Effects of an eight-week physical conditioning program on disease signs and symptoms in children with chronic arthritis

Abstract

Objective. To investigate the effects of an 8-week, 24-session weight-bearing physical conditioning program on disease signs and symptoms in children with chronic arthritis.Methods. In a within-subjects, repeated measures design, 25 subjects, ages 8 -17 years, with chronic polyarticular juvenile rheumatoid arthritis (JRA), were assessed at study entry, after an 8-week control period, and after an 8-week exercise period, for 1) disease status, based on joint count (JC) and articular severity index (ASI) (sum of scores for joint swelling, pain on motion, tenderness, and limitations of motion); 2) worst pain during the past week, using a 10-cm visual analog scale (VAS), and 3) aerobic endurance, using the 9-minute run-walk test of the Health Related Physical Fitness Test battery. The 60-minute conditioning program included warm-up (10 minutes), low-impact aerobics (25 minutes), strengthening (15 minutes), and cool-down and flexibility exercises (10 minutes). Subjects exercised twice a week at their rheumatology center and once a week at home, using a commercial exercise videotape supplied by the investigator. Results. Significant improvement was found in the ASI (Friedman analysis of variance [ANOVA]), JC, and 9-minute run-walk test (repeated measures ANOVA) from the pre-to post-exercise tests. Mean VAS pain scores decreased 16% from study entry to the post-exercise test. Statistically significant improvement (reliable change index Ͼ 1.96) occurred in 80% of subjects on the ASI and 72% on the JC. Conclusion.Children and adolescents with chronic polyarticular JRA can improve their aerobic endurance through participation in weight-bearing physical conditioning programs without disease exacerbation or increased pain, and may achieve decreased joint signs and symptoms through increased physical activity.

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

“…Several studies have shown that children with polyarticular JIA are less active than their healthy counterparts and exhibit reduced aerobic and anaerobic exercise capacity (66,67). There is evidence that regular physical conditioning improves joint pain and range of motion in patients with JIA (68,69). A number of reports have suggested that engagement in both low-and high-intensity exercise programs results in improved physical function and decreased pain in patients with JIA (70,71), although a Cochrane meta-analysis of existing randomized controlled trials did not show statistically significant benefits (72).…”

Physical activity in adolescents with juvenile idiopathic arthritis

“…Is it safe for patients with JIA to participate in PA? Evidence is accumulating that it is safe, feasible, and acceptable for patients with JIA to participate in PA, exercise programs, and exercise testing (33)(34)(35)(36). To increase their PA, it is unnecessary to increase vigorous PA, which can be difficult for adolescents with JIA.…”

Juvenile idiopathic arthritis and physical activity: Possible inflammatory and immune modulation and tracks for interventions in young populations

“…Studies on physical exercise programs in JIA patients show that exercise training is beneficial for this population [5,15,21,[27][28][29][30][31][32][33][34][35][36]. The trends for outcome measures all point to benefits of exercise, with increased strength and range of motion, improved joint stiffness, and better quality of life [37].…”