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

Abstract

BackgroundDecreased 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.MethodsMuscle 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.ResultsThere 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.ConclusionsA 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.

Biomarkers of bone remodeling in children with mucopolysaccharidosis types I, II, and VI

“…The CHQ-PF50 is a 50-item, parent-completed questionnaire designed to measure the physical and psychosocial well-being of children between the ages of 5 and 18. The CHQ-PF50 has established reliability and validity and has been widely used in studies of chronic illness in childhood [29-31]. Items are measured on a Likert scale, summed for each subscale and linearly transformed to a 0 to 100 scale, where higher scores reflect better functioning.…”

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].…”

“…The chronic inflammatory systemic feature of JIA is mediated by cytokine products of an activated immune system, including tumor necrosis factor (TNF)-α, interleukin-1 (IL-1) and interleukin-6 (IL-6) [3,4]. Aftereffects of JIA can include pain, fatigue, reduced fitness, reduced activity, sleep disturbances, muscle atrophy, decreased bone mineral composition (BMC) and impaired quality of life [1,5], as well as growth retardation (with low IGF-1 levels in all disease onset subtypes) [6]. Furthermore, chronic inflammation can lead to numerous abnormalities including anorexia, cachexia, cachectic obesity, dyslipidemia and insulin resistance [7].…”

Specific Sports Habits, Leisure‐Time Physical Activity, and School‐Educational Physical Activity in Children With Juvenile Idiopathic Arthritis: Patterns and Barriers

“…Functional ability in patients with juvenile idiopathic arthritis (JIA) and their prognosis have improved considerably over the last decade due to early, targeted treatment with biologics such as etanercept . Consequently, a motivating approach to physical activity and participation in sport has emerged, because studies have shown that physical activity and exercise training in patients with JIA are both safe and beneficial in terms of numerous health and disease outcomes (e.g., quality of life, cardiovascular fitness, muscle strength, pain, number of swollen joints) . Nevertheless, children with JIA are still less physically active , participate less often in competitive sports, and spend more time sedentary compared with their peers without JIA .…”