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Sarac DC, Bayraktar D, Ozer Kaya D, Altug Gucenmez O, Oskay D. The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial. Pediatr Pulmonol 2024; 59:562-573. [PMID: 38038160 DOI: 10.1002/ppul.26783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Although inspiratory muscle training (IMT) has proven effective in adult rheumatic diseases, its impact on juvenile idiopathic arthritis (JIA) remains unexplored. The present study aimed to investigate the effects of IMT in children with JIA. METHODS Thirty-three children (13-18 years) with JIA were divided into two groups as exercise (n = 17) and control (n = 16). The exercise group performed IMT at home daily for 8 weeks. The initial IMT load was set as 60% of maximal inspiratory pressure (PImax ) and increased by %10 of the initial load every 2 weeks. The control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), FVC/FEV1 , PImax , and maximal expiratory pressure (PEmax ) were evaluated. Peak oxygen consumption (VO2max ), metabolic equivalents (METs), and maximal heart rate were measured with cardiopulmonary exercise test. Functional capacity and quality of life were assessed with 6-min walk distance and Pediatric Quality of Life Inventory 3.0 Arthritis Module. All participants were evaluated at baseline and post-treatment. RESULTS FVC ( ↑ 0.20 (95% CI: 0.07/0.32) liters), FEV1 ( ↑ 0.14 (95% CI: 0.02/0.25) liters), PImax (↑19.11 (95% CI: 9.52/28.71) cmH2 O), PEmax (↑12.41 (95% CI: 3.09/21.72) cmH2 O), VO2peak (↑158.29 (95% CI: 63.85/252.73) ml/min), and METs (↑0.92 (95% CI: 0.34/1.49) [ml/kg/min]) significantly improved only in the exercise group (p < .05). The difference over time in FVC, FEV1 , PImax , VO2peak , and METs were significantly higher in exercise group compared to control group (p < .05). CONCLUSIONS IMT seems to be an effective option for improving respiratory functions and aerobic exercise capacity in JIA.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Ozge Altug Gucenmez
- Clinic of Pediatric Rheumatology, University of Health Sciences Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkiye
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkiye
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Pella E, Sgouropoulou V, Theodorakopoulou M, Iatridi F, Boutou A, Karpetas A, Papagianni A, Sarafidis P, Dimitroulas T. Cardiorespiratory fitness assessed with cardiopulmonary exercise testing in patients with juvenile idiopathic arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:3526-3533. [PMID: 37280055 DOI: 10.1093/rheumatology/kead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES JIA is the most common type of arthritis in children and adolescents, causing joint damage, chronic pain and disability. Deconditioning is also prevalent in patients with JIA due to both inactivity and the disease progression, resulting in reduced cardiorespiratory fitness (CRF). We aimed to evaluate CRF of patients with JIA compared with healthy controls. METHODS This is a systematic review and meta-analysis of studies using cardiopulmonary exercise testing (CPET) to examine differences in determinants of CRF between patients with JIA vs healthy controls. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases, manual search of article references and grey literature. Quality assessment was undertaken with Newcastle-Ottawa Scale. RESULTS From 480 literature records initially retrieved, eight studies (538 participants) were included in final meta-analysis. VO2peak was significantly lower in patients with JIA compared with controls [weighted mean difference (WMD): -5.95 ml/kg/min (95% CI -9.26, -2.65)]. Exercise duration and VO2peak (% predicted) were found to be significantly impaired in patients with JIA compared with controls [standardized mean difference: -0.67 (95% CI -1.04, -0.29) and WMD: -11.31% (95% CI -20.09, -2.53), respectively], while no significant differences were found in maximum heart rate. CONCLUSION VO2peak and other CPET variables were lower in patients with JIA compared with controls, indicating reduced CRF in the former. Overall, exercise programs for patients with JIA should be promoted as part of their treatment to improve physical fitness and reduce muscle atrophy. PROSPERO REGISTRATION CRD42022380833.
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Affiliation(s)
- Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Sgouropoulou
- 1st Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Räsänen K, Markula-Patjas K, Kantanen S, Sipilä K, Lakka TA, Arikoski P, Piippo-Savolainen E. Impaired cardiorespiratory and neuromuscular fitness in children and adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study in the era of biologic drug therapies. Pediatr Rheumatol Online J 2023; 21:26. [PMID: 36932386 PMCID: PMC10022213 DOI: 10.1186/s12969-023-00808-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND In recent years, biologic drug therapies have altered the course of juvenile idiopathic arthritis (JIA) possibly also improving the patients' physical fitness. However, studies measuring both cardiorespiratory and muscular fitness in children with JIA are sparse and have failed to show consistent results. Our aim was to assess both cardiorespiratory and neuromuscular fitness and contributing factors in children and adolescents with JIA in the era of biologic drug therapies. METHODS This cross-sectional study consisted of 73 JIA patients (25 boys, 48 girls) aged 6.8- 17.5 years and 73 healthy age- and sex-matched controls, investigated in 2017-2019. Cardiorespiratory fitness was assessed by maximal ergospirometry and neuromuscular fitness by speed, agility, balance, and muscle strength tests. RESULTS Means (± SD) of maximal workload (Wmax/kg) and peak oxygen uptake (VO2peak/kg,) were lower in JIA patients than in controls (Wmax/kg: 2.80 ± 0.54 vs. 3.14 ± 0.50 Watts, p < 0.01; VO2peak/kg: 38.7 ± 7.53 vs. 45.8 ± 6.59 ml/min/kg, p < 0.01). Shuttle-run, sit-up and standing long jump test results were lower in JIA patients than in controls (p < 0.01). Mean (± SD) daily activity was lower (89.0 ± 44.7 vs. 112.7 ± 62.1 min/day, p < 0.05), and sedentary time was higher (427 ± 213 vs. 343 ± 211 min/day, p < 0.05) in JIA patients compared to controls. Physical activity and cardiorespiratory or neuromuscular fitness were not associated with disease activity. CONCLUSIONS JIA patients were physically less active and had lower cardiorespiratory and neuromuscular fitness than their same aged controls with no JIA. Therefore, JIA patients should be encouraged to engage in physical activities as a part of their multidisciplinary treatment protocols to prevent adverse health risks of low physical activity and fitness.
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Affiliation(s)
- Kati Räsänen
- Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, PL100, 70029 KYS, Finland.
| | - Kati Markula-Patjas
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Saija Kantanen
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology and Nuclear Medicine, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Timo A Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Pekka Arikoski
- Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, PL100, 70029 KYS, Finland
| | - Eija Piippo-Savolainen
- Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, PL100, 70029 KYS, Finland
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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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Jonyk L, Sagawa Junior Y, Tordi N, Ballot Schmit C. Description of physical activity in children with juvenile idiopathic arthritis using accelerometry. Arch Pediatr 2023; 30:83-88. [PMID: 36513538 DOI: 10.1016/j.arcped.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/22/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Juvenile idiopathic arthritis (JIA) can lead to functional impotence and reduced physical activity (PA) in patients. The objective of this study was to monitor the daily PA of children aged 6-18 years with JIA using accelerometry based on disease activity and individual abilities, and to compare this with age recommendations. METHODS Patients volunteering for the study wore an accelerometer for 7 consecutive days; data were evaluated using a wGT3X ActiGraph™. The 2010 World Health Organization (WHO) recommendations were used for comparison. RESULTS We collected accelerometry data for 24 patients of the University Hospital Center (UHC) of Besançon. Only two patients did not reach the recommendations of moderate-to-vigorous PA (MVPA). Time spent in MVPA was negatively correlated with age, BMI, number of joints with active arthritis, JADAS score, and visual analogue pain assessment (VAPA). Patients with active disease, those with upper extremity pain, and female patients had significantly lower PA scores. CONCLUSIONS Almost all of the patients of the UHC of Besançon who accepted the study reached the WHO recommendations. Having an active disease, having painful upper limbs, or being a girl is associated with decreased PA.
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Affiliation(s)
- L Jonyk
- Department of Pediatrics, University Hospital Center Jean Minjoz, Besançon, France.
| | - Y Sagawa Junior
- Clinical Functional Exploration Laboratory of Movement, Department of Physical Medicine and Rehabilitation, University Hospital Center of Besançon, Besançon 25000, France
| | - N Tordi
- Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comté, Besançon, France
| | - C Ballot Schmit
- Department of Pediatrics, University Hospital Center Jean Minjoz, Besançon, France
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de Koning L, Warnink-Kavelaars J, van Rossum M, Limmen S, Van der Looven R, Muiño-Mosquera L, van der Hulst A, Oosterlaan J, Rombaut L, Engelbert R. Physical activity and physical fitness in children with heritable connective tissue disorders. Front Pediatr 2023; 11:1057070. [PMID: 37009265 PMCID: PMC10065825 DOI: 10.3389/fped.2023.1057070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/21/2023] [Indexed: 04/04/2023] Open
Abstract
Objectives Health problems in patients with heritable connective tissue disorders (HCTD) are diverse and complex and might lead to lower physical activity (PA) and physical fitness (PF). This study aimed to investigate the PA and PF of children with heritable connective tissue disorders (HCTD). Methods PA was assessed using an accelerometer-based activity monitor (ActivPAL) and the mobility subscale of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT). PF was measured in terms of cardiovascular endurance using the Fitkids Treadmill Test (FTT); maximal hand grip strength, using hand grip dynamometry (HGD) as an indicator of muscle strength; and motor proficiency, using the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOTMP-2). Results A total of 56 children, with a median age of 11.6 (interquartile range [IQR], 8.8-15.8) years, diagnosed with Marfan syndrome (MFS), n = 37, Loeys-Dietz syndrome (LDS), n = 6, and genetically confirmed Ehlers-Danlos (EDS) syndromes, n = 13 (including classical EDS n = 10, vascular EDS n = 1, dermatosparaxis EDS n = 1, arthrochalasia EDS n = 1), participated. Regarding PA, children with HCTD were active for 4.5 (IQR 3.5-5.2) hours/day, spent 9.2 (IQR 7.6-10.4) hours/day sedentary, slept 11.2 (IQR 9.5-11.5) hours/day, and performed 8,351.7 (IQR 6,456.9-1,0484.6) steps/day. They scored below average (mean (standard deviation [SD]) z-score -1.4 (1.6)) on the PEDI-CAT mobility subscale. Regarding PF, children with HCTD scored well below average on the FFT (mean (SD) z-score -3.3 (3.2)) and below average on the HGD (mean (SD) z-score -1.1 (1.2)) compared to normative data. Contradictory, the BOTMP-2 score was classified as average (mean (SD) z-score.02 (.98)). Moderate positive correlations were found between PA and PF (r(39) = .378, p < .001). Moderately sized negative correlations were found between pain intensity and fatigue and time spent actively (r(35) = .408, p < .001 and r(24) = .395 p < .001, respectively). Conclusion This study is the first to demonstrate reduced PA and PF in children with HCTD. PF was moderately positively correlated with PA and negatively correlated with pain intensity and fatigue. Reduced cardiovascular endurance, muscle strength, and deconditioning, combined with disorder-specific cardiovascular and musculoskeletal features, are hypothesized to be causal. Identifying the limitations in PA and PF provides a starting point for tailor-made interventions.
