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Py S, Maylié F, Parmentier AL, Vidal C, Cuinet B, Mauny F, Lohse A, Toussirot E, Yoshimasa S, Tordi N, Binda D, Ballot-Schmit C. ATHLETIQUE: interest of an adapted physical activity program in patients with juvenile idiopathic arthritis: a feasibility and preliminary effectiveness study. Front Immunol 2023; 14:1213799. [PMID: 37441067 PMCID: PMC10333511 DOI: 10.3389/fimmu.2023.1213799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Juvenile Idiopathic Arthritis (JIA) is associated with joint inflammation, pain and limited joint mobility, impacting the practice of physical activities. Adapted Physical Activities (APA) are an increasingly used method of rehabilitation, but additional studies are needed to define the nature of the most appropriate physical activity for patients with JIA. The "ATHLETIQUE" project aims to evaluate the impact of a program integrating APA sessions with use of a pedometer watch, on disease activity in patients with JIA. Methods This study will be a randomized, multicenter, open-label, controlled clinical trial with 2 parallel arms. The patients included in this study will be children and adolescents with JIA, aged 6 to 17 years. The experimental group (30 patients) will participate in an APA program for 3 months and will use a pedometer watch for one year. We will evaluate and compare the change in disease activity measurements (primary objective), fatigue, pain, quality of life, level of physical activity, functional capacities, and muscle strength (secondary objectives) after 14, 26 and 50 weeks. The control group (10 patients) will undergo the same evaluations as the experimental group but will not participate in the APA program and will not wear the pedometer watch. Expected results The APA program may help to promote an active lifestyle with regular physical activity, preventing comorbidities and motor disability. Promising results on disease activity, functional capacities and quality of life would enable us to envisage a larger research program with a view to optimizing and assessing APA for children with JIA. Discussion This study will be conducted in the short and medium-term, with one-year follow-up, including 3 months of APA sessions for the experimental group. The sessions proposed during the APA program will mainly be aerobic and bodyweight exercises. Furthermore, in contrast to previous studies on this topic, our study will integrate a novel element, namely the use of a pedometer watch. This watch will help to implement strategies to address motivation. This study aims to improve physical and mental well-being, provide a basis for the design of a larger study, and propose recommendations adapted to children with JIA. Trial registration Registered with ClinicalTrials.gov under the number NCT05572424.
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Affiliation(s)
| | | | | | | | | | | | - Anne Lohse
- Rheumatology Department, Nord Franche-Comté Hospital, Trevenans, France
| | - Eric Toussirot
- Inserm CIC 1431, CHU Besançon, Besançon, France
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU Besançon, Besançon, France
- Département Universitaire de Thérapeutique, Université de Franche-Comté, Besançon, France
- UMR 1098 RIGHT, Inserm, Établissement Français du Sang, Université Franche-Comté, Besançon, France
| | - Sagawa Yoshimasa
- Inserm CIC 1431, CHU Besançon, Besançon, France
- Laboratoire d’Exploration Fonctionnelle Clinique du Mouvement, CHU Besançon, Besançon, France
- UR 481 LINC Neurosciences and Cognition, Université de Franche-Comté, Besançon, France
| | - Nicolas Tordi
- PEPITE, Platform Exercise Performance Health Innovation (EPHI), Université de Franche-Comté, Besançon, France
| | - Delphine Binda
- Inserm CIC 1431, CHU Besançon, Besançon, France
- UR 481 LINC Neurosciences and Cognition, Université de Franche-Comté, Besançon, France
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de Oliveira RJ, Londe AC, de Souza DP, Marini R, Fernandes PT, Appenzeller S. Physical Activity Influences Health-Related Quality of Life in Adults with Juvenile Idiopathic Arthritis. J Clin Med 2023; 12:jcm12030771. [PMID: 36769423 PMCID: PMC9917453 DOI: 10.3390/jcm12030771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
This cross-sectional study aimed to evaluate the impact of physical activity and physical fitness on the health-related quality of life (HQoL) of adult patients with Juvenile Idiopathic Arthritis (JIA). Fifty-nine JIA patients and sixty healthy individuals participated in this study. All individuals had the following evaluations performed: body composition (electrical bioimpedance), physical fitness (6 min walk test (6MWT)), physical activity level (International Physical Activity Questionnaire (IPAQ)), and HQoL (Quality of Life Questionnaire in relation to Health-Short Form (SF36)). Thirty-nine (66%) JIA patients were considered sedentary compared with 15 (25%) in the control group (p < 0.01). JIA patients had a lower HQoL compared with the control group in all variables studied (p < 0.05). JIA patients who were very physically active had better HQoL conditions in the categories of functional capacity (p = 0.001), limitations by physical aspects (p = 0.003), and emotional aspects (p = 0.002) compared with sedentary patients. JIA patients had more cardiovascular abnormalities and walked shorter distances compared with healthy controls in the 6MWT. In conclusion, we observed that HQoL was reduced in adults with JIA. A high percentage of JIA patients were sedentary with lower physical fitness, but physically active patients had a better HQoL than sedentary patients. The duration of physical activity, rather than intensity, influenced the mental aspects of HQoL.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Ana Carolina Londe
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Débora Pessoa de Souza
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Science, Faculty of Physical Education, University of Campinas (UNICAMP), Campinas 13083-851, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology—School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
- Correspondence: ; Fax: +55-19-3289-1818
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Gizik J, Meister S, Hartmann M, Sahm D, Georgi M, Baumeister N, Kühne M, Haas JP, Schwirtz A. Physiotherapie und Sport bei Kinderrheuma – Shake your
bones. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1757-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungIm Rahmen kindlicher rheumatischer Erkrankungen haben die zumeist schmerzhaften
Entzündungsvorgänge am muskulo-skelettalen System
(z. B.: Gelenke, Muskeln, Sehnen, Gefäße) Auswirkungen
auf die tägliche Mobilität der Betroffenen. Immobilität,
körperliche und sportliche Inaktivität sind oft die Folge. Die
geltenden Richtlinien der Nationalen Empfehlungen für Bewegung und
Bewegungsförderung werden daher oftmals nicht erreicht.
