Exercise and fitness in children with arthritis: Evidence of benefits for exercise and physical activity

A sedentary lifestyle is known to be a significant risk factor for mortality from all causes in adults (1). Increased physical activity (PA) is associated with improved health and delayed mortality from chronic disease (2). The increasing prevalence of risk factors for cardiovascular disease in children (3) and the potential tracking of PA habits into adulthood (4) influenced the Healthy People 2010 objectives that call for all children to increase their PA (5). Children with juvenile arthritis (JA) experience joint swelling, pain, and limited mobility, which contribute to decreased PA, fitness, and function, increasing their risk for disability from long-term disease (6). Research documents significant cardiovascular and musculoskeletal deficits and delayed motor development in children with JA (7–21). Although impairments are most pronounced in children with severe articular disease, poor fitness is also reported in those with mild symptoms, and deficits often persist long after arthritis resolves (12,13). Studies show that children with JA can undergo exercise testing (7–17) and participate in sports and physical conditioning programs (22–27) without disease exacerbation. However, there is a paucity of evidence demonstrating the effectiveness of PA and exercise on physical fitness, function, and general health in children with JA. This article reviews what is known about muscle structure and function, aerobic capacity, and PA in children with JA and their response to exercise programs. Areas of limited knowledge and suggestions for future research are discussed. A search of the literature was conducted using Medline via Ovid for studies examining exercise capacity and the effects of exercise in children with JA. The search was limited to studies involving humans and written in the English language. This was not an exhaustive review, and because many of the studies are published only in abstract form, no attempt was made to assess or rate the quality of the studies cited.