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Affiliation(s)
- Lisanne de Koning
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Correspondence: Lisanne de Koning
| | - Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
| | - Marion van Rossum
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Selina Limmen
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
| | - Ruth Van der Looven
- Department of Physical and Rehabilitation Medicine, Child Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Laura Muiño-Mosquera
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Annelies van der Hulst
- Department of Pediatric Cardiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Raoul Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
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Wieringa WG, van Berkel RJ, Los LI, Lelieveld OTHM, Armbrust W. Physical and Psychosocial Health in Pediatric Uveitis Patients. Ocul Immunol Inflamm 2022; 30:1692-1700. [PMID: 34228595 DOI: 10.1080/09273948.2021.1934484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the possible associations between childhood noninfectious uveitis and cardio-respiratory fitness, physical activity, health related quality of life and fatigue. METHODS Cross-sectional analysis of 23 patients with noninfectious uveitis, aged 8-18 years. BMI, exercise capacity, muscle strength and physical activity were measured. Health-related quality of life and fatigue were assessed. The results were compared to standardized values for age matched healthy children. RESULTS Twenty-three patients were included. Children with uveitis had a higher bodyweight and body mass index. Children with uveitis had lower cardio-respiratory fitness and they were less physically active, but they experienced a normal quality of life and normal fatigue. Parents of children with uveitis reported a lower quality of life and more fatigue for their children than parents of healthy children. CONCLUSION Our study indicates that children with noninfectious uveitis are at risk of developing lower physical and psychosocial health.
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Affiliation(s)
- Wietse G Wieringa
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rosanne J van Berkel
- Department of Children's Rheumatology and Immunology, Beatrix Children's Hospital, Groningen, RB, The Netherlands
| | - Leonoor I Los
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, AV, The Netherlands
| | - Otto T H M Lelieveld
- Center of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wineke Armbrust
- Department of Children's Rheumatology and Immunology, Beatrix Children's Hospital, Groningen, RB, The Netherlands
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Turkucar S, Bayraktar D, Manci E, Adiguzel Dundar H, Makay B, Bediz CS, Savci S, Unsal E. Comparison of Anaerobic Exercise Capacity in Children With Familial Mediterranean Fever and Healthy Controls. J Clin Rheumatol 2022; 28:e330-e333. [PMID: 34665572 DOI: 10.1097/rhu.0000000000001710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE Anaerobic exercise capacity is an important component of performing daily activities during childhood. However, diminished anaerobic exercise capacity has been reported in children with chronic conditions. Therefore, the aim of this study was to compare anaerobic exercise capacities between children with familial Mediterranean fever (FMF) and healthy peers. METHODS Twenty-one children with FMF (FMF group) and 21 physically matched healthy controls (control group) were included. Peak power, peak power/kg, average power, and average power were evaluated using the Wingate Anaerobic Test. RESULTS The peak power (FMF group: 254.8 W [IQR 25/75: 216.4/293.0 W] vs control group: 333.7 W [IQR 25/75: 241.3/570.5 W], p = 0.009), peak power/kg (FMF group: 6.3 W/kg [IQR 25/75: 5.2/7.0 W/kg] vs control group: 7.0 W/kg [IQR 25/75: 6.1/8.6 W/kg], p = 0.046), average power (FMF group: 186.0 W [IQR 25/75: 164.3/211.2 W] vs control group: 231.8 W [IQR 25/75: 181.8/338.1 W], p = 0.006), and average power/kg (FMF group: 4.5 W/kg [IQR 25/75: 3.8/5.0 W/kg] vs control group: 5.1 W/kg [IQR 25/75: 4.2/5.9 W/kg], p = 0.040) were found significantly higher in the control group compared with FMF group. CONCLUSIONS Children with FMF seems to have diminished anaerobic exercise capacity compared with their healthy peers.
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Affiliation(s)
- Serkan Turkucar
- From the Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University
| | | | - Hatice Adiguzel Dundar
- From the Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University
| | - Balahan Makay
- From the Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University
| | - Cem Seref Bediz
- Division of Exercise Physiology, Department of Physiology, Faculty of Medicine
| | - Sema Savci
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Erbil Unsal
- From the Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University
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9
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Acar ME, Bayraktar D, Gucenmez S, Sarac DC, Buker N, Kocak UZ, Solmaz D, Akar S. Investigating the lower extremity-related anaerobic exercise capacity and functional status in adult patients with familial Mediterranean fever. Mod Rheumatol 2021; 32:980-985. [PMID: 34850105 DOI: 10.1093/mr/roab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES No studies examined the lower extremity-related anaerobic exercise capacity or functional status in adult patients with FMF. METHODS Twenty-four patients with FMF (12 males) and 24 age-sex-matched healthy controls (13 males) were included in the study. Lower extremity-related anaerobic exercise capacity was assessed by using Wingate Anaerobic Test. Lower extremity-related functional status was examined by using 9-Step Stair Climb Test, 10-Repetition Chair Stand Test, and Six-Minute Walking Distance. Muscle strength of hip flexors, hip extensors, knee flexors, and knee extensors were evaluated by using a hand-held dynamometer. RESULTS Patients with FMF had significantly poorer results in all anaerobic exercise capacity parameters and functional status assessments (P < 0.05), except muscle strength measurements (P > 0.05). Both average and peak anaerobic exercise capacities correlated significantly with all muscle strength measurements, 9-Step Stair Climb Test, 10-Repetition Chair Stand Test times, and Six-Minute Walk Distances (P < 0.05) in patients with FMF. CONCLUSION Lower extremity-related anaerobic exercise capacity and functional status seem to be diminished in adult patients with FMF. Evaluating these parameters may be beneficial for planning more appropriate and individualized treatment regimens such as patient education and exercise counselling for patients with FMF.
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Affiliation(s)
- Merve Eylul Acar
- Institute of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Sercan Gucenmez
- Department of Rheumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Nurullah Buker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Umut Ziya Kocak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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Acer Kasman S, Karaahmet ÖZ, Bal Hastürk A, Başaran Ö, Çelikel Acar B, Gezer HH, Çakcı A. The importance of lower extremity involvement type on exercise performances, function, and quality of life in peripheral predominant forms of juvenile idiopathic arthritis. Adv Rheumatol 2021; 61:39. [PMID: 34174968 DOI: 10.1186/s42358-021-00195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) can cause reduced exercise capacity, deterioration in functional activities, and poor health-related quality of life. This study aims to objectively reveal lower extremity involvement in the peripheral predominant forms of juvenile idiopathic arthritis through qualitative evaluations and to determine the effects of these involvements on exercise, function, and quality of life. METHODS Thirty-two patients with a history of peripheral arthritis and aged between 7 and 16 years participated in the study. Demographics, JIA subtype, disease duration, arthritis and deformities of the lower extremity, disease activity score, 6-min walk test (6MWT), cycling exercise test (CYC-E), childhood health assessment questionnaire (CHAQ), and pediatric quality of life inventory (PedsQoL) scores were recorded. In case of clinical suspicion of arthritis, an ultrasonographic examination was performed for a definitive diagnosis. Regression analyses were performed to explore the most associated lower extremity involvement and patient characteristics for each of the dependent variables including 6MWT, CYC-E, CHAQ, and PedsQoL. RESULTS Of the total number of patients, with a mean age of 12.91 (SD 2.37) years, 28.1% had knee arthritis, 15.6% foot arthritis, 12.5% hip arthritis, and 37.5% lower extremity deformity. The parameters that were most associated with CHAQ and PedsQoL were hip and knee arthritis, whereas CYC-E was found to be most associated with knee arthritis and height, and 6MWT was found to be most associated with hip arthritis, knee arthritis, and demographic characteristics. CONCLUSION This study emphasizes the importance of hip and knee arthritis, which are among the determinants of walking endurance, function, and quality of life; and knee arthritis, which is among the determinants of cycling performance in JIA with lower extremity involvement.
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Affiliation(s)
- Sevtap Acer Kasman
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey. .,Present affiliation: Department of Rheumatology, University of Health Sciences Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey.
| | - Özgür Zeliha Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey
| | - Ajda Bal Hastürk
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, University of Health Sciences Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Banu Çelikel Acar
- Department of Pediatric Rheumatology, University of Health Sciences Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Halise Hande Gezer
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey
| | - Aytül Çakcı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey
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11
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Astley C, Gil S, Clemente G, Terreri MT, Silva CA, Campos LMA, Aikawa NE, de Sá Pinto AL, Pereira RMR, Roschel H, Gualano B. Poor physical activity levels and cardiorespiratory fitness among patients with childhood-onset takayasu arteritis in remission: a cross-sectional, multicenter study. Pediatr Rheumatol Online J 2021; 19:39. [PMID: 33752674 PMCID: PMC7986021 DOI: 10.1186/s12969-021-00519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/04/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It is currently unknown whether patients with childhood-onset Takayasu disease (c-TA) are prone to physical inactivity and poor aerobic capacity. In this study, we assessed physical activity levels and cardiorespiratory fitness along with health-related quality of life (HRQL) and various traditional and non-traditional risk factors in patients with c-TA vs. healthy controls. METHODS c-TA patients with non-active disease (n = 17) and age- and sex-matched healthy controls (n = 17) were enrolled in the study. We assessed physical activity levels, aerobic capacity, body composition, systemic inflammation, cardiometabolic markers, disease-related parameters, and HRQL. RESULTS c-TA patients showed greater time spent in sedentary behavior (P = 0.010), and lower moderate-to-vigorous physical activity (P > 0.001) and lower step counts per day (P > 0.001). VO2peak (P < 0.001) and chronotropic response (P = 0.016) were significantly lower in patients with c-TA and they had worse HRQL in physical domain (P < 0.001), lower bone mineral content and density, and higher insulin levels vs. healthy controls (all P ≤ 0.05). CONCLUSIONS c-TA patients exhibited reduced physical activity levels and aerobic capacity, worse cardiometabolic risk factors and HRQL parameter compared with healthy peers. Physical inactivity and aerobic deconditioning emerge as potentially novel risk factors for c-TA. The role of physical activity interventions in preventing poor outcomes and improving HRQL in c-TA remains to be explored.
