
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Affiliation(s)
- E Paap
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
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Klepper SE. Exercise and fitness in children with arthritis: evidence of benefits for exercise and physical activity. ARTHRITIS AND RHEUMATISM 2003; 49:435-43. [PMID: 12794801 DOI: 10.1002/art.11055] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Susan E Klepper
- Program in Physical Therapy, Columbia University, New York, New York 10032, USA
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Akikusa J, Allen R. Reducing the impact of rheumatic diseases in childhood. Best Pract Res Clin Rheumatol 2002. [DOI: 10.1053/berh.2002.0232] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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