Bewegungsreduzierte oder -inaktive Patienten können jedoch durch
verschiedene Maßnahmen in ihrem Bewegungsverhalten gefördert
werden. Die Physiotherapie bietet eine erste Möglichkeit in
geschütztem Rahmen und unter fachlicher Aufsicht körperlich und
sportlich aktiv zu sein. Neben der Wiederherstellung und Verbesserung des
physiologischen Bewegungsausmaßes liegen die Erhaltung der
Selbstständigkeit und Lebensqualität im Vordergrund der
physiotherapeutischen Behandlung. Dazu zählen Aktivierung, Anbahnung von
physiologischen Bewegungsabläufen, Korrektur von Gelenkachsen und das
Vermitteln von Körperwahrnehmung bei körperlicher
Aktivität. Medizinisches Fachwissen und Verständnis sowie Wissen
über die Anforderungen verschiedener Sportartenprofile
ermöglicht gezielte Hilfestellungen. Durch kontinuierliche, engmaschige
Begleitung und langsame Steigerung von Intensität und Umfang in der
Physiotherapie können Ängste und Bedenken bezüglich dem
Wiedereinstieg bzw. Einstieg in sportliche Betätigung abgebaut werden.
Der jeweilige Gesundheitszustand und die Situation der
Entzündungsaktivität sind maßgebend für die
Therapieinterventionen. Sport gilt heute in der Physiotherapie als
Therapieelement und hilft Beschwerden zu lindern, verbessert körperliche
Defizite und vermittelt dabei Freude an der Bewegung. Für
Alltagsaktivitäten und den Freizeitsport kann eine individuelle
Sportberatung basierend auf dem bestehenden Erkrankungsstatus, dem funktionellen
und sportmotorischen Leistungsniveau sowie den eigenen Interessen wirkungsvoll
zu einem aktiven Lebensstil beitragen. Eine weitere Möglichkeit der
angeleiteten Bewegungsförderung stellt der Schulsport dar. Individuelle,
differenzierte Schulsportteilnahmebescheinigungen verbessern die Inklusion. Ein
auf den Erkrankungsstatus angepasstes und vorgegebenes Trainingsprogramm kann
mithilfe konkreter Vorgaben bei der Umsetzung der sportlichen Ziele
unterstützen. In Zukunft soll ein digital gestütztes
professionelles Monitoring die Bewegungsempfehlungen für zuhause noch
weiter verbessern und helfen den Mangel an flächendeckenden
Beratungsstellen für Erkrankte mit kindlichem Rheuma zu verringern.
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Affiliation(s)
- Josephine Gizik
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Sophia Meister
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Matthias Hartmann
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Daniel Sahm
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Mathias Georgi
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Nadja Baumeister
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Mareike Kühne
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie,
Garmisch-Partenkirchen, Germany
| | - Ansgar Schwirtz
- Technische Universität München, Fakultät
für Sport- und Gesundheitswissenschaften, Professur für
Biomechanik im Sport, München, Germany
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Iversen MD, Andre M, von Heideken J. Physical Activity Interventions in Children with Juvenile Idiopathic Arthritis: A Systematic Review of Randomized Controlled Trials. Pediatric Health Med Ther 2022; 13:115-143. [PMID: 35444485 PMCID: PMC9015041 DOI: 10.2147/phmt.s282611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/25/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Children with juvenile arthritis (JA) experience pain, stiffness, fatigue, and decreased motion leading to difficulties with daily activities and low physical activity (PA). PA is critical to improve health and function and mitigate JA-associated symptoms. This study evaluated the evidence for PA interventions in children with JA. Materials and Methods A systematic review of randomized controlled trials (RCTs) of PA interventions in children with JA was conducted. Ovid (Medline), Cochrane Library, EMBASE, and CINAHL databases were searched for papers published in English between 1/1/1946 and 9/1/2021. Studies which concurrently assessed medical interventions were excluded. Participant and intervention characteristics and outcomes were extracted. Study internal validity and intervention attributes were assessed. Results A total of 555 studies were identified, with 13 studies from 10 countries included. Data from 672 children diagnosed with juvenile idiopathic arthritis (JIA) (range of mean ages, 8.7 to 16.1 years) were analyzed. Fifty-two percent of intervention arms incorporated strengthening exercise alone or combined with other exercise, with 61.9% performed 3x/week. About 43.5% of sessions lasted >45 to ≤60 minutes and 65.2% of programs were ≥12 to <28 weeks. PA interventions improved function and symptoms without adverse events. Intervention details were missing especially regarding PA intensity, reasons for dropouts, and adherence. Only two studies incorporated strategies to promote adherence. Discussion RCTs of PA interventions in JA only include JIA. Available RCTs used mixed modes of interventions. Reporting of PA interventions lacks sufficient detail to discern the dose-response relationship. Strategies to motivate engagement in PA and to support families to promote PA are lacking, as are studies of long-term outcomes. Conclusion There are limited RCTs of PA interventions in JIA. Adherence was better with low intensity programs. PA interventions for JIA yield positive health benefits but better reporting of PA intervention details is needed to generate more high-quality evidence and inform clinical practice. Prospero Registration Maura Iversen, Johan von Heideken, Marie Andre. Physical Activity in Children with Rheumatic Diseases: a systematic review. PROSPERO 2021 CRD42021274634 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274634.