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Affiliation(s)
- Camilla Astley
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Saulo Gil
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
| | - Gleice Clemente
- Division of Paediatric Rheumatology, Department of Paediatrics, Federal University of Sao Paulo, SP, Sao Paulo, Brazil
| | - Maria Teresa Terreri
- Division of Paediatric Rheumatology, Department of Paediatrics, Federal University of Sao Paulo, SP, Sao Paulo, Brazil
| | - Clovis Artur Silva
- Paediatric Rheumatology Unit of Children and Adolescents' Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucia Maria Arruda Campos
- Paediatric Rheumatology Unit of Children and Adolescents' Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nadia Emi Aikawa
- Paediatric Rheumatology Unit of Children and Adolescents' Institute, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Lúcia de Sá Pinto
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa Maria R Pereira
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil.
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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12
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Physical activity assessment in children and adolescents with juvenile idiopathic arthritis compared with controls. Arch Pediatr 2020; 28:47-52. [PMID: 33250332 DOI: 10.1016/j.arcped.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/13/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We aimed to assess physical activity (PA) in children with juvenile idiopathic arthritis (JIA) compared with healthy peers and to determine factors influencing PA level. METHODS This was a cross-sectional study of the measured level of PA in children with JIA, compared with age- and gender-matched healthy schoolchildren. PA was estimated using a physical activity questionnaire for children and for adolescents (cPAQ/aPAQ). Disease activity was evaluated with the Juvenile Arthritis Disease Activity Score (JADAS). Functional ability was assessed with the Childhood Health Assessment Questionnaire (CHAQ). RESULTS A total of 55 children with JIA and 55 healthy control schoolchildren were included. Children with JIA had significantly lower levels of PA compared with their healthy peers as assessed with the cPAQ/aPAQ (P=0.0121). In total, 76% of the JIA group spent the day sleeping and sitting, which was significantly higher compared with the reference group (P=0.001 and P=0.055, respectively). Low PA level was associated with systemic JIA (P=0.002, OR=2.123), polyarticular JIA with positive rheumatoid factor (P=0.001, OR=2.014), JADAS-27≥6 (P=0.001, OR=2.524), patients undergoing treatment (P=0.001, OR=1.271), and higher CHAQ (P=0.002, OR=2.461). CONCLUSION Children with JIA were less physically active than their healthy peers and less active than recommended for general health.
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13
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Risum K, Edvardsen E, Godang K, Selvaag AM, Hansen BH, Molberg Ø, Bollerslev J, Holm I, Dagfinrud H, Sanner H. Physical Fitness in Patients With Oligoarticular and Polyarticular Juvenile Idiopathic Arthritis Diagnosed in the Era of Biologics: A Controlled Cross-Sectional Study. Arthritis Care Res (Hoboken) 2020; 71:1611-1620. [PMID: 30474929 DOI: 10.1002/acr.23818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/20/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To perform a comprehensive evaluation of and identify correlates for physical fitness in consecutive patients with juvenile idiopathic arthritis (JIA) who have been diagnosed in the era of biologics and to compare the results with those obtained in healthy controls. METHODS The study cohort included 60 patients with JIA (50 girls) ages 10-16 years and 60 age- and sex-matched controls. The JIA group included 30 patients with persistent oligoarticular JIA and 30 patients with extended oligoarticular or polyarticular disease. Measures of physical fitness included cardiorespiratory fitness (CRF) by peak oxygen uptake (Vo2peak ) during a continuous graded treadmill exercise test, muscle strength by isokinetic and isometric knee and hand grip evaluations, and bone mineral density (BMD) and body composition by dual-energy x-ray absorptiometry. Physical activity was assessed by accelerometry. RESULTS Forty-two percent of the patients were being treated with biologic drugs. Patients with JIA demonstrated lower muscle strength and total body BMD compared to controls, but there were no differences in CRF and body composition. Physical fitness was comparable between the persistent oligoarticular and extended oligoarticular/polyarticular-JIA groups. In patients with JIA, we identified associations between higher vigorous physical activity and higher CRF and muscle strength, but did not find any association between physical fitness and disease variables. CONCLUSION In this cohort of patients with JIA, we found suboptimal muscle strength and BMD compared to controls, but no differences in CRF and body composition. Vigorous physical activities appeared important for optimizing muscle strength and CRF in patients with JIA; the importance of such activities should be highlighted in patient education.
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Affiliation(s)
- Kristine Risum
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Elisabeth Edvardsen
- Oslo University Hospital, Ullevål and Norwegian School of Sports Sciences, Oslo, Norway
| | | | | | | | - Øyvind Molberg
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Jens Bollerslev
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Inger Holm
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | | | - Helga Sanner
- Oslo University Hospital, Rikshospitalet and Bjørknes University College, Oslo, Norway
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14
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Body composition in children with chronic inflammatory diseases: A systematic review. Clin Nutr 2020; 39:2647-2662. [PMID: 32035751 DOI: 10.1016/j.clnu.2019.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/18/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Aberrations in body composition are expected in children suffering from chronic inflammatory conditions. The objective is to examine whether children with inflammatory bowel disease (IBD: Crohn's disease and ulcerative colitis), coeliac disease, asthma and juvenile idiopathic arthritis (JIA) have an altered body composition as compared to healthy children. METHODS A systematic review, registered in Prospero (registration number: CRD42018107645), was conducted according to PRISMA guidelines. We conducted a search of three databases, Pubmed, Cochrane and Scopus. An assessment of the quality of the study was performed. RESULTS Data from 50 studies, 32 with IBD, 8 with coeliac disease, 2 with asthma and 8 with JIA, involving 2399 children were selected for review after applying the eligibility criteria. In all but 4 studies, children with Crohn's disease exhibited decreased amounts of fat mass and fat free mass. Reductions in fat mass were also evident in studies in children with coeliac disease. It is uncertain whether body composition is altered in children with asthma or JIA. CONCLUSIONS Children with Crohn's disease manifest with lowered adiposity and lean mass and therefore are likely to be at risk for suffering malnutrition-related clinical complications. Apart from Crohn's disease, data examining body composition in children with chronic inflammatory conditions are scarce and there is a paucity of reports examining the relationship between inflammation and body composition. Interpretation of the current study results is hampered by the low quality of the studies and due to the fact that the analyses have been habitually secondary outcomes.
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15
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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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16
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Nowak AM, Molik B, Marszałek J. Anaerobic performance among children with spina bifida. J Sports Med Phys Fitness 2019; 60:132-139. [PMID: 31343148 DOI: 10.23736/s0022-4707.19.09883-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children and adolescents with spina bifida demonstrate less physical activity. Most of them are wheelchair users. It is important to control their physical fitness for instance their anaerobic performance. They need anaerobic performance to daily activities like transfers that require short and high intensity movements. The aim of this study was to assess anaerobic performance among children with spina bifida and to evaluate their results in relation to normative values from able-bodied peers, as well as to find appropriate, easy and feasible field-based tests measuring anaerobic performance of children with spina bifida in non-laboratory settings. METHODS Ninety-five children and adolescents with spina bifida were divided according to gender and age (four male and four female groups) and performed the 30-second Wingate Anaerobic Test (WAnT), the handgrip test and the chest pass test. The Kolmogorov-Smirnov test, the Kruskal-Wallis test, the Mann-Whitney U-test, the Pearson correlation (P<0.05) and Effect Size were applied in this study. RESULTS Differences in MP, PP, rMP and rPP between age groups were found. A significant and strong correlation of the 30-second WAnT results (MP, PP) with the handgrip test and the chest pass test was found (P<0.01; r>0.7). CONCLUSIONS In conclusion, anaerobic performance of children with spina bifida varies depending on the age group and is "very poor" compared to anaerobic performance of their able-bodied peers. The chest pass test may be a good non-laboratory test to be used to indirectly assess anaerobic performance of children with spina bifida.
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Affiliation(s)
- Agnieszka M Nowak
- Department of Physiotherapy, Jozef Pilsudski University of Physical Education, Warsaw, Poland -
| | - Bartosz Molik
- Department of Physiotherapy, Jozef Pilsudski University of Physical Education, Warsaw, Poland
| | - Jolanta Marszałek
- Department of Physiotherapy, Jozef Pilsudski University of Physical Education, Warsaw, Poland
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17
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Rochette E, Bourdier P, Pereira B, Echaubard S, Borderon C, Caron N, Chausset A, Courteix D, Fel S, Kanold J, Paysal J, Ratel S, Rouel N, Sarret C, Terral D, Usclade A, Merlin E, Duché P. Impaired Muscular Fat Metabolism in Juvenile Idiopathic Arthritis in Inactive Disease. Front Physiol 2019; 10:528. [PMID: 31118902 PMCID: PMC6506786 DOI: 10.3389/fphys.2019.00528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/12/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives: The objective of this study was to evaluate muscular metabolic function in children with inactive juvenile idiopathic arthritis (JIA). Methods: Fifteen children with inactive JIA and fifteen healthy controls were matched by sex, biological age, and Tanner stage. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates. Results: Between the two groups, heart rate values and carbohydrate oxidation rates were the same, regardless of the relative intensity of exercise. Lipid oxidation rates were lower in JIA patients, regardless of the percentage of VO2 peak (p < 0.05). Respiratory exchange ratios beyond 50% of VO2 peak were higher in patients with JIA (p < 0.05). Respective maximal fat oxidation rates (MFO) for controls and children with JIA were 218.7 ± 92.2 vs. 157.5 ± 65.9 mg ⋅ min-1 (p = 0.03) and 4.9 ± 1.9 vs. 3.4 ± 1.2 mg ⋅ min-1 ⋅ kg-1 (p = 0.04). There was no difference between the two groups in heart rate, percentage of VO2 peak, or power of exercise to achieve MFO. Controls reached their MFO at an exercise power significantly higher than did JIA subjects (42.8 ± 16.8 and 31.9 ± 9.8 W, p = 0.004). Conclusion: Children with JIA show metabolic disturbance during exercise, even when the disease is considered inactive. This disturbance is seen in a lower lipid oxidation rate during submaximal exercise.
