Physical fitness levels in children with polyarticular juvenile rheumatoid arthritis

Abstract

Children with juvenile rheumatoid arthritis (IRA) often exhibit fatigue and prolonged exercise recovery. Improved fitness through physical conditioning has not been a goal of standard medical or physical treatment regimens for IRA, and fitness levels of children with IRA have rarely been studied. We compared physical fitness in 20 6 to 11-year-old patients with polyarticular JRA with sex-, age-, and size-matched controls, using the Health Related Physical Fitness Test (HRPFTJ, (I national, standardized, norm-referenced test. We correlated fitness scores with summary joint counts, and with a n articular severity index (sum of joint swelling, tenderness, pain, and limited range for each child). The results showed that children with polyarticular IRA were less physically fit than normally active (noncompetitively athletic) children of the same sex, age, and size. There was no statistically significant relationship between increased joint counts, andlor disease severity scores, and reduced fitness scores. This suggests that physical' fitness levels are less related to degree of "disease activity" than is often thought. We conclude tha,t ( 1 ) a readily available, nationally standardized fitness test can be used to assess children with IRA: and [Z)fitness levels and measures of disease activity do not correlate. We believe that multiple factors, perhaps including family, physician, and school concerns about potential disease exacerbation following exercise, may account for the low fitness levels observed in children with IRA.

Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis

“…As the child develops and grows, they may be excluded from learning new skills, such as hopping, running, jumping, climbing and skipping or joint movements may be adapted so that function and independence are impaired. [3][4][5]7 Children with JIA may be less fit [15][16][17] and active 18 than healthy children, and functional limitations and pain may affect their ability to perform some physical or social activities as more energy and effort are required. 19,20 Evidence to date Hydrotherapy and land-based physiotherapy treatments are designed to increase range of motion, muscle strength, physical fitness, quality of life (QoL) and function, in addition to reducing pain.…”

Fitting into the prevailing teenage culture: A grounded theory on female adolescents with chronic arthritis

“…As mentioned previously, attending physical education classes is a predictor of well-being for children with chronic arthritis (Sällfors et al, 2004), but physical fitness cannot be maintained at the same level as for non-disabled peers, if at all. Studies indicate that children with arthritis are less active physically, in general, than their peers (Klepper, Barbee, Effgren & Singsen, 1992;Hendersson, Lowell, Specker & Campaigne, 1995;Sällfors et al, 2004).…”

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

“…A later study by the same investigators reported decreased exercise time, lower peak heart rate, and higher metabolic cost for submaximal exercise in 30 children with JRA compared with healthy controls (10). Klepper et al (11), using the standardized Health Related Physical Fitness Test (HRPFT) (12), reported significantly lower scores on the 9-minute run-walk test of aerobic endurance in 20 children with polyarticular JRA, ages 6 -11 years, compared with healthy controls. No significant relationship was found between low fitness scores and measures of disease severity in any of these studies, suggesting deconditioning may be multifactorial.…”

“…Moncur et al (16) reported increased maximal aerobic capacity and exercise time and decreased swollen joint count (JC) in 7 adolescents and young adults with JRA following 12 weeks of stationary cycling. Klepper and colleagues (17) found improved performance on the HRPFT 9-minute walk-run test in 5 children and adolescents after 6 weeks of low impact aerobic dance. Aside from these findings, little is known about the effects of specific modes of exercise on the joints of children with JRA.…”