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Affiliation(s)
- Maura D Iversen
- College of Health Professions, Sacred Heart University, Fairfield, CT, USA
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Section of Clinical Sciences, Division of Immunology, Rheumatology & Immunity, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Correspondence: Maura D Iversen, College of Health Professions, Sacred Heart University, 5151 Park Avenue, Fairfield, CT, 06825, USA, Tel +1 203 396-8024, Fax +1 203-396-8025, Email
| | - Marie Andre
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Heideken
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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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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Bourdier P, Birat A, Rochette E, Doré É, Courteix D, Dutheil F, Pereira B, Ratel S, Merlin E, Duché P. Muscle function and architecture in children with juvenile idiopathic arthritis. Acta Paediatr 2021; 110:280-287. [PMID: 32420673 DOI: 10.1111/apa.15335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
AIM To assess muscle function and functional abilities in children with juvenile idiopathic arthritis (JIA). METHODS Fourteen children with JIA and 14 healthy controls matched for age and sex were included. Muscle characteristics, both structural (thickness, cross-sectional area (CSA) and fascicle angle) and qualitative (intermuscular adipose tissue; IMAT), were assessed in thigh muscles using ultrasound and peripheral quantitative computed tomography (pQCT). Muscle function and functional abilities were determined from the assessment of maximal voluntary isometric contraction (MVIC) knee extensors force and vertical jump performance. RESULTS No significant difference in MVIC force was observed between the two groups. However, squat jump height was significantly reduced in children with JIA (18.3 ± 5.4 vs 24.3 ± 7.9 cm, P < .05). No differences in structural parameters were observed, but IMAT/CSA (0.22 ± 0.02 vs 0.25 ± 0.03; P = .01) was significantly lower in children with JIA than in healthy children. CONCLUSION Knee extensor muscle architecture and force were comparable between children with and without JIA, but functional abilities (vertical jump performance) were poorer in JIA. The lower IMAT area in JIA could result from a lower physical activity level compared with healthy children.
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Affiliation(s)
- Pierre Bourdier
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Anthony Birat
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Emmanuelle Rochette
- INSERM, CIC 1405, Unité CRECHE, CHU Clermont‐Ferrand Université Clermont Auvergne Clermont‐Ferrand France
- CHU Clermont‐Ferrand Clermont‐Ferrand France
- Laboratoire IAPS Université de Toulon Toulon France
| | - Éric Doré
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Daniel Courteix
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Frédéric Dutheil
- CNRS Laboratoire de Psychologie Sociale et Cognitive (LaPSCo) UCA‐CNRS 6024, CHU Université Clermont Auvergne Clermont–Ferrand France
- Faculty of Health School of Exercise Science Australian Catholic University Melbourne Vic. Australia
| | | | - Sébastien Ratel
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Etienne Merlin
- INSERM, CIC 1405, Unité CRECHE, CHU Clermont‐Ferrand Université Clermont Auvergne Clermont‐Ferrand France
- CHU Clermont‐Ferrand Clermont‐Ferrand France
- INRA, UMR 1019 UNH, ECREIN Université Clermont Auvergne Clermont‐Ferrand France
| | - Pascale Duché
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
- Laboratoire IAPS Université de Toulon Toulon France
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Pritchard L, Verschuren O, Roy M, Kaup C, Rumsey DG. Reproducibility of the Six‐Minute Walk Test in Children and Youth with Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 74:686-690. [DOI: 10.1002/acr.24492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Lesley Pritchard
- Department of Physical Therapy Faculty of Rehabilitation Medicine University of Alberta Canada Edmonton Alberta
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine Utrecht University Utrecht the Netherlands
| | - Michelle Roy
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
| | - Cara Kaup
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
| | - Dax G. Rumsey
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
- Department of Pediatrics Faculty of Medicine and Dentistry University of Alberta Canada Edmonton Alberta
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Calık BB, Gur Kabul E, Korkmaz C, Tekin ZE, Yener GO, Yuksel S. The efficacy of clinical Pilates exercises in children and adolescents with juvenile idiopathic arthritis: A pilot study. REVISTA COLOMBIANA DE REUMATOLOGÍA 2020; 27:269-277. [DOI: 10.1016/j.rcreu.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
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Impact of core stability exercises on bone mineralization and functional capacity in children with polyarticular juvenile idiopathic arthritis: a randomized clinical trial. Clin Rheumatol 2020; 40:245-253. [PMID: 32514677 DOI: 10.1007/s10067-020-05219-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children. The core stability exercises ensure proper muscular strength and balance around the lumbo-pelvic-hip complex. OBJECTIVE This study evaluated whether the use of core stability exercises would increase the effectiveness of conventional physical therapy (PT) in enhancing bone mineralization and improving functional capacity in children with polyarticular JIA. METHODS Thirty-three children with polyarticular JIA (age; 10-14 years) assigned randomly into two groups: the control group (n = 16) received the conventional PT, and the study group (n = 17) received the core stability exercises in addition to the same conventional PT program. Both core stability and conventional PT exercises continued for 3 months. The measures of bone mineralization and functional ability were investigated by dual-energy X-ray absorptiometry (DXA) device and 6-min walk test (6MWT), respectively, at baseline and immediately post-treatment. RESULTS Analysis of covariance (ANCOVA) revealed significant differences between groups in favor of the study group regarding measures of bone mineralization of lumbar spine and femoral neck regions as P < 0.05, except for volumetric bone mineral density of lumbar spine the P > 0.05. There was a significant difference between the two groups concerning functional capacity measured in 6MWT (P < 0.05), where children in the study group walked 531.71 ± 90.59 m compared with the control group 509.31 ± 73.10 m. CONCLUSION Core stability exercises are an effective adjunctive therapy to enhance bone health status and improve functional capacity in children with polyarticular JIA. Key Points • In addition to conventional physical therapy, core stability exercises had a definite effect on improving bone health status and quality of life in children with polyarticular juvenile idiopathic arthritis. • Improved bone mineralization and functional capacity due to core stability exercises contain two parts: strengthening training and controlling equilibrium.
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[Back to school physical education despite rheumatism : Development and testing of a sport scientific-based physical education certification]. Z Rheumatol 2019; 77:651-666. [PMID: 30069740 DOI: 10.1007/s00393-018-0518-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Taking part in physical education is an important element of social participation for children with chronic diseases. Nevertheless, children suffering from rheumatism mostly receive recommendations to stop sport activities either completely or partially, without underlying scientific guidelines. OBJECTIVE The aim was the development of an IT-tool based on scientific data in order to create individualized recommendations for sport activities plus verification of its practical feasibility. MATERIAL AND METHODS An interdisciplinary group of experts developed and approved a prototype of the rheumatism and sports compass (Rheuma und Sport Kompass, RSK) based on the literature and own experience. They considered individual health factors and biomechanics of sports functions. The prototype was tested, revised and reconsidered in an interim evaluation. The resulting RSKv1 was evaluated in a clinical observation phase with 61 patients. The results were subsequently incorporated into the final version of RSK during an interdisciplinary decision-making process. This was verified in a feasibility study with a follow-up survey of rheumatic patients with a RSK partial participation certification for physical education including: clinical assessment during 8 lessons of physical education and after 8 lessons of physical education. Teachers rated the RSK online after 8 lessons. The evaluation was descriptive and differences in mean values were tested. RESULTS AND DISCUSSION In this study 50 patients and 31 teachers were evaluated. The affliction of pain decreased in terms of frequency, amount and duration after physical education with RSK. No worsening in health was reported after participation in sports. The teachers rated the RSK as understandable, practicable and they felt confident to allow the patients to participate in classes. The RSK was rated significantly better than a standard certification text. With the RSK, patients can be advised to safely take part in physical education.