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Affiliation(s)
- Emmanuelle Rochette
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France.,Laboratoire des Adaptations Métaboliques en Conditions Physiologiques et Physiopathologiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Centre de Recherche en Nutrition Humaine d'Auvergne, Clermont-Ferrand, France
| | - Pierre Bourdier
- Laboratoire des Adaptations Métaboliques en Conditions Physiologiques et Physiopathologiques, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à la Recherche Clinique et à l'Innovation, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Stéphane Echaubard
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Corinne Borderon
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Caron
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Chausset
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Courteix
- Laboratoire des Adaptations Métaboliques en Conditions Physiologiques et Physiopathologiques, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Solenne Fel
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Justyna Kanold
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Justine Paysal
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Ratel
- Laboratoire des Adaptations Métaboliques en Conditions Physiologiques et Physiopathologiques, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nadège Rouel
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Catherine Sarret
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Terral
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandra Usclade
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Etienne Merlin
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,CIC 1405, Unité CRECHE, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France.,INRA, UMR 1019 UNH, ECREIN, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Pascale Duché
- Laboratoire des Adaptations Métaboliques en Conditions Physiologiques et Physiopathologiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Centre de Recherche en Nutrition Humaine d'Auvergne, Clermont-Ferrand, France.,Laboratoire Impact de l'Activité Physique sur la Santé, Université de Toulon, Toulon, France
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18
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Milatz F, Klotsche J, Niewerth M, Geisemeyer N, Trauzeddel R, Weißbarth-Riedel E, Kallinich T, Peitz J, Hartmann M, Minden K. Participation in school sports among children and adolescents with juvenile idiopathic arthritis in the German National Paediatric Rheumatologic Database, 2000-2015: results from a prospective observational cohort study. Pediatr Rheumatol Online J 2019; 17:6. [PMID: 30744659 PMCID: PMC6371582 DOI: 10.1186/s12969-019-0306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Regular school sports can help adolescents achieve the recommended amount of daily physical activity and provide knowledge, attitudes and behavioral skills that are needed in order to adopt and maintain a physically active lifestyle. Furthermore, it reaches all children including those that are at risk for engaging in more sedentary types of behavior. Since adolescents with juvenile idiopathic arthritis (JIA) are less involved in physical and social activities than their healthy peers, the objectives were to (1) estimate the prevalence of participation in school sports among patients with JIA; (2) determine the correlates associated with school sports absenteeism; and (3) investigate whether attendance in school sports has changed in the era of biologics. METHODS Data from schoolchildren with JIA recorded in the German National Paediatric Rheumatologic Database (NPRD) in the years 2000 to 2015 were considered for the analyses. Data from the year 2015 were inspected to analyze correlates of school sports absenteeism. Whether school sports participation had changed between 2000 and 2015 was determined using linear mixed models. RESULTS During the 15-year period, the participation rates in school sports were determined in 23,016 patients. The proportion of patients who participated in school sports almost always steadily increased from 31% in 2000 to 64% in 2015 (β = 0.017, 95% confidence interval (CI) 0.015, 0.020), whereas the exemption rate simultaneously decreased from 44% in 2000 to 16% in 2015 [β = - 0.009, 95% CI -0.011, - 0.007]. In 2015, the data from 5879 patients (mean age 13.1 ± 3.3 years, female 65%, disease duration 5.9 ± 4.0 years, persistent oligoarthritis 37%) were available for evaluation. Full exemption from school sports (in 16.1% of cases) was associated with functional limitations, disease activity and any use of DMARDs, intra-articular glucocorticoid injections or physiotherapy. CONCLUSIONS School sports attendance among children and adolescents with JIA has increased significantly over the past 15 years. Possible explanations include improved functional ability probably due to better treatment options. The integration of patients with child acceptable symptom states who have previously been fully exempted from school sports needs to be addressed in the future.
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Affiliation(s)
- Florian Milatz
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117, Berlin, Germany.
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Martina Niewerth
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Nils Geisemeyer
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Ralf Trauzeddel
- 0000 0000 8778 9382grid.491869.bDepartment of Paediatric Rheumatology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Elisabeth Weißbarth-Riedel
- 0000 0001 2180 3484grid.13648.38Paediatric Rheumatology Clinics, University Hospital Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Tilmann Kallinich
- 0000 0001 2218 4662grid.6363.0Department of Pediatrics, Division of Pneumonology and Immunology with intensive Medicine, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Joachim Peitz
- Paediatric Rheumatology Centre, Asklepios Clinic, Sankt Augustin, Arnold-Janssen-Straße 29, 53757 Sankt Augustin, Germany
| | - Matthias Hartmann
- German Centre for Paediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
| | - Kirsten Minden
- 0000 0001 2218 4662grid.6363.0Epidemiology Unit, German Rheumatism Research Centre Berlin and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Chariteplatz 1, 10117 Berlin, Germany
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Abstract
PURPOSE To examine safety and efficacy of exercise training (ET) for juvenile idiopathic arthritis (JIA) to improve physical fitness, pain, functional capability, and quality of life. METHODS Ovid Medline, PubMed, CINAHL, PEDro, and Web of Science were searched from 1995 to April 2018 to find English-language articles examining effects of ET in JIA, ages 4 to 21 years. Quality of evidence/strength of clinical recommendations were assessed using the Cochrane GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results were reported using the 2009 Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) checklist for health care interventions. RESULTS Nine papers met inclusion criteria. A total of 457 individuals with JIA, ages 4 to 19.9 years, received ET or alternate activity, wait-list, or no intervention. Moderate-quality evidence supports Stott Pilates and underwater knee-resistance exercise. No adverse effects of ET were reported. CONCLUSIONS Moderate-quality evidence exists for ET (30-50 minutes, 2-3 times/week, 12-24 weeks) to decrease pain, improve range of motion, knee strength, functional capability, and quality of life in JIA.
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The effects of 8-week water-running program on exercise capacity in children with juvenile idiopathic arthritis: a controlled trial. Rheumatol Int 2018; 39:59-65. [PMID: 30430201 DOI: 10.1007/s00296-018-4209-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
Exercise capacity has been reported to be lower in children with Juvenile Idiopathic Arthritis (JIA). Therefore, the aim was to investigate the effects of an 8-week water-based exercise program on exercise capacity in children with JIA. Forty-two children with JIA were divided into two groups as: exercise group [n = 21, water-running, moderate-intensity exercise (60-70%), two times/week], and control group (n = 21, no additional treatment other than the prescribed medication). All children were assessed at baseline and post-intervention in terms of physical and disease-related characteristics, pain at rest and in activity (visual analog scale), range of motion (Escola Paulista de Medicina Range of Motion Scale), aerobic exercise capacity (cycle ergometer), and anaerobic exercise capacity (Wingate Test). Anaerobic exercise capacity was found to be improved in the exercise group [baseline: 5.54 W/kg (IQR 25/75: 4.07/6.88 W/kg) vs. post-intervention: 6.0 W/kg (IQR 25/75: 4.8/7.4 W/kg), p = 0.002], while no improvements were observed in the control group [baseline: 5.29 W/kg (IQR 25/75: 4.75/5.85 W/kg) vs. post-intervention: 5.5 watts/kg (IQR 25/75: 5.0/6.1 W/kg), p = 0.076]. The amount of the changes related to anaerobic exercise capacity were higher in the exercise group [exercise group: 0.6 W/kg (IQR 25/75: 0.3/1.3 W/kg) vs. control group: 0.2 W/kg (IQR 25/75: - 0.1/0.5 W/kg), p = 0.024]. No changes were detected related to aerobic exercise capacity in any of the groups (p > 0.05). An 8-week water-running program might be beneficial to improve anaerobic exercise capacity, but it is not enough to improve the aerobic exercise capacity in children with JIA.
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Houghton KM, Macdonald HM, McKay HA, Guzman J, Duffy C, Tucker L. Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:67. [PMID: 30348221 PMCID: PMC6198360 DOI: 10.1186/s12969-018-0283-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Arthritis in childhood can be associated with muscle weakness around affected joints, low bone mass and low bone strength. Exercise is recognized as an important part of management of children with juvenile idiopathic arthritis (JIA) but the exercise prescription to best promote bone and muscle health is unknown. We therefore aimed to: 1. assess feasibility and safety of a 6-month home- and group-based exercise program for children with JIA; 2. estimate the effect of program participation on bone mass and strength, muscle function and clinical outcomes and 3. determine if any positive changes in bone and muscle outcomes are maintained 6 months later. METHODS We recruited 24 children with JIA who were part of the Linking Exercise, Physical Activity and Pathophysiology in Childhood Arthritis (LEAP) study to participate in a 6-month home-based exercise program involving jumping and handgrip exercises, resistance training and one group exercise session per month. We assessed lumbar spine bone mass (dual energy X-ray absorptiometry), distal tibia and radius bone microarchitecture and strength (high-resolution peripheral quantitative computed tomography), muscle function (jumping mechanography, dynamometry) and clinical outcomes (joint assessment, function, health-related quality of life) at baseline, 6- and 12-months. Adherence was assessed using weekly activity logs. RESULTS Thirteen children completed the 6-month intervention. Participants reported 9 adverse events and post-exercise pain was rare (0.4%). Fatigue improved, but there were no other sustained improvements in muscle, bone or clinical outcomes. Adherence to the exercise program was low (47%) and decreased over time. CONCLUSION Children with JIA safely participated in a home-based exercise program designed to enhance muscle and bone strength. Fatigue improved, which may in turn facilitate physical activity participation. Prescribed exercise posed adherence challenges and efforts are needed to address facilitators and barriers to participation in and adherence to exercise programs among children with JIA. TRIAL REGISTRATION Data of the children with JIA are from the LEAP study (Canadian Institutes of Health Research (CIHR; GRANT# 107535 ). http://www.leapjia.com/.
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Affiliation(s)
- Kristin M. Houghton
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Heather M. Macdonald
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada
| | - Heather A. McKay
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Orthopaedics, University of British Columbia, Vancouver, BC Canada
| | - Jaime Guzman
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Ciarán Duffy
- 0000 0000 9402 6172grid.414148.cDivision of Rheumatology, Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori Tucker
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
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Bonney E, Aertssen W, Smits-Engelsman B. Psychometric properties of field-based anaerobic capacity tests in children with Developmental Coordination Disorder. Disabil Rehabil 2018; 41:1803-1814. [PMID: 29509037 DOI: 10.1080/09638288.2018.1446189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Assessment of anaerobic capacity in children with Developmental Coordination Disorder (DCD) is essential for treatment planning. However, available field-based measures have no established validity and reliability in this population. Purpose: To examine the psychometric properties of selected field-based anaerobic capacity tests in children with and without DCD. Methods: School-aged children (6-16 years) with and without DCD participated in the study. The children completed the shuttle run sub-item of the Bruninks-Oseretsky test of motor proficiency-second edition, the 10 × 5 m sprint tests (straight and slalom) and the muscle power sprint test (MPST). Results: The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and 10 × 5 m sprint tests possess good construct validity and test-retest reliability in children with DCD. The 10 × 5 m sprint test-slalom was found to be the most responsive test among children with DCD. However, the MPST was less reliable in children with DCD compared to their typically developing peers, leading to a very large Smallest Detectable Difference. Conclusions: The findings suggest that the selected anaerobic capacity measures have sound psychometric properties among children with DCD with the exception of the MPST. Clinicians working on children with DCD could use these tests in their practice, especially in situations where logistical resources are limited. Implications for Rehabilitation Field-based anaerobic capacity tests are suitable measures for assessing anaerobic capacity in children with Developmental Coordination Disorder, particularly in situations where laboratory assessments are not feasible. The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and the 10 × 5 sprint tests (straight and slalom) have good construct validity in this population. The 10 × 5 sprint test (slalom) is the most sensitive anaerobic capacity test among children with Developmental Coordination Disorder.
