Physical Activity Interventions in Children with Juvenile Idiopathic Arthritis: A Systematic Review of Randomized Controlled Trials

Abstract

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.

Keywords:

• physical activity
• juvenile idiopathic arthritis
• exercise

Abbreviations

JIA, Juvenile idiopathic arthritis; PA, physical activity; RCT, randomized controlled trials; JA, juvenile arthritis; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO, International prospective register for systematic reviews; AEs, adverse events; DOs, drop outs; PEDro, Physiotherapy Evidence Database; AMSTRAM 2, A MeaSurement Tool to Assess systematic Reviews; CERT, Consensus on Exercise Reporting Template; METs, metabolic equivalent of task; VO2 Max, maximal aerobic capacity; HRQoL, health-related quality of life; ROM, range-of-motion.

Data Sharing Statement

The data extracted from these 13 studies are available from the corresponding author on reasonable request.

Acknowledgments

Karolinska Institutet librarians, Jonas Pettersson and Sabina Gillsund assisted with the literature search following the criteria outlined in our PROSPERO application.

Author Contributions

M.D. Iversen and J. von Heideken contributed to the conception of the study, study design, study execution, data collection and synthesis, data interpretation, and all drafts and revisions of the manuscript. M. Andre contributed to data synthesis, clinical relevance of the data and its interpretation, the analysis of results, and writing of the manuscript. All authors reviewed the final draft of the manuscript, agreed on the version to submit to this journal and agreed to take responsibility and be accountable for the contents of the article.

Disclosure

The authors report no competing interests that could have influenced the conduct of this study.

Additional information

Funding

There was no specific funding for this project.