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Physical Activity Interventions in Children with Juvenile Idiopathic Arthritis: A Systematic Review of Randomized
Maura D Iversen1,2,3, Marie Andre2, Johan von Heideken2
1College of Health Professions, Sacred Heart University, Fairfield, CT, USA.
Insights
Physical activity interventions improve function and symptoms in children with juvenile arthritis (JA). However, limited studies exist, and detailed reporting is needed for optimal clinical practice and evidence generation.
Area of Science:
- Pediatric Rheumatology
- Exercise Science
- Evidence-Based Practice
Background:
- Children with juvenile arthritis (JA) face pain, stiffness, fatigue, and reduced mobility, impacting daily activities and physical activity (PA) levels.
- Physical activity is crucial for improving health, function, and managing JA symptoms in pediatric populations.
Purpose of the Study:
- To systematically review and evaluate the evidence for physical activity interventions in children diagnosed with juvenile arthritis.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted using major databases (Ovid, Cochrane, EMBASE, CINAHL) from 1946 to 2021.
- Included studies focused solely on PA interventions in children with JA, excluding those with concurrent medical treatments.
- Extracted data included participant and intervention characteristics, outcomes, internal validity, and intervention attributes.
Main Results:
- 13 RCTs involving 672 children with juvenile idiopathic arthritis (JIA) were analyzed.
- PA interventions, particularly strengthening exercises performed multiple times weekly, improved function and symptoms without adverse events.
- Intervention details, adherence strategies, and long-term outcomes were frequently missing, with only two studies addressing adherence.
Conclusions:
- Limited RCTs exist for PA interventions in JIA, with better adherence observed in low-intensity programs.
- PA interventions offer positive health benefits for JIA, but enhanced reporting of intervention specifics is essential for robust evidence and clinical guidance.
- Further research should focus on detailed reporting, adherence promotion, and long-term effects of PA in pediatric rheumatic diseases.
Introduction:
Children with juvenile arthritis (JA) experience pain, stiffness, fatigue, and decreased motion leading to difficulties with daily activities and low physical activity (PA). PA is critical to improve health and function and mitigate JA-associated symptoms. This study evaluated the evidence for PA interventions in children with JA.
Materials And Methods:
A systematic review of randomized controlled trials (RCTs) of PA interventions in children with JA was conducted. Ovid (Medline), Cochrane Library, EMBASE, and CINAHL databases were searched for papers published in English between 1/1/1946 and 9/1/2021. Studies which concurrently assessed medical interventions were excluded. Participant and intervention characteristics and outcomes were extracted. Study internal validity and intervention attributes were assessed.
Results:
A total of 555 studies were identified, with 13 studies from 10 countries included. Data from 672 children diagnosed with juvenile idiopathic arthritis (JIA) (range of mean ages, 8.7 to 16.1 years) were analyzed. Fifty-two percent of intervention arms incorporated strengthening exercise alone or combined with other exercise, with 61.9% performed 3x/week. About 43.5% of sessions lasted >45 to ≤60 minutes and 65.2% of programs were ≥12 to <28 weeks. PA interventions improved function and symptoms without adverse events. Intervention details were missing especially regarding PA intensity, reasons for dropouts, and adherence. Only two studies incorporated strategies to promote adherence.
Discussion:
RCTs of PA interventions in JA only include JIA. Available RCTs used mixed modes of interventions. Reporting of PA interventions lacks sufficient detail to discern the dose-response relationship. Strategies to motivate engagement in PA and to support families to promote PA are lacking, as are studies of long-term outcomes.
Conclusion:
There are limited RCTs of PA interventions in JIA. Adherence was better with low intensity programs. PA interventions for JIA yield positive health benefits but better reporting of PA intervention details is needed to generate more high-quality evidence and inform clinical practice.
Prospero Registration:
Maura Iversen, Johan von Heideken, Marie Andre. Physical Activity in Children with Rheumatic Diseases: a systematic review. PROSPERO 2021 CRD42021274634 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274634.
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