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Affiliation(s)
- Emmanuel Bonney
- a Department of Health & Rehabilitation Sciences , University of Cape Town , Cape Town , South Africa
| | - Wendy Aertssen
- b Avansplus, University for Professionals , Breda , The Netherlands
| | - Bouwien Smits-Engelsman
- a Department of Health & Rehabilitation Sciences , University of Cape Town , Cape Town , South Africa
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Abstract
Bone health in children with rheumatic conditions may be compromised due to several factors related to the inflammatory disease state, delayed puberty, altered life style, including decreased physical activities, sun avoidance, suboptimal calcium and vitamin D intake, and medical treatments, mainly glucocorticoids and possibly some disease-modifying anti-rheumatic drugs. Low bone density or even fragility fractures could be asymptomatic; therefore, children with diseases of high inflammatory load, such as systemic onset juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, and those requiring chronic glucocorticoids may benefit from routine screening of bone health. Most commonly used assessment tools are laboratory testing including serum 25-OH-vitamin D measurement and bone mineral density measurement by a variety of methods, dual-energy X-ray absorptiometry as the most widely used. Early disease control, use of steroid-sparing medications such as disease-modifying anti-rheumatic drugs and biologics, supplemental vitamin D and calcium, and promotion of weight-bearing physical activities can help optimize bone health. Additional treatment options for osteoporosis such as bisphosphonates are still controversial in children with chronic rheumatic diseases, especially those with decreased bone density without fragility fractures. This article reviews common risk factors leading to compromised bone health in children with chronic rheumatic diseases and discusses the general approach to prevention and treatment of bone fragility.
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Physical activity for paediatric rheumatic diseases: standing up against old paradigms. Nat Rev Rheumatol 2017; 13:368-379. [DOI: 10.1038/nrrheum.2017.75] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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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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Kwon HJ, Kim YL, Lee HS, Lee SM. A study on the physical fitness of children with juvenile rheumatoid arthritis. J Phys Ther Sci 2017; 29:378-383. [PMID: 28356614 PMCID: PMC5360993 DOI: 10.1589/jpts.29.378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/18/2016] [Indexed: 01/21/2023] Open
Abstract
[Purpose] This study was conducted to assess the physical fitness of children with juvenile rheumatoid arthritis (JRA). [Subjects and Methods] In total, 26 children with juvenile rheumatoid arthritis (JRA) and 25 healthy controls participated in this study. Using the physical fitness measurement instruments, the Inbody 720 and Quark b2, the elements of physical fitness that were assessed included muscular strength, muscular endurance, flexibility, lung capacity, and body composition. [Results] The results revealed significant differences in muscular strength, muscular endurance, lung capacity, body composition, functional ability, and health-related quality of life between the children with juvenile rheumatoid arthritis (JRA) and the control group. [Conclusion] These results suggested that children with juvenile rheumatoid arthritis (JRA) have inferior physical fitness when compared to healthy children. The present study was conducted to develop an accurate evaluation standard to assess the physical fitness of children with juvenile rheumatoid arthritis (JRA).
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Affiliation(s)
- Hyo-Jeong Kwon
- Department of Physical Therapy, Sahmyook University: 26-21 Gongneung2-dong, Nowon-gu, Seoul 139-742, Republic of Korea
| | - You Lim Kim
- Department of Physical Therapy, Sahmyook University: 26-21 Gongneung2-dong, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Hyun Soo Lee
- Department of Physical Therapy, Sahmyook University: 26-21 Gongneung2-dong, Nowon-gu, Seoul 139-742, Republic of Korea
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University: 26-21 Gongneung2-dong, Nowon-gu, Seoul 139-742, Republic of Korea
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Armbrust W, Lelieveld OHTM, Tuinstra J, Wulffraat NM, Bos GJFJ, Cappon J, van Rossum MAJ, Sauer PJJ, Hagedoorn M. Fatigue in patients with Juvenile Idiopathic Arthritis: relationship to perceived health, physical health, self-efficacy, and participation. Pediatr Rheumatol Online J 2016; 14:65. [PMID: 27919265 PMCID: PMC5139083 DOI: 10.1186/s12969-016-0125-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/24/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fatigue is common in patients with JIA and affects daily life negatively. We assessed the presence and severity of fatigue in patients with JIA, including factors presumed associated with fatigue (e.g., disease activity, disability, pain, physical activity, exercise capacity, and self-efficacy), and whether fatigue is related to participation in physical education classes, school attendance, and sports frequency. METHODS The current study used baseline data of 80 patients with JIA (age 8-13) who participated in an intervention aimed at promoting physical activity. Primary outcome measurements were fatigue, assessed using the Pediatric-Quality-of-Life-Inventory (PedsQl)-Fatigue-scale and energy level assessed using a VAS scale. Other outcome measurements were disease activity (VAS Physician Global Assessment Scale), disability (Childhood Health Assessment Questionnaire), physical activity (accelerometer), exercise capacity (Bruce treadmill test), self-efficacy (Childhood Arthritis Self-Efficacy Scale), and participation (self-report). RESULTS Sixty percent of patients with JIA suffered from daily low-energy levels; 27% suffered from very low-energy levels more than half the week. Low energy levels were best predicted by disability and low physical activity. Fatigue measured with the PEDsQL was higher compared to the control-population. Disability and low self-efficacy were main predictors of fatigue. Self-efficacy was a predictor of fatigue but did not act as moderator. Fatigue was a predictor for sports frequency but not for school attendance. CONCLUSION Fatigue is a significant problem for JIA patients. Interventions aimed at reducing perceived disability, stimulating physical activity, and enhancing self-efficacy might reduce fatigue and thereby enhance participation. TRIAL REGISTRATION Trial number ISRCTN92733069.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
| | - Otto H. T. M. Lelieveld
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Jolanda Tuinstra
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico M. Wulffraat
- Department of Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - G. J. F. Joyce Bos
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Jeannette Cappon
- Reade, Center for Rehabilitation and Rheumatology, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Marion A. J. van Rossum
- Reade, Center for Rehabilitation and Rheumatology, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Groningen, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Nørgaard M, Lomholt JJ, Thastum M, Herlin M, Twilt M, Herlin T. Accelerometer-assessed daily physical activity in relation to pain cognition in juvenile idiopathic arthritis. Scand J Rheumatol 2016; 46:22-26. [DOI: 10.3109/03009742.2016.1160146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Nørgaard
- Department of Physiotherapy, Unit of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - JJ Lomholt
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M Herlin
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - M Twilt
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Herlin
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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Caldwell HAT, Proudfoot NA, King-Dowling S, Di Cristofaro NA, Cairney J, Timmons BW. Tracking of physical activity and fitness during the early years. Appl Physiol Nutr Metab 2016; 41:504-10. [PMID: 27045869 DOI: 10.1139/apnm-2015-0338] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The early years are characterized by rapid physical growth and the development of behaviours such as physical activity. The objectives of this study were to assess the 12-month changes in and the tracking of physical activity and fitness in 400 preschoolers (201 boys, 4.5 ± 0.9 years of age). Physical activity data, expressed as minutes per day and as the percentage of time spent at various intensities while wearing an accelerometer, were collected in 3-s epochs for 7 days. Short-term muscle power, assessed with a 10-s modified Wingate Anaerobic Test, was expressed as absolute (W) and relative (W/kg) peak power (PP) and mean power (MP). Aerobic fitness, assessed with the Bruce Protocol progressive treadmill test, was expressed as maximal treadmill time and heart rate recovery (HRR). Light physical activity decreased by 3.2 min/day (p < 0.05), whereas vigorous physical activity increased by 3.7 min/day (p < 0.001), from year 1 to year 2. Physical activity exhibited moderate tracking on the basis of Spearman correlations (r = 0.45-0.59, p < 0.001) and fair tracking on the basis of κ statistics (κ = 0.26-0.38). PP and MP increased from year 1 (PP, 94.1 ± 37.3 W; MP, 84.1 ± 30.9 W) to year 2 (PP, 125.6 ± 36.2 W; MP, 112.3 ± 32.2 W) (p < 0.001) and tracked moderately to substantially (PP, r = 0.89, κ = 0.61; MP, r = 0.86, κ = 0.56). Time to exhaustion on the treadmill increased from 9.4 ± 2.3 min to 11.8 ± 2.3 min (p < 0.001) and tracked strongly (r = 0.82, κ = 0.56). HRR was unchanged at 65 ± 14 beats/min (p = 0.297) and tracked fairly (r = 0.52, κ = 0.23). The findings indicate that fitness tracks better than physical activity over a 12-month period during the early years.