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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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van Dijkhuizen EHP, Egert T, Egert Y, Costello W, Schoemaker C, Fernhout M, Kepic M, Martini A, Scala S, Rotstein-Grein I, Vastert SJ, Wulffraat NM. Patient's experiences with the care for juvenile idiopathic arthritis across Europe. Pediatr Rheumatol Online J 2018; 16:10. [PMID: 29422094 PMCID: PMC5806356 DOI: 10.1186/s12969-018-0226-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To assess the views of juvenile idiopathic arthritis (JIA) patients and their parents on the care and treatment they receive in referral pediatric rheumatology centers throughout Europe. METHODS In a collaboration between physicians and patient associations, a questionnaire was developed, covering various domains of JIA care, including demographics, diagnosis, referrals to various health care professionals, access to pain and fatigue management and support groups, information they received about the disease and awareness of and participation in research. The questionnaire was translated and distributed by parent associations and pediatric rheumatologists in 25 countries, 22 of which were European. After completion the replies were entered on the PRINTO website. Replies could either be entered directly by parents on the website or on paper. In these cases, the replies were scanned and emailed by local hospital staff to Utrecht where they were entered by I.R. in the database. RESULTS The survey was completed by 622 parents in 23 countries. The majority (66.7%) of patients were female, with median age 10-11 years at the completion of the questionnaire. Frequencies of self-reported JIA categories corresponded to literature. Some patients had never been referred to the ophthalmologist (22.8%) or physiotherapist (31.7%). Low rates of referral or access to fatigue (3.5%) or pain management teams (10.0%), age appropriate disease education (11.3%), special rehabilitation (13.7%) and support groups (20.1%) were observed. Many patients indicated they did not have contact details for urgent advice (35.9%) and did not receive information about immunizations (43.2%), research (55.6%) existence of transition of care clinics (89,2%) or financial support (89.7%). While on immunosuppressive drugs, about one half of patients did not receive information about immunizations, travelling, possible infections or how to deal with chickenpox or shingles. CONCLUSIONS Low rates of referral to health care professionals may be due to children whose illness is well managed and who do not need additional support or information. Improvements are needed, especially in the areas of supportive care and information patients receive. It is also important to improve doctor patient communication between visits. Physicians can be instrumental in the setting up of support groups and increasing patients' awareness of existing support. Suggestions are given to convey crucial pieces of information structurally and repeatedly to ensure, among other things, compliance.
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Affiliation(s)
- E. H. Pieter. van Dijkhuizen
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
| | | | - Yona Egert
- Inbar Parent Association, Jerusalem, Israel
| | - Wendy Costello
- iCAN Irish Children’s Arthritis Network, Dublin, Republic of Ireland
| | - Casper Schoemaker
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,Netherlands JIA patient/parent organization, Amsterdam, Netherlands
| | - Marlous Fernhout
- Netherlands JIA patient/parent organization, Amsterdam, Netherlands
| | - Mirjam Kepic
- Slovenian JIA patient organization, Ljubljana, Slovenia
| | - Alberto Martini
- 0000 0004 1760 0109grid.419504.dPaediatric Rheumatology, IRCCS G. Gaslini, Genoa, Italy
| | - Silvia Scala
- 0000 0004 1760 0109grid.419504.dPaediatric Rheumatology, IRCCS G. Gaslini, Genoa, Italy
| | - Ingrid Rotstein-Grein
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,Department of Pediatric Rheumatology, Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Sebastiaan J. Vastert
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
| | - Nico M. Wulffraat
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
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Kuntze G, Nesbitt C, Whittaker JL, Nettel-Aguirre A, Toomey C, Esau S, Doyle-Baker PK, Shank J, Brooks J, Benseler S, Emery CA. Exercise Therapy in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:178-193.e1. [DOI: 10.1016/j.apmr.2017.05.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 01/18/2023]
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Blitz J, Stern SM, Marzan K. Do pedometers with or without education on exercise increase functional walking capacity and physical activity level in adolescents with juvenile idiopathic arthritis? Physiother Theory Pract 2017; 34:359-366. [PMID: 29131689 DOI: 10.1080/09593985.2017.1401189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To evaluate the impact of pedometer use on the physical activity (PA) and functional walking capacity (FWC) of adolescents with juvenile idiopathic arthritis (JIA) and lower extremity (LE) involvement. Twenty-seven adolescents, aged 11-19 years with JIA and LE involvement, participated in the three-phase pedometer study that introduced the use of a pedometer and an education seminar at 6 weeks. Measurements were taken at the baseline first visit and at weeks 6, 12, and 20. The primary outcome measure was the 6-minute walk test (6MWT). Thirteen completed the study. Six-minute walk distance (6MWD) significantly increased from baseline (458.0 ± 70.8 m) to the end of phase 1 (501.4 ± 59.8 m) (p = 0.035), prior to receiving the pedometer; and from baseline to the end of study (p = 0.0037). No significant changes in 6MWD were found between weeks 6 and 12 (intervention) (p = 0.77) or between weeks 12 and 20 (follow through phase) (p = 0.27). In adolescents with LE JIA, consistent guidance and support by rheumatology professionals appears to positively influence PA and measures of FWC as seen through improved 6MWD. There was insufficient evidence to show that pedometers further increased FWC or PA.
