Internet Program for Physical Activity and Exercise Capacity in Children With Juvenile Idiopathic Arthritis: A Multicenter Randomized Controlled Trial

Armbrust, Wineke; Bos, G J F Joyce; Wulffraat, Nico; Brussel, Marco van; Cappon, Jeannette; Dijkstra, Pieter U.; Geertzen, Jan H. B.; Legger, G. Elizabeth; Rossum, Marion A. J. J. van; Sauer, Pieter J. J.; Lelieveld, Otto T H M

doi:10.1002/acr.23100

Cited by 30 publications

(153 citation statements)

References 47 publications

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“…Strava) or internet-based interventions to monitor and encourage adherence, particularly when participants are not in close geographic proximity [ 42 – 44 ]. Armbrust and colleagues recently reported promising results for their internet-based PA intervention, “Rheumates @ Work” (R@W) [ 45 ]. In contrast to the present study, R@W did not include a prescriptive exercise component.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, each week of the interactive, cognitive-behavioral program targeted a different theme such as health education and barriers and benefits of being physically active through online films, animations, puzzles and/or assignments. Acceptance and satisfaction with R@W were very high (93.8% and 85%, respectively) among children aged 8 to 13 years [ 44 ] and this translated into improvements in children’s PA and exercise capacity [ 45 ]. Further, low program costs suggest this might be a feasible program for others to implement, perhaps in combination with recommended activities to promote muscle and bone strength, rather than a prescriptive exercise component.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis

et al. 2018

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BackgroundArthritis 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.MethodsWe 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.ResultsThirteen 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.ConclusionChildren 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 registrationData of the children with JIA are from the LEAP study (Canadian Institutes of Health Research (CIHR; GRANT# 107535). http://www.leapjia.com/Electronic supplementary materialThe online version of this article (10.1186/s12969-018-0283-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis

et al. 2018

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“…Functional therapies including physiotherapy may help to overcome these detrimental effects. A number of studies have shown the potential of physical therapy as well as its safety in the non-active phase of the disease [ 17 , 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Patient’s experiences with the care for juvenile idiopathic arthritis across Europe

Dijkhuizen

Egert²,

Egert³

et al. 2018

Pediatr Rheumatol

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BackgroundTo 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.MethodsIn 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.ResultsThe 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.ConclusionsLow 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.Electronic supplementary materialThe online version of this article (10.1186/s12969-018-0226-0) contains supplementary material, which is available to authorized users.

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“…In 2008, Tim Takken and co-workers published a Cochrane review on exercise therapy in JIA [142]. They identified three eligible EX-RCTs representing 212 children with JIA, that employed an exercise therapy protocol [143]. Pooled outcome measures included functional ability, quality of life, and aerobic fitness.…”

Section: Systemic Inflammatory/autoimmune Diseasementioning

confidence: 99%

“…Since the Cochrane review article, new data has emerged that provides further, support for the effectiveness of exercise in JIA. An EX-RCT of 48 children ages 8–13 years old, who participated in a 14-week cognitive behavioral intervention to increase PA levels, reported improvements in self-reported and objective PA measures as well as improvements in exercise capacity within the intervention group that persisted to three months post intervention [143]. The control group experienced a decline in exercise capacity over the same time period, however the differences between the experimental and control groups were not statistically significant [143].…”

Section: Systemic Inflammatory/autoimmune Diseasementioning

confidence: 99%

Physical activity for children with chronic disease; a narrative review and practical applications

et al. 2019

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BackgroundPhysical activity (PA) is associated with a diverse range of health benefits. International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits. However, current guidelines are intended for healthy children, and thus may not be applicable to children with a chronic disease. Specifically, the dose of PA and disease specific exercise considerations are not included in these guidelines, leaving such children with few, if any, evidence-based informed suggestions pertaining to PA. Thus, the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases: respiratory, congenital heart, metabolic, systemic inflammatory/autoimmune, and cancer.MethodsFor each disease, we present the pathophysiology of exercise intolerance, summarize the pediatric exercise intervention research, and provide PA suggestions. ResultsOverall, exercise intolerance is prevalent in pediatric chronic disease. PA is important and safe for most children with a chronic disease, however exercise prescription should involve the entire health care team to create an individualized program.ConclusionsFuture research, including a systematic review to create evidence-based guidelines, is needed to better understand the safety and efficacy of exercise among children with chronic disease.

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Internet Program for Physical Activity and Exercise Capacity in Children With Juvenile Idiopathic Arthritis: A Multicenter Randomized Controlled Trial

Cited by 30 publications

References 47 publications

Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis

Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis

Patient’s experiences with the care for juvenile idiopathic arthritis across Europe

Physical activity for children with chronic disease; a narrative review and practical applications

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