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Affiliation(s)
- Hilary A T Caldwell
- a Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada.,b Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Nicole A Proudfoot
- a Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada.,b Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Sara King-Dowling
- a Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada.,b Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Natascja A Di Cristofaro
- a Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - John Cairney
- b Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.,c Department of Family Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Brian W Timmons
- a Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada.,b Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
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Zoli A, Bosello S, Comerci G, Galiano N, Forni A, Loperfido F, Ferraccioli GF. Preserved cardiorespiratory function and NT-proBNP levels before and during exercise in patients with recent onset of rheumatoid arthritis: the clinical challenge of stratifying the patient cardiovascular risks. Rheumatol Int 2015; 37:13-19. [DOI: 10.1007/s00296-015-3390-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
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Armbrust W, Siers NE, Lelieveld OTHM, Mouton LJ, Tuinstra J, Sauer P. Fatigue in patients with juvenile idiopathic arthritis: A systematic review of the literature. Semin Arthritis Rheum 2015; 45:587-95. [PMID: 26656031 DOI: 10.1016/j.semarthrit.2015.10.008] [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: 07/07/2015] [Revised: 09/14/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To perform a systematic review of the current literature on studies related to fatigue in children with JIA. We studied the measurements that were used to assess fatigue and we focused on three outcome measurements, namely, (1) the prevalence of fatigue in JIA patients, (2) the determinants of and associations with fatigue in JIA patients, and (3) the impact of fatigue in JIA patients on daily life. METHODS A search was conducted in the electronic databases Pubmed and Embase from January 1, 2000 until August 27, 2015. The quality in prognostic factors (QUIPS) tool was used to assess the risk of bias (ROB) in the selected studies, focused on the outcome fatigue. Of all, two authors independently judged the ROB. RESULTS A total of 15 studies were included in this review. To assess fatigue, two unidimensional and three multidimensional scales were used, which hampered comparison. Fatigue was reported to be present in 60-76% of the patients with JIA and was related to time of day, disease activity, pain, psychosocial factors, and sleep. Minor consequences for daily life were found, though this was not studied extensively. CONCLUSION Fatigue is common in patients with JIA. The cause reflects a complex interplay of different factors. Based on results from this review and its body of knowledge, a conceptual model for fatigue in patients with JIA is proposed. Consensus is needed for future studies on how to assess fatigue. We promote the use of a combination of unidimensional and validated multidimensional measurements.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, Beatrix Children's Hospital, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Nicole E Siers
- Center for Human Movement Sciences, University Medical Center Groningen (UMCG), University of Groningen, A. Deusinglaan 1, Groningen, The Netherlands
| | - Otto T H M Lelieveld
- Center for Rehabilitation, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Leonora J Mouton
- Center for Human Movement Sciences, University Medical Center Groningen (UMCG), University of Groningen, A. Deusinglaan 1, Groningen, The Netherlands
| | - Jolanda Tuinstra
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Oostersingel, entrance 45, Groningen, The Netherlands
| | - Pieter Sauer
- Department of Pediatric Rheumatology, Beatrix Children׳s Hospital, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, The Netherlands
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Zwinkels M, Verschuren O, Lankhorst K, van der Ende-Kastelijn K, de Groot J, Backx F, Visser-Meily A, Takken T. Sport-2-Stay-Fit study: Health effects of after-school sport participation in children and adolescents with a chronic disease or physical disability. BMC Sports Sci Med Rehabil 2015; 7:22. [PMID: 26445674 PMCID: PMC4594646 DOI: 10.1186/s13102-015-0016-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children and adolescents with a chronic disease or physical disability have lower fitness levels compared to their non-disabled peers. Low physical fitness is associated with reduced physical activity, increased cardiovascular diseases, and lower levels of both cognitive and psychosocial functioning. Moreover, children and adolescents with a chronic disease or physical disability participate less in both recreational and competitive sports. A variety of intervention studies have shown positive, but only temporary, effects of training programs. Next to issues related to the chronic condition itself, various personal and environmental factors play a key role in determining the extent to which they participate in sports or physical activities. Due to these barriers, sport participation in the immediate after-school hours seems to be a feasible solution to get these children and adolescents physical active structurally. To investigate if an after school sport program can sustain the positive effects of an intervention, a standardized interval training will be given to improve physical fitness levels. High-intensity Interval Training (HIT) is superior to moderate-intensity continuous training in improving physical fitness in patients with chronic diseases. Therefore, the Sport-2-Stay-Fit study will investigate whether after school sport participation can increase the sustainability of a HIT program in children and adolescents with a chronic disease or physical disability. METHODS The Sport-2-Stay-Fit study is a clinical controlled trial. A total of 74 children and adolescents in the age of 6-19 years with a chronic disease or physical disability will be included. This could be either a cardiovascular, pulmonary, metabolic, musculoskeletal or neuromuscular disorder. Both children and adolescents who are ambulatory or propelling a manual wheelchair will be included. All participants will follow a HIT program of eight weeks to improve their physical fitness level. Thereafter, the intervention group will participate in sport after school for six months, while the control group receives assessment only. Measurements will take place before the HIT, directly after, as well as, six months later. The primary objective is anaerobic fitness. Secondary objectives are agility, aerobic fitness, strength, physical activity, cardiovascular health, cognitive functioning, and psychosocial functioning. DISCUSSION If effective, after school sport participation following a standardized interval training could be implemented on schools for special education to get children and adolescents with a chronic disease or physical disability active on a structural basis. TRIAL REGISTRATION This trial is registered at the Dutch Trial Register #NTR4698.
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Affiliation(s)
- Maremka Zwinkels
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, the Netherlands ; Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, the Netherlands ; Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands
| | - Kristel Lankhorst
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands ; Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences, Utrecht, the Netherlands
| | - Karin van der Ende-Kastelijn
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands ; Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences, Utrecht, the Netherlands
| | - Janke de Groot
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands ; Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences, Utrecht, the Netherlands
| | - Frank Backx
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne Visser-Meily
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Utrecht, the Netherlands ; Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tim Takken
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands ; Child Development and Exercise Center, University Medical Center Utrecht, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
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Nørgaard M, Twilt M, Andersen LB, Herlin T. Accelerometry-based monitoring of daily physical activity in children with juvenile idiopathic arthritis. Scand J Rheumatol 2015; 45:179-87. [DOI: 10.3109/03009742.2015.1057862] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Nørgaard
- Department of Physiotherapy, Aarhus University Hospital, Aarhus, Denmark
| | - M Twilt
- Paediatric Rheumatology Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - LB Andersen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - T Herlin
- Paediatric Rheumatology Clinic, Aarhus University Hospital, Aarhus, Denmark
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Armbrust W, Bos JJFJ, Cappon J, van Rossum MAJ, Sauer PJJ, Wulffraat N, van Wijnen VK, Lelieveld OTHM. Design and acceptance of Rheumates@Work, a combined internet-based and in person instruction model, an interactive, educational, and cognitive behavioral program for children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2015; 13:31. [PMID: 26202161 PMCID: PMC4511536 DOI: 10.1186/s12969-015-0029-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease. Patients suffer daily discomforts such as pain, fatigue, stiffness, and mood disturbances. Their exercise capacity is decreased to a variable degree and physical activity levels may be impaired. To prevent long-term cardiovascular risks associated with JIA and medication, it is important to encourage physical activity. To achieve this we developed Rheumates@Work (R@W), a combined internet-based and in person instruction model, an interactive, educational, and cognitive behavioral program. The aim of this study is twofold: to describe the theoretical background and design of R@W based on Pender's Health Promotion Model, and to assess its acceptance. METHODS We enrolled 8 to 13-year-old JIA patients, from 3 outpatients clinics in The Netherlands, in R@W. Inclusion criteria were a low disease activity (VAS physician <20 mm), comprehension of the Dutch language and absence of relevant co-morbidity. We assessed acceptance by measuring the participants' commitment to the program, the level of interaction on patient's initiative (f.e. mails send by the patient), technical aspects and satisfaction. Commitment was defined as the percentage of participants that completed the assignments and how much encouragement the participants needed for this. Satisfaction was measured with an anonymous questionnaire concerning f.e. time investment and perceived benefits. Costs were monitored. RESULTS Of the 64 patients we enrolled, 23 boys and 41 girls, 93.8 % completed the program. Participant-initiated interaction was seen in 10.7 %, 24.7 % send a mail because of technical problems. Eighty-two percent of the participants and 99 % of the parents liked the program, and 85 % of the participants indicated that they had learnt something, or quite a lot. Development costs of the program were low. CONCLUSION The HPM is suitable for a behavioral intervention program such as R@W. Acceptance and satisfaction of R@W were high and the costs of the program were low. TRIAL NUMBER ISRCTN92733069.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
| | - Joyce J. F. J. Bos
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Jeannette Cappon
- Amsterdam Center for Rheumatology and immunology Reade, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands.
| | - Marion A.J. J. van Rossum
- Amsterdam Center for Rheumatology and immunology Reade, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Groningen, The Netherlands
| | - Nico Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Veera K. van Wijnen
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Groningen, The Netherlands
| | - Otto T. H. M. Lelieveld
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
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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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Hulsegge G, Henschke N, McKay D, Chaitow J, West K, Broderick C, Singh-Grewal D. Fundamental movement skills, physical fitness and physical activity among Australian children with juvenile idiopathic arthritis. J Paediatr Child Health 2015; 51:425-32. [PMID: 25176021 DOI: 10.1111/jpc.12733] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 11/28/2022]
Abstract
AIM To describe fundamental movement skills (FMS), physical fitness and level of physical activity among Australian children with juvenile idiopathic arthritis (JIA) and compare this with healthy peers. METHODS Children aged 6-16 years with JIA were recruited from hospital rheumatology clinics and private rheumatology rooms in Sydney, Australia. All children attended an assessment day, where FMS were assessed by a senior paediatric physiotherapist, physical fitness was assessed using the multistage 20-metre shuttle run test, and physical activity and physical and psychosocial well-being were assessed with questionnaires. These results were compared with age- and gender-matched peers from the NSW Schools Physical Activity and Nutrition Survey and the Health of Young Victorians Study using logistic regression analysis. RESULTS Twenty-eight children with JIA participated in this study. There were no differences in the proportion of children who had mastered FMS between children with JIA and their healthy peers (P > 0.05). However, there was a trend for children with JIA to have poorer physical fitness and be less physically active than healthy peers. Parents of children with JIA indicated more physical and psychosocial impairments among their children and themselves compared with parents of healthy children (P < 0.05). CONCLUSIONS This is the first study in Australia to compare FMS, physical activity and fitness in children with JIA and their peers. While older children with JIA appear to have poorer physical fitness and physical activity levels than their peers, there is no difference in FMS.
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Affiliation(s)
- Gerben Hulsegge
- Musculoskeletal Division, George Institute for Global Health, Sydney, New South Wales, Australia; EMGO Institute for Health and Care Research, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands; Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Rohekar S, Chan J, Tse SM, Haroon N, Chandran V, Bessette L, Mosher D, Flanagan C, Keen KJ, Adams K, Mallinson M, Thorne C, Rahman P, Gladman DD, Inman RD. 2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations. J Rheumatol 2015; 42:665-81. [DOI: 10.3899/jrheum.141001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/01/2023]
Abstract
Objective.The Canadian Rheumatology Association (CRA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) have collaborated to update the recommendations for the management of spondyloarthritis (SpA).Methods.A working group was assembled and consisted of the SPARCC executive committee, rheumatologist leaders from SPARCC collaborating sites, Canadian rheumatologists from across the country with an interest in SpA (both academic and community), a rheumatology trainee with an interest in SpA, an epidemiologist/health services researcher, a member of the CRA executive, a member of the CRA therapeutics committee, and a patient representative from the Canadian Spondylitis Association. An extensive review was conducted of literature published from 2007 to 2014 involving the management of SpA. The working group created draft recommendations using multiple rounds of Web-based surveys and an in-person conference.Results.Recommendations for the management of SpA were created. Part II: Specific Management Recommendations addresses management with nonpharmacologic methods, nonsteroidal anti-inflammatories and analgesics, disease-modifying antirheumatic drugs, antibiotics, tumor necrosis factor inhibitors, other biologic agents, and surgery. Also included are 10 modifications for application to juvenile SpA.Conclusion.These recommendations were developed based on current literature and applied to a Canadian healthcare context. It is hoped that implementation of these recommendations will promote best practices in the treatment of SpA.