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Affiliation(s)
- Jill Blitz
- a Department of Pediatrics, Division of Pediatric Rehabilitation Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA
| | - Sara M Stern
- b Department of Pediatrics, Division of Pediatric Immunology, Rheumatology, and Allergy , University of Utah School of Medicine, Primary Children's Medical Center , Salt Lake City , UT , USA
| | - Katherine Marzan
- c Department of Pediatrics, Division of Rheumatology , Children's Hospital Los Angeles , Los Angeles , CA , USA.,d Keck School of Medicine of USC
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Physical Exercise and Physical Activity for Children and Adolescents With Juvenile Idiopathic Arthritis: A Literature Review. Pediatr Phys Ther 2017; 29:256-260. [PMID: 28654499 DOI: 10.1097/pep.0000000000000436] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This is a review of studies that investigate the efficacy of exercise therapy and physical activity for children with juvenile idiopathic arthritis since the 2008 Cochrane Review. METHOD Studies were identified that investigated the use of physical activity and exercise therapy in the treatment of children and adolescents with juvenile idiopathic arthritis, excluding the Cochrane Review. Two reviewers individually analyzed the results of the search to determine the eligibility of studies. The randomized controlled trial study designs were evaluated using PEDro scales. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE Recent literature supports the importance of the combination of strengthening, stretching, proprioceptive, and balance exercises and activities in water. Many of the reviewed studies proposed an intensive program of physical activity and exercise therapy, conducted 3 times a week for 12 weeks.
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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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Pinto AJ, Benatti FB, Roschel H, de Sá Pinto AL, Silva CA, Sallum AME, Gualano B. Poor muscle strength and function in physically inactive childhood-onset systemic lupus erythematosus despite very mild disease. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:509-514. [PMID: 27914598 DOI: 10.1016/j.rbre.2016.07.012] [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: 01/22/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare muscle strength (i.e. lower- and upper-body strength) and function between physically inactive childhood-onset systemic lupus erythematosus patients (C-SLE) and healthy controls (CTRL). METHODS This was a cross-sectional study and the sample consisted of 19 C-SLE (age between 9 and 18 years) and 15 CTRL matched by age, sex, body mass index (BMI), and physical activity levels (assessed by accelerometry). Lower- and upper-body strength was assessed by the one-repetition-maximum (1-RM) test. Isometric strength was assessed through a handgrip dynamometer. Muscle function was evaluated by the timed-stands test (TST) and the timed-up-and-go test (TUG). RESULTS When compared with CTRL, C-SLE showed lower leg-press and bench-press 1-RM (p=0.026 and p=0.008, respectively), and a tendency toward lower handgrip strength (p=0.052). C-SLE showed lower TST scores (p=0.036) and a tendency toward higher TUG scores (p=0.070) when compared with CTRL. CONCLUSION Physically inactive C-SLE patients with very mild disease showed reduced muscle strength and functionality when compared with healthy controls matched by physical activity levels. These findings suggest C-SLE patients may greatly suffer from a physically inactive lifestyle than healthy controls do. Moreover, some sub-clinical "residual" effect of the disease or its pharmacological treatment seems to affect C-SLE patients even with a well-controlled disease.
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Affiliation(s)
- Ana Jéssica Pinto
- Universidade de São Paulo (USP), Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil
| | - Fabiana Braga Benatti
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Hamilton Roschel
- Universidade de São Paulo (USP), Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Ana Lúcia de Sá Pinto
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Clovis Artur Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Instituto da Criança, São Paulo, SP, Brazil
| | | | - Bruno Gualano
- Universidade de São Paulo (USP), Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil.
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Pinto AJ, Benatti FB, Roschel H, de Sá Pinto AL, Silva CA, Sallum AME, Gualano B. Redução na força muscular e capacidade funcional em pacientes fisicamente inativos com lúpus eritematoso sistêmico de início juvenil, apesar de doença muito leve. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Pinto AJ, Miyake CNH, Benatti FB, Silva CA, Sallum AME, Borba E, de Sá-Pinto AL, Bonfá E, Gualano B. Reduced Aerobic Capacity and Quality of Life in Physically Inactive Patients With Systemic Lupus Erythematosus With Mild or Inactive Disease. Arthritis Care Res (Hoboken) 2016; 68:1780-1786. [DOI: 10.1002/acr.22905] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/23/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
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Poor agreement of objectively measured and self-reported physical activity in juvenile dermatomyositis and juvenile systemic lupus erythematosus. Clin Rheumatol 2016; 35:1507-14. [DOI: 10.1007/s10067-016-3234-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 02/07/2023]
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Effect of Strengthening Versus Balance-Proprioceptive Exercises on Lower Extremity Function in Patients with Juvenile Idiopathic Arthritis. Am J Phys Med Rehabil 2015; 94:417-24, quiz 425-8. [PMID: 25802953 DOI: 10.1097/phm.0000000000000279] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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LeBlanc CM. Participation in Leisure Activities among Canadian Children with Arthritis. A Wakeup Call for Physicians. J Rheumatol 2015; 42:909-911. [PMID: 26034228 DOI: 10.3899/jrheum.150386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Claire M LeBlanc
- Dip Sport Medicine, Associate Professor Pediatrics, McGill University; Division of Rheumatology, Montreal Children's Hospital, C504-2300 Rue Tupper, Montreal, Quebec H3H 1P3, Canada.
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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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Hansmann S, Benseler SM, Kuemmerle-Deschner JB. Dynamic knee joint function in children with juvenile idiopathic arthritis (JIA). Pediatr Rheumatol Online J 2015; 13:8. [PMID: 25829894 PMCID: PMC4379600 DOI: 10.1186/s12969-015-0004-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a chronic illness with a high risk of developing long-term disability. Disease activity is currently being monitored and quantified by ACR core set. Here, joint inflammation is determined; however joint function is the crucial component for developing disability. The aim of this study was to quantify and compare dynamic joint function in healthy and arthritic knee joints and to evaluate response to improvement. METHODS A single center cohort study of consecutive children presenting to the rheumatology outpatient clinic was performed to measure dynamic knee joint function. Serial measures were performed if possible. Splint fixed electrogoniometers were used to measure dynamic knee joint function including ROM and flexion and extension torque. RESULTS A total of 54 children were tested including 44 with JIA, of whom eight had to be excluded for non-JIA-related knee problems. The study included 36 JIA patients of whom eight had strictly unilateral knee arthritis, and nine controls. Dynamic joint function ROM and torque depended on age and bodyweight, as demonstrated in healthy joints. ROM and torques were significant lower in arthritic compared to unaffected knee joints in children with unilateral arthritis and across the cohort. Importantly, extension torque was the most sensitive marker of impaired joint function. Follow up measurements detected responsiveness to change in disease activity. CONCLUSIONS Measuring dynamic joint function with electrogoniometers is feasible and objective. Active ROM and torque during flexion and extension of arthritic knee joints were significant lower compared to unaffected. In dynamic joint measurement extension torque is a sensitive marker for disease activity.
