title: Effects of an eight-week physical conditioning program on disease signs and symptoms in children with chronic arthritis. The effects of vigorous exercise training on physical function in children with arthritis: a randomized, controlled, single-blinded trial. Limited search strategies were effective in finding relevant nonrandomized studies. Pilot study of fitness training and exercise testing in polyarticular childhood arthritis. A two-year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis. Aquatic fitness training for children with juvenile idiopathic arthritis. Daily pain and symptoms in children with polyarticular 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 video-tape 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 > 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 OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion , peak oxygen uptake , peak power , and self-reported physical function in children with juvenile idiopathic arthritis ( JIA ) . METHODS Eighty children with JIA , ages 8 - 16 years , were enrolled in a r and omized , single-blind controlled trial . Both groups participated in a 12-week , 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group . Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour ( VO(2submax ) ) as the primary outcome , maximal oxygen uptake , and peak power at the beginning and end of the program . Physical function was measured using the Child Health Assessment Question naire ( C-HAQ ) . RESULTS The exercise program was well tolerated in both groups . There was no difference in VO(2submax ) or any other exercise testing measures between the groups through the study period and no indication of improvement . Both groups showed significant improvements in C-HAQ with no difference between the groups . Adherence was higher in the control group than the experimental group . CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function . The intensity of aerobic training did not seem to provide any additional benefits , but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with , and provide a degree of benefit equivalent to more intensive programs BACKGROUND AND OBJECTIVE Search ing for nonr and omized studies in electronic data bases is complicated because there is a variety of study design s and lack of st and ardization in the terminology . The purpose of this study was to develop and evaluate a method to limit search strategies according to study design of comparative nonr and omized studies ( cNRSs ) . METHODS Four up date d Cochrane systematic review s that included nonr and omized studies ( cohort , case-control , and cross-sectional studies ) of the effects of health care interventions were selected . Search strategies limited to study design were devised for each one of these topic areas in two electronic data bases ( MEDLINE and EMBASE ) . A progressive method ( PM ) and a fixed method for selecting the most appropriate search terms associated with study design of nonr and omized studies are suggested . RESULTS The results showed that the sensitivity of search strategies ( in two data bases combined ) limited to study design were between 90 % and 100 % for the PM using both controlled vocabulary ( CV ) and textwords ( TWs ) and between 95 % and 100 % for a fixed set of controlled vocabulary and TWs . CONCLUSIONS It is possible and acceptable to use search strategies limited to study design of cNRSs of health care interventions OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs OBJECTIVE To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis ( JIA ) in order to identify patients who will develop bone mass reductions . METHODS We conducted a prospect i ve cohort study of 108 children with early JIA ( ages 6 - 18 years ; mean disease duration 19.3 months ) who were individually matched with 108 healthy children for age , sex , race , and county of residence .  Bone mass and changes in total body , spine , femur , and forearm bone mineral density and bone mineral content ( BMC ) , body composition , growth , and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later . Low bone mass was defined as a Z score > 1 SD below the reference population . RESULTS Of the 200 children evaluated at followup , the 100 healthy children had greater gains in total body BMC ( P = 0.035 ) , distal radius BMC ( P < 0.001 ) , and total body lean mass ( P < 0.001 ) than did the 100 JIA patients . Low or very low total body BMC was observed in 24 % of the patients and 12 % of the healthy children . Bone formation , bone resorption , and weight-bearing activities were reduced in the patients compared with the healthy children . Multiple regression analysis showed that in patients with JIA , serum bone-specific alkaline phosphatase , serum C-telopeptide of type I collagen , and weight-bearing activities were independent predictors of changes in total body BMC . Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset . CONCLUSION Patients with JIA have moderate reductions in bone mass gains , bone turnover , and total body lean mass early in the disease course OBJECTIVE To evaluate the effects of an aquatic training programme for JIA patients . METHODS Fifty-four patients with JIA ( age range 5 to 13 yr ) participated in this study and were r and omized into an experimental ( n = 27 ) and a control ( n = 27 ) group . The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions . Effects were analysed on the following domains : functional ability , health-related quality of life , joint status and physical fitness . RESULTS Although all measures improved more in the experimental group than the control group , none of the differences was statistically significant . CONCLUSIONS The current research found no significant effect of an aquatic fitness training programme in children with JIA . Since there were no signs of worsening in health status , one can conclude that this was a safe exercise programme OBJECTIVE To analyze patterns of daily pain , stiffness , and fatigue related to juvenile arthritis ; to examine the relationships of demographics , disease severity , and psychological adjustment to daily disease symptoms ; and to examine daily disease symptoms as predictors of reduced participation in school and social activity . METHODS For a 2-month period , 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function . Children also underwent an initial evaluation and 4 followup evaluations that included a joint count , laboratory testing , and completion of question naires assessing physical and psychosocial functioning . RESULTS Children reported having pain an average of 73 % of days , with the majority of children ( 76 % ) reporting pain on > 60 % of all days . On average , children described the intensity of their daily pain as being in the mild to moderate range ; however , a significant subgroup ( 31 % ) reported pain in the severe range . Higher physician global assessment ratings , increased functional disability , and increased anxiety were significantly associated with increased daily pain and other daily symptoms . Multilevel r and om-effects analyses indicated that increased daily symptoms of pain , stiffness , and fatigue were significant predictors of reduced participation in school and social activities . CONCLUSION Physicians should consider treating pain more aggressively in children with arthritis , in order to preserve function in school and social domains , as well as physical function . Moreover , optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as st and ard pharmacologic interventions
target: Results suggest that youth with JIA participated less in both  social and physical leisure activities  as compared to healthy peers , and those with JIA did not meet national recommendations for physical activity .
  Characterization of leisure activity remains limited and mostly focused on physical activity in JIA .
background: UNLABELLED The aim of this systematic review is to describe participation in social and physical leisure activities among children and adolescents with JIA , as well as identify potential determinants of leisure participation .