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Ferraz RB, Gualano B, Filho CM, Almeida MG, Perandini LA, Dassouki T, Sá-Pinto AL, Lima FR, Roschel H. Safety and feasibility of maximal physical testing in rheumatic diseases: a cross-sectional study with 5,910 assessments. Rheumatol Int 2014; 35:1027-36. [PMID: 25373541 DOI: 10.1007/s00296-014-3169-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/27/2014] [Indexed: 11/28/2022]
Abstract
The purpose of the study was to report on the safety and feasibility of the application of maximal physical tests in a heterogeneous cohort of rheumatic patients. This is a 5-year retrospective descriptive report on the incidence of events associated with maximal physical testing from 536 patients, totalizing 5,910 tests. Tests were classified as cardiopulmonary, muscle strength, and physical functioning tests. Any adverse events during the tests and limiting factors incurring in tests cancellation were reported. Eighteen out of 641 cardiopulmonary exercise tests had an adverse occurrence, with cardiac disturbance (1.4% of total tests) being the most prevalent. Moreover, 14 out of 641 tests were not feasible. Out of 3,478 tests comprising leg press, bench press, knee extension, and handgrip tests, 15 tests had an adverse event. The most common occurrence was joint pain (0.4% of total tests), which was also the most frequent factor precluding testing (0.5% of total tests). Forty-five out of 3,478 (1.3%) of the tests were not feasible. There was a very low incidence of events (0.2%) during the physical functioning tests. Joint pain was the only adverse event during the tests, whereas physical limitations were the most important barriers for the execution of the tests (1.1% of total tests). The incidence of limiting events in this test was 1.6% (n = 29). This report brings new data on the safety and feasibility of maximal physical testing in rheumatic patients. The physical tests described in this study may be applied for testing rheumatic patients both in research and clinical setting.
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Affiliation(s)
- Rodrigo Branco Ferraz
- Division of Rheumatology, Faculty of Medicine, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - 3° andar - sala 3131 - Cerqueira César, São Paulo, 05403-000, Brazil
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Determinants of health-related quality of life impairment in Egyptian children and adolescents with juvenile idiopathic arthritis: Sharkia Governorate. Rheumatol Int 2014; 34:1095-101. [PMID: 24469640 DOI: 10.1007/s00296-014-2950-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to identify the possible determinants of impaired health-related quality of life (HRQOL) in Egyptian children and adolescents with juvenile idiopathic arthritis (JIA). Fifty-eight consecutive patients of JIA aged from 8 to 18 years underwent assessment of socio-economic and demographic characteristics; HRQOL using Pediatric Quality of Life Inventory 4.0 Generic Core Scale, disease activity using the Juvenile Arthritis Disease Activity Score based on 27 joints (JADAS-27), functional ability using the childhood health assessment questionnaire (CHAQ), pain score on visual analog scale and psychological symptoms using the Children's Depression Inventory (CDI) score. Multivariate modeling was applied to determine the factors that associated with HRQOL impairment. A total of 55 % of the patients (32 of 58) had impaired HRQOL (<78.6). In multiple regression analyses, high CHAQ scores (OR 6.0, 95 % CI 2.0-17.5, P = 0.001), pain (OR 3.1, 95 % CI 1.9-6.3, P = 0.01), stop going to school (OR 3.9, 95 % CI 2.0-7.3, P = 0.01), low socioeconomic status (OR 2.3, 95 % CI 1.09-4.7, P = 0.04) and high psychological symptoms (OR 4.2, 95 % CI 2.0-12.6, P = 0.001) were determinants for HRQOL impairment. HRQOL impairment is a significant problem in Egyptian children and adolescents with JIA. These findings underscore the critical need for monitoring of HRQOL in these patients. More attention should be given to JIA patients who stop going to school and who has low socioeconomic status.
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Regular aerobic training combined with range of motion exercises in juvenile idiopathic arthritis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:748972. [PMID: 24579086 PMCID: PMC3919112 DOI: 10.1155/2014/748972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 11/13/2013] [Accepted: 11/18/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the effects of regular aerobic training combined with range of motion (ROM) exercises on aerobic capacity, quality of life, and function in children with juvenile idiopathic arthritis (JIA). METHODS Thirty patients with JIA and 20 healthy age-matched controls (mean age ± SD, 11.3 ± 2.4 versus 11.0 ± 2.3, resp.; P > 0.05) were included. All patients performed aerobic walking (4 days a week for 8 weeks) and active and passive ROM exercises of involved joints. All patients completed the childhood health assessment questionnaire (CHAQ) and the child health questionnaire. ROM measurements of joints were performed by using universal goniometer. Aerobic capacity was determined by measuring peak oxygen uptake (VO2peak) during an incremental treadmill test. RESULTS Peak oxygen uptake and exercise duration were significantly lower in JIA group than in controls (32.5 ± 6.6 versus 35.9 ± 5.8 and 13.9 ± 1.9 versus 15.0 ± 2.0, resp.; P < 0.05 for both). Eight-week combined exercise program significantly improved exercise parameters of JIA patients (baseline versus postexercise VO2peak and exercise duration, 32.5 ± 6.6 to 35.3 ± 7.9 and 13.9 ± 1.9 to 16.3 ± 2.2, resp.; P < 0.001 for both). Exercise intervention significantly improved CHAQ scores in JIA patients (0.77 ± 0.61 to 0.20 ± 0.28, P < 0.001). CONCLUSION We suggest that regular aerobic exercise combined with ROM exercises may be an important part of treatment in patients with JIA.
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Armbrust W, Kaak JG, Bouma J, Lelieveld OTHM, Wulffraat NM, Sauer PJJ, van Sonderen E. Assessment of disease activity by patients with juvenile idiopathic arthritis and the parents compared to the assessment by pediatric rheumatologists. Pediatr Rheumatol Online J 2013; 11:48. [PMID: 24368009 PMCID: PMC3879656 DOI: 10.1186/1546-0096-11-48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/16/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Self assessment of arthritis is important for recognition of disease activity and early initiation of therapy. Proper interpretation of physical symptoms is necessary for this. The purpose was to investigate the assessment by patients and parents of disease activity in juvenile idiopathic arthritis (JIA) and to compare their assessments to rheumatologists' assessments. METHODS Patients and parents assessed 69 joints on a paper homunculus and marked each joint with a different color according to presumed presence of disease: active disease (AD), doubt, and non-active disease (NAD). Their assessments were compared to the rheumatologists' assessments. If patients and/or parents marked an inflamed joint, it counted as AD. Pain, functional impairment, and disease duration were analyzed to differentiate more precise between true and false positive and true and false negative assessments. RESULTS We collected assessments of 113 patients and/or parents. AD was assessed 54 times, 33 of which were true positives. NAD was assessed 23 times, 22 of which were true negatives. Doubt was expressed 36 times, 9 of which were assessed by the rheumatologist as AD. Sensitivity and specificity of AD was 0.77 and 0.31. Pain and functional impairment scored highest in AD, intermediate in doubt, and lowest in NAD. CONCLUSION Patients and/or parents seldom missed arthritis but frequently overestimated disease activity. Pain, functional impairment, disease duration, gender, and age did not differentiate between true and false positives for. Patients perceived JIA as active if they experienced pain and functional impairment. To reduce overestimation of the presence of AD we need to improve their understanding of disease activity by teaching them to distinguish between primary symptoms of JIA and symptoms like pain and functional impairment.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
| | - Jolanda G Kaak
- University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, Groningen, the Netherlands
| | - Jelte Bouma
- Department of Health Sciences, University Medical Center Groningen, Health Psychology Section, University of Groningen, Groningen, the Netherlands
| | - Otto T H M Lelieveld
- Department of Rehabilitation,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nico M Wulffraat
- Department of Childrens Rheumatology and Immunology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Pieter J J Sauer
- University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, Groningen, the Netherlands
| | - Eric van Sonderen
- Department of Health Sciences, University Medical Center Groningen, Health Psychology Section, University of Groningen, Groningen, the Netherlands
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Limenis E, Grosbein HA, Feldman BM. The Relationship Between Physical Activity Levels and Pain in Children with Juvenile Idiopathic Arthritis. J Rheumatol 2013; 41:345-51. [DOI: 10.3899/jrheum.130734] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Pain and reduced physical activity levels are common in children with juvenile idiopathic arthritis (JIA). Currently, there is no consensus about the role of physical activity in managing pain in JIA. The purpose of our study was to assess the relationship between physical activity level and pain in children ages 11 to 18 years with JIA.Methods.A random sample of 50 patients with JIA were approached by mailed questionnaires. Physical activity was determined using the Physical Activity Questionnaire (PAQ). Pain measures included the Numerical Rating Scale (pain severity), SUPER-KIDZ body diagram (number of painful areas), and the Child Activities Limitations Inventory-21 (pain interference). Generalized linear models were used to assess the relationship between physical activity and pain, as well as the roles of sex and age.Results.The response rate was 84%. Thirty-four respondents completed the questionnaire package. The median age was 15 years. The mean PAQ score was 2.16/5. Physical activity declines with increasing age in youth with JIA (r = 0.53, p = 0.0014). Lower physical activity is associated with greater pain interference (r = 0.39, p = 0.0217) and more severe pain (r = 0.35, p = 0.0422).Conclusion.Children with JIA report significantly less activity than healthy children based on PAQ scores, with physical activity declining throughout adolescence. Physical activity is inversely related to pain interference and severity in children with JIA. Our findings suggest that physical activity interventions may play an important role in the management of pain in JIA.