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Affiliation(s)
- Sandra Hansmann
- Rheumatology, General Pediatrics, Oncology and Hematology University Children’s Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Susanne M Benseler
- Rheumatology, General Pediatrics, Oncology and Hematology University Children’s Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany ,Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Jasmin B Kuemmerle-Deschner
- Rheumatology, General Pediatrics, Oncology and Hematology University Children’s Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
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Abstract
Physical activity and participation in sports are important for the well being of children and youth and should be encouraged by health care providers. Individuals with chronic diseases are often less active, which can have a negative impact on their health. This article will review the effects of exercise on a few chronic medical conditions including juvenile arthritis, cystic fibrosis, and hypertension. The clinician's role in providing advice about sport participation will also be addressed.
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Eid MA, Ibrahim MM, Aly SM. Effect of resistance and aerobic exercises on bone mineral density, muscle strength and functional ability in children with hemophilia. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2014. [DOI: 10.1016/j.ejmhg.2013.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Functional capacity, strength, and quality of life in children and youth with familial Mediterranean fever. Pediatr Phys Ther 2014; 26:347-52. [PMID: 24979093 DOI: 10.1097/pep.0000000000000052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine functional capacity and muscle strength in children and youth with familial Mediterranean fever (FMF) as compared with controls, and to assess whether these factors influence quality of life (QOL) in FMF. METHODS A total of 100 subjects with FMF and 55 control subjects (8-18 years old) without known health issues were enrolled in the study. The 6-Minute Walk Test (6MWT) was used to evaluate functional capacity. Quadriceps strength was measured with a hand-held dynamometer. Quality of life was evaluated with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS Significant differences were found between subjects with FMF and controls in the 6MWT and strength test. PedsQL scores of subjects with FMF were significantly lower than the scores of the controls. The 6MWT and quadriceps strength were weakly correlated with the PedsQL. CONCLUSION Subjects with FMF displayed lower functional capacity and QOL than peers who are healthy. Decreased functional capacity was correlated with decreased QOL in those with FMF.
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Van Oort C, Tupper SM, Rosenberg AM, Farthing JP, Baxter-Jones AD. Safety and feasibility of a home-based six week resistance training program in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013; 11:46. [PMID: 24359015 PMCID: PMC3878188 DOI: 10.1186/1546-0096-11-46] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA), among the most common chronic diseases of childhood, can be associated with attenuated physical activity levels, reduced fitness, decreased functionality and pain. This pilot study aimed to determine the safety, feasibility and effect of a six week resistance training program in children with JIA. METHODS Youth (8-18 years) with JIA participated in a home-based resistance training program. Participants reported pain on an electronic diary once a day for one week prior to training, then once a day on non-exercise days and three times a day (before-exercise, after-exercise, and end-of-day) on exercise days for the subsequent six weeks of training. Secondary outcome measures included inflammation (assessed by ultrasound), muscle size (assessed by ultrasound), muscle strength (assessed by dynamometer) and functional ability (assessed by childhood health assessment questionnaire), measured at baseline and post-training. Participants were also instructed to wear an accelerometer one week prior to training to estimate baseline physical activity levels. Statistical analyses included safety (pain changes and any adverse events), feasibility (adherence to program and modifications made to exercises) and effect of program (differences in secondary measures pre and post training). An alpha level of p < 0.05 was accepted as significant. RESULTS Seven participants completed an average of 12.7 ± 3.4 (range 8-17) exercise sessions out of a possible 18 (70.6%). No adverse events were reported and pain did not increase over the seven weeks. Secondary measures revealed a significant increase in vastus lateralis thickness from pre to post training (p < 0.05). End-of-day pain intensity was correlated to end-of-day stiffness, fatigue and mood (r = .864, r = .581, r = -.637, respectively, p < 0.001). Pain intensity was also correlated with ratings of perceived exertion of the exercise (r = 0.324, p < 0.01). Only two children met the recommended 60 minutes of moderate to vigorous physical activity per day. CONCLUSIONS A six week home-based resistance training program is both safe (absence of pain changes or adverse events over the six weeks) and feasible (comparable adherence rates to other exercise studies involving JIA and individually modifiable) in children with JIA.
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Affiliation(s)
- Cameron Van Oort
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Susan M Tupper
- Saskatoon Health Region, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Alan M Rosenberg
- Department of Pediatrics, College of Medicine, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Jonathan P Farthing
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Adam D Baxter-Jones
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada.
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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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Mendonça TM, Terreri MT, Silva CH, Neto MB, Pinto RM, Natour J, Len CA. Effects of Pilates Exercises on Health-Related Quality of Life in Individuals With Juvenile Idiopathic Arthritis. Arch Phys Med Rehabil 2013; 94:2093-102. [DOI: 10.1016/j.apmr.2013.05.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/23/2013] [Indexed: 11/25/2022]
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Sandstedt E, Fasth A, Eek MN, Beckung E. Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial. Pediatr Rheumatol Online J 2013; 11:7. [PMID: 23432796 PMCID: PMC3614532 DOI: 10.1186/1546-0096-11-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decreased muscle strength, fitness and well-being are common in children and adolescents with juvenile idiopathic arthritis (JIA) compared to healthy peers. Biological drugs have improved health in children with JIA, but despite this pain is still a major symptom and bone health is reported as decreased in the group. The improvement made by the biological drugs makes it possible to more demanding exercises. To jump is an exercise that can improve bone heath, fitness and muscle strength. The aim of the study was to see if an exercise programme with jumps had an effect on muscle strength, physical fitness and well-being and how it was tolerated. METHODS Muscle strength and well-being were studied before and after a 12-week exercise programme in 54 children and adolescents with JIA, 9-21 years old. The participants were randomized into an exercise and a control group. Muscle strength, fitness and well-being were documented before and after the training period and at follow-up after 6 months. Physical activity in leisure time was documented in diaries. The fitness/exercise programme was performed at home three times a week and included rope skipping and muscle strength training exercises.Assessment included measurement of muscle strength with a handheld device, and with Grip-it, step-test for fitness with documentation of heart rate and pain perception and two questionnaires (CHAQ, CHQ) on well-being. RESULTS There were no differences between exercise and control group regarding muscle strength, grip strength, fitness or well-being at base line. Muscle weakness was present in hip extensors, hip abductors and handgrip. For the exercise group muscle strength in hip and knee extensors increased after the 12-week exercise programme and was maintained in knee extensors at follow-up. There was no change in fitness tested with the individually adapted step-test. The CHQ questionnaire showed that pain was common in the exercise group and in the control group. There were only small changes in the CHAQ and CHQ after the training period. The fitness/exercise programme was well tolerated and pain did not increase during the study. CONCLUSIONS A weight bearing exercise programme, with muscle strength training with free weights and rope skipping was well tolerated without negative consequences on pain. It also improved muscle strength in the legs and can be recommended for children and adolescents with JIA.