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Shiff NJ, Brant R, Guzman J, Cabral DA, Huber AM, Miettunen P, Roth J, Scuccimarri R, Alos N, Atkinson SA, Collet JP, Couch R, Cummings EA, Dent PB, Ellsworth J, Hay J, Houghton K, Jurencak R, Lang B, Larche M, Leblanc C, Rodd C, Saint-Cyr C, Stein R, Stephure D, Taback S, Rauch F, Ward LM. Glucocorticoid-related changes in body mass index among children and adolescents with rheumatic diseases. Arthritis Care Res (Hoboken) 2013; 65:113-21. [PMID: 22826190 PMCID: PMC4459861 DOI: 10.1002/acr.21785] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/19/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the temporal and dose-related effects of glucocorticoids (GCs) on body mass index (BMI) in children with rheumatic diseases. METHODS Children initiating GCs for a rheumatic disease (n = 130) were assessed every 3 months for 18 months. BMI, weight, and height Z score trajectories were described according to GC starting dosage in prednisone equivalents: high (≥1.0 mg/kg/day), low (<0.2 mg/kg/day to a maximum of 7.5 mg/day), and moderate (between high and low) dosage. The impact of GC dosing, underlying diagnosis, pubertal status, physical activity, and disease activity on BMI Z scores and on percent body fat was assessed with longitudinal mixed-effects growth curve models. RESULTS The GC starting dose was high in 59% and moderate in 39% of patients. The peak BMI Z score was +1.29 at 4 months with high-dose GCs and +0.69 at 4.2 months with moderate-dose GCs (P < 0.001). Overall, 50% (95% confidence interval 41-59%) of the children returned to within +0.25 SD of their baseline BMI Z score. Oral GC dose over the preceding 3 months was the most significant determinant of BMI Z score and percent body fat. The proportion of days in receipt of GCs, disease activity, and a diagnosis of systemic-onset juvenile idiopathic arthritis were also associated with BMI Z scores. The correlation between changes in BMI and changes in percent body fat was 0.09. CONCLUSION In children with rheumatic diseases starting moderate and high doses of GCs, BMI Z scores peaked at 4 months, and only half returned to within +0.25 SD of their baseline BMI Z score after 18 months.
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Affiliation(s)
- Natalie J Shiff
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Abstract
Juvenile idiopathic arthritis (JIA) is a common chronic childhood illness. Pain is the most common and distressing symptom of JIA. Pain has been found to negatively impact all aspects of functioning, including physical, social, emotional and role functions. Children with arthritis continue to experience clinically significant pain despite adequate doses of disease-modifying antirheumatic drugs and anti-inflammatory agents. The present article reviews the prevalence and nature of pain in JIA, the biopsychosocial factors that contribute to the pain experience, current approaches to assessing pain in this population, and ways of managing both acute and persistent pain using pharmacological, physical and psychological therapies. Finally, new approaches to delivering disease self-management treatment for youth with JIA using the Internet will be outlined.
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Munsterman T, Takken T, Wittink H. Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity. BMC Musculoskelet Disord 2012; 13:202. [PMID: 23078261 PMCID: PMC3575246 DOI: 10.1186/1471-2474-13-202] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 10/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. METHODS Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. RESULTS In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. CONCLUSION Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls.
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Affiliation(s)
- Tjerk Munsterman
- Physical Therapy Center, Martini Hospital Groningen, P.O. Box 30033, 9700 RM Groningen, Netherlands
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Taxter A, Foss KB, Melson P, Ford KR, Shaffer M, Myer GD. Juvenile idiopathic arthritis and athletic participation: are we adequately preparing for sports integration? PHYSICIAN SPORTSMED 2012; 40:49-54. [PMID: 23528621 DOI: 10.3810/psm.2012.09.1981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Children with juvenile idiopathic arthritis (JIA) now have well-controlled disease due to improved therapies and management strategies. Children with JIA are more active than in the past and often participate in dynamic, high-loading sports. Standard measures of disease control include examination findings, laboratory values, and patient-directed surveys. However, these standards do not address the subtle deficits in biomechanics and neuromuscular control, which could place affected joints at higher risk for injury. Currently, there are limited evidence-based guidelines to structure conditioning recommendations as to the fitness and mechanics needed to provide safe integration into sports in this population; therefore, tools that objectively measure function with high accuracy and precision may be warranted. Previous work using 3-dimensional motion analysis demonstrated usefulness in guiding physical therapy treatment to correct these deficits. The use of a multidisciplinary team, including physical therapy, rheumatology, and sports medicine, is crucial for preparing these children to return to play. We suggest that the child transition into a sport preparatory-conditioning program to address any underlying deficits. A pediatric exercise specialist who is sensitive to the needs of this population can work with a physical therapist to then appropriately integrate the child safely into sport. Encouraging an active lifestyle is vital to the management of JIA and does not worsen the symptoms associated with childhood arthritis.
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Affiliation(s)
- Alysha Taxter
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA
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Houghton K. Physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis. PHYSICIAN SPORTSMED 2012; 40:77-82. [PMID: 23528624 DOI: 10.3810/psm.2012.09.1979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Arthritis in childhood can be associated with low levels of physical activity and poor physical fitness. Children with arthritis may have decreased aerobic and anaerobic fitness, muscle weakness, low bone mass, and low bone strength. Suboptimal physical activity and exercise capacity may contribute to further deconditioning and disability, placing children with arthritis at risk for poor health outcomes. Recent studies suggest that exercise therapy is safe and does not worsen arthritis. Exercise therapy may improve function, quality of life, and physical fitness. However, little is known about the exercise prescription that is most effective to improve clinical outcomes in children with arthritis. This article reviews the current literature on physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis.
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Affiliation(s)
- Kristin Houghton
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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van Pelt PA, Takken T, van Brussel M, de Witte I, Kruize AA, Wulffraat NM. Aerobic capacity and disease activity in children, adolescents and young adults with juvenile idiopathic arthritis (JIA). Pediatr Rheumatol Online J 2012; 10:27. [PMID: 22925405 PMCID: PMC3551670 DOI: 10.1186/1546-0096-10-27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 08/14/2012] [Indexed: 01/13/2023] Open
Abstract
UNLABELLED BACKGROUND As patients with juvenile idiopathic arthritis (JIA) progress into adulthood, long-term outcome is determined by disease activity, physical and psychosocial development. Decreased aerobic capacity may play a critical role in health-related outcomes in JIA, since it has been linked with cardiovascular morbidity and mortality in late adulthood. The objectives of the current study are to examine the aerobic capacity and its relation to parameters of disease activity in children, adolescents and young adults with JIA. METHODS Sixty-three patients with JIA (aged 10-27 years) were cross sectional studied regarding their aerobic capacity and correlations were made to demographic, disease-related variables, and medication utilization. in a cross-sectional study group of 63 patients of all subtypes. Patients were divided in three age groups, 10-13 years; 14-17 years and 18-27 years. RESULTS Reduced aerobic capacity is found in clinical remission as well as active disease in all subtypes and all age groups. Aerobic capacity is more impaired in active disease shown by DAS 28, JADAS 27, ESR and serum thrombocyte counts. Lower haemoglobin has a negative impact. Long-term used medication including methotrexate and corticosteroids didn't influence outcome. There is no association with current sports participation. CONCLUSION Reduced aerobic capacity is present in children and adolescents with JIA, both in active disease and in patients with remission. Measures of aerobic capacity may serve as important outcome measure in JIA.
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Affiliation(s)
- Philomien A van Pelt
- Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital UMC Utrecht, Utrecht, The Netherlands
| | - Marco van Brussel
- Child Development & Exercise Center, Wilhelmina Children’s Hospital UMC Utrecht, Utrecht, The Netherlands
| | - Inge de Witte
- Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Aike A Kruize
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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van Pelt PA, Takken T, van Brussel M, de Witte M, Kruize AA, Wulffraat NM. Aerobic capacity and disease activity in children, adolescents and young adults with juvenile idiopathic arthritis (JIA). Pediatr Rheumatol Online J 2012; 10:25. [PMID: 22905830 PMCID: PMC3511878 DOI: 10.1186/1546-0096-10-25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/14/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND As patients with juvenile idiopathic arthritis (JIA) progress into adulthood, long-term outcome is determined by disease activity, physical and psychosocial development. Decreased aerobic capacity may play a critical role in health-related outcomes in JIA, since it has been linked with cardiovascular morbidity and mortality in late adulthood. The objectives of the current study are to examine the aerobic capacity and its relation to parameters of disease activity in children, adolescents and young adults with JIA. METHODS Sixty-three patients with JIA (aged 10-27 years) were cross sectional studied regarding their aerobic capacity and correlations were made to demographic, disease-related variables, and medication utilization. in a cross-sectional study group of 63 patients of all subtypes. Patients were divided in three age groups, 10-13 years; 14-17 years and 18-27 years. RESULTS Reduced aerobic capacity is found in clinical remission as well as active disease in all subtypes and all age groups. Aerobic capacity is more impaired in active disease shown by DAS 28, JADAS 27, ESR and serum thrombocyte counts. Lower haemoglobin has a negative impact. Long-term used medication including methotrexate and corticosteroids didn't influence outcome. There is no association with current sports participation. CONCLUSION Reduced aerobic capacity is present in adolescents and young adults with JIA, both in active disease and in patients with remission. Measures of aerobic capacity may serve as important outcome measure in JIA.
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Affiliation(s)
- Philomine A van Pelt
- Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Marco van Brussel
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Mirjam de Witte
- Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Aike A Kruize
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Tunar M, Ozen S, Goksen D, Asar G, Bediz CS, Darcan S. The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus. J Diabetes Complications 2012; 26:348-51. [PMID: 22609217 DOI: 10.1016/j.jdiacomp.2012.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/26/2012] [Accepted: 04/10/2012] [Indexed: 11/15/2022]
Abstract
UNLABELLED Physical activity is a substantial method in the management of children and adolescents with Type 1 diabetes mellitus but it is not considered as a treatment for diabetes. The aim of this study was to investigate the effects of Pilates exercises on metabolic control and physical performance in patients with type 1 diabetes mellitus. Thirty one sedentary patients with type 1 diabetes mellitus, ranging in age from 12 to 17 (experimental group, n=17 and control group, n=14) were submitted to 12 weeks of Pilates training. Participants underwent tests to determine the physical performance and metabolic control before and after 12 weeks of Pilates session. At the end of study, there were significant alterations in physical performance of the study group. Peak power, mean power, vertical jump and flexibility of study group increased. There were no alterations for this parameters in the control group. There was no significant difference for glycated hemoglobin (HbA1c) in both groups. CONCLUSIONS Physical performance increased via Pilates exercises in the patients with type 1 DM. However there were no changes in metabolic control. In the present study, the positive effects of exercise on metabolic control could not be shown in patients with Type 1 DM.
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Affiliation(s)
- Mert Tunar
- Dokuz Eylul University, School of Sport Science and Technologies 35340, İnciralti, Izmir, Turkey.
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