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Affiliation(s)
- Eva Sandstedt
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
| | - Anders Fasth
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Meta Nyström Eek
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Eva Beckung
- Department of Neuroscience and Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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Bone health in children and adolescents with juvenile idiopathic arthritis and the influence of short-term physical exercise. Pediatr Phys Ther 2012; 24:155-61; discussion 162. [PMID: 22466383 DOI: 10.1097/pep.0b013e31824cce6e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study bone mineral density (BMD) in 54 children and adolescents with juvenile idiopathic arthritis before and after a short-term exercise program. METHODS Fifty-four children, 41 girls and 13 boys, median age 13.9 years, participated in a 12-week exercise program, with 33 children in an exercise group. The program consisted of one hundred 2-footed jumps with a rope and standardized muscle strength exercise. Both BMD and bone mineral content were assessed with dual-energy x-ray absorptiometry (DXA) and DXA Laser Calscan for the heel at the start and after 3 and 6 months. RESULTS The study group had BMD measurements within the reference range compared with normative data with Z score at start. Bone mineral density values in total body, but not Z score, increased significantly (P = .012) in the exercise group. CONCLUSIONS The study group had BMD measurements within the reference range. Twelve weeks of exercise increases BMD in children with juvenile idiopathic arthritis.
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The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol 2011; 30:1415-20. [PMID: 21887489 DOI: 10.1007/s10067-011-1832-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/09/2011] [Accepted: 08/14/2011] [Indexed: 10/17/2022]
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Hashkes PJ, Laxer RM. Management of juvenile idiopathic arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Omori C, Prado DML, Gualano B, Sallum AME, Sá-Pinto AL, Roschel H, Perondi MB, Silva CAA. Responsiveness to exercise training in juvenile dermatomyositis: a twin case study. BMC Musculoskelet Disord 2010; 11:270. [PMID: 21106107 PMCID: PMC3009627 DOI: 10.1186/1471-2474-11-270] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 11/25/2010] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patients with juvenile dermatomyositis (JDM) often present strong exercise intolerance and muscle weakness. However, the role of exercise training in this disease has not been investigated. PURPOSE this longitudinal case study reports on the effects of exercise training on a 7-year-old patient with JDM and on her unaffected monozygotic twin sister, who served as a control. METHODS Both the patient who was diagnosed with JDM as well as her healthy twin underwent a 16-week exercise training program comprising aerobic and strengthening exercises. We assessed one repetition-maximum (1-RM) leg-press and bench-press strength, balance, mobility and muscle function, blood markers of inflammation and muscle enzymes, aerobic conditioning, and disease activity scores. As a result, the healthy child had an overall greater absolute strength, muscle function and aerobic conditioning compared to her JDM twin pair at baseline and after the trial. However, the twins presented comparable relative improvements in 1-RM bench press, 1-RM leg press, VO2peak, and time-to-exhaustion. The healthy child had greater relative increments in low-back strength and handgrip, whereas the child with JDM presented a higher relative increase in ventilatory anaerobic threshold parameters and functional tests. Quality of life, inflammation, muscle damage and disease activity scores remained unchanged. RESULTS AND CONCLUSION this was the first report to describe the training response of a patient with non-active JDM following an exercise training regimen. The child with JDM exhibited improved strength, muscle function and aerobic conditioning without presenting an exacerbation of the disease.
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Affiliation(s)
- Clarissa Omori
- Pediatric Rheumatology Unit, Children's Institute, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Danilo ML Prado
- Pediatric Rheumatology Unit, Children's Institute, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Bruno Gualano
- School of Physical Education and Sports, University of Sao Paulo (Av Mello de Moaraes, 65 - Butantã), Sao Paulo (Postal code: 05508-030), Brazil
- Division of Rheumatology, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Adriana ME Sallum
- Pediatric Rheumatology Unit, Children's Institute, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Ana L Sá-Pinto
- Division of Rheumatology, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Hamilton Roschel
- School of Physical Education and Sports, University of Sao Paulo (Av Mello de Moaraes, 65 - Butantã), Sao Paulo (Postal code: 05508-030), Brazil
- Division of Rheumatology, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Maria B Perondi
- Pediatric Rheumatology Unit, Children's Institute, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
| | - Clovis AA Silva
- Pediatric Rheumatology Unit, Children's Institute, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
- Division of Rheumatology, School of Medicine, University of Sao Paulo (Av. Dr. Arnaldo, 455 - Cerqueira César), Sao Paulo (Postal code: 01246-903), Brazil
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Takken T. Physical fitness, activity and training in children with juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/phe.10.54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Physical activity and fitness are increasingly recognized as important outcomes in the follow-up and treatment of patients with juvenile idiopathic arthritis. In the past, major concerns were on the detrimental effects of physical exercise; now evidence is growing on the beneficial effects of exercise. The purpose of these exercise programs is to promote a more active lifestyle and/or enhance physical fitness. This article will review the findings of recent studies in juvenile idiopathic arthritis in the area of physical fitness, physical activity and training. It is advised that clinicians are discussing appropriate levels of physical activity (daily participation in >60 min of moderate-to-vigorous physical activity) with their patients in clinical consultations.
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Affiliation(s)
- Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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41
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Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations. Int J Pediatr 2010; 2010. [PMID: 20862334 PMCID: PMC2939399 DOI: 10.1155/2010/835984] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/31/2010] [Accepted: 07/09/2010] [Indexed: 11/18/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) patients (n = 36) with symmetrical polyarticular joint involvement of the lower extremities and healthy controls (n = 20) were compared concerning differences in kinematic, kinetic, and spatio-temporal parameters with 3D gait analysis. The aims of this study were to quantify the differences in gait between JIA patients and healthy controls and to provide data for more detailed sport activities recommendations. JIA-patients showed reduced walking speed and step length, strongly anterior tilted pelvis, reduced maximum hip extension, reduced knee extension during single support phase and reduced plantar flexion in push off. Additionally the roll-off procedure of the foot was slightly decelerated. The reduced push off motion in the ankle was confirmed by lower peaks in ankle moment and power. The gait of JIA-patients can be explained as a crouch-like gait with hyperflexion in hip and knee joints and less plantar flexion in the ankle. A preventive mobility workout would be recommendable to reduce these restrictions in the future. Advisable are sports with emphasis on extension in hip, knee, and ankle plantar flexion.
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van der Net J, Wissink B, van Royen A, Helders PJM, Takken T. Aerobic capacity and muscle strength in juvenile-onset mixed connective tissue disease (MCTD). Scand J Rheumatol 2010; 39:387-92. [PMID: 20604672 DOI: 10.3109/03009741003742714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To study the aerobic capacity and muscle strength in children and adolescents with mixed connective tissue disease (MCTD). Frequently reported clinical symptoms include joint swelling, muscle weakness, fatigue, decreased stamina/exercise tolerance, and shortness of breath. The exercise capacity of patients with MCTD has not been studied systematically in this detail before. METHODS Eleven children and adolescents diagnosed with MCTD (mean age 15.7 years, range 11.3–19.9 years) were studied. Maximal exercise testing on a cycle ergometer was used to determine the peak oxygen uptake (VO2peak) and a hand-held dynamometer was used to measure muscle strength. Cardiac and pulmonary function tests (ultrasonography, electrocardiography, spirometry) were used to measure cardiac function and obstructive or restrictive respiratory impairment. Complementary data (e.g. disease duration and concurrent symptoms) were collected from a medical chart review. RESULTS VO2peak was significantly lower in patients with MCTD compared to the VO2peak of healthy subjects (Z-score –1.9, p = 0.008). The strength of the proximal muscles (hip flexors, shoulder abductors, knee extensors) of the patients was significantly lower than in the controls, whereas the strength of the distal muscles (dorsal flexors of the foot and handgrip strength) showed no differences. In eight children, arthritis was observed. No clinically relevant impairment in cardiac or pulmonary function was observed. CONCLUSIONS Aerobic capacity and also proximal muscle strength were significantly impaired in our sample of children and adolescents with MCTD. Because respiratory problems were non-dominant in our patient group, the decreased aerobic capacity and muscle strength were probably caused by musculoskeletal impairments. Further studies in larger multicentre samples are warranted to confirm our findings.
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Affiliation(s)
- J van der Net
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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Abstract
The presence of certain medical or orthopedic conditions need not preclude adolescents from being physically active and participating in sports. The benefits of continued physical activity far outweigh any concerns for potential complications for most such conditions. This article reviews sport participation guidelines for adolescents with conditions that include juvenile chronic arthritis, eye injures, solitary kidney, skin conditions, scoliosis, and spondylolysis.
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Affiliation(s)
- Eugene Diokno
- Arnold Palmer Sports Health Center, Union Memorial Hospital, Baltimore, MD 21218, USA.
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Gualano B, Sá Pinto AL, Perondi B, Leite Prado DM, Omori C, Almeida RT, Sallum AME, Silva CAA. Evidence for prescribing exercise as treatment in pediatric rheumatic diseases. Autoimmun Rev 2010; 9:569-73. [PMID: 20388559 DOI: 10.1016/j.autrev.2010.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 04/06/2010] [Indexed: 10/19/2022]
Abstract
There has been an increasing recognition of adverse short-, mid-, or long-term effects associated with the treatment as well as the disease itself that impair the health-related quality of life and functional capacity of children and adolescents with rheumatic diseases. Interestingly, cumulative evidence has suggested that exercise training may benefit patients with juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile dermatomyositis and juvenile fibromyalgia, attenuating several clinical symptoms related to physical disability. Remarkably, recent evidence also suggests that exercise may have direct effects on the pathogenesis of autoimmune diseases by attenuating chronic low-grade systemic inflammation. It is also important to emphasize that no exercise-related adverse effects have been reported. This short review provides the evidence for physical training as a treatment of pediatric rheumatic diseases, introducing a novel concept that exercise is a treatment for these populations.
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Affiliation(s)
- Bruno Gualano
- Universidade de São Paulo, School of Physical Education and Sports, Brazil.
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The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol 2010; 22:213-7. [DOI: 10.1097/bor.0b013e328335d1a2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effect of adapted physical activity on health-related quality of life among hospitalized children and adolescents (the ACTIV'HOP randomized controlled trial): Design and methods. Contemp Clin Trials 2010; 31:165-71. [DOI: 10.1016/j.cct.2009.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 11/26/2009] [Accepted: 12/02/2009] [Indexed: 11/21/2022]
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Current World Literature. Curr Opin Rheumatol 2010; 22:229-34. [DOI: 10.1097/bor.0b013e32833755c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kemp S, Roberts I, Gamble C, Wilkinson S, Davidson JE, Baildam EM, Cleary AG, McCann LJ, Beresford MW. A randomized comparative trial of generalized vs targeted physiotherapy in the management of childhood hypermobility. Rheumatology (Oxford) 2009; 49:315-25. [DOI: 10.1093/rheumatology/kep362] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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van Brussel M, van Doren L, Timmons BW, Obeid J, van der Net J, Helders PJM, Takken T. Anaerobic-to-aerobic power ratio in children with juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2009; 61:787-93. [DOI: 10.1002/art.24536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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