Years ago, the conservative approach to exercise for children with arthritis discouraged participation in team sports and other higher impact activities such as running. It was thought that the impact on the joints would cause increase flares and damage to the joints. But today, many doctors suggest playing team sports or participating in other activities during periods when the child is symptom-free or has symptoms under control. Although contact sports are never recommended, some aggressive sports with heavy running like soccer may be an option. During flares, doctors advise limiting certain activities, especially ones that may have a greater impact on the joints involved.
Similar to adults, studies have shown that children with JRA may experience significant disability arising from muscle and joint pain, weakness, swelling, contractures and general physical deconditioning. Studies have also shown that children with JRA participate in fewer physical activities and sleep more than other children. The physical symptoms and pain contribute to the lack of physical activity, both creating a spiral that results in deconditioning and disability.
While team sports and activities do not replace therapeutic exercise programs, they are an important part of a child’s health and overall well-being. Physical activity and team sports keeps joints and muscles strong, promotes flexibility and encourages play and social interaction with other children. Team sports and exercise also help a child build confidence in their physical abilities. Activities that exercise joints and muscles without too much stress are especially encouraged. Examples are swimming and riding a bicycle. Other activities, such as dance, yoga and or Tai Chi can benefit children as well as adults by improving flexibility, stamina and coordination. Dance has the added benefits of promoting social interaction and being a creative outlet for children (and adults).
A recent study published in the June issue of Arthritis Care and Research found that it is generally safe and acceptable for children with JRA to participate in formal exercise training and structured fitness programs. The pilot study was conducted as a precursor to a large randomized trial to test that structured fitness and exercise benefits children with JRA through improved physical function and quality of life. The participants in the study enrolled in a 12-week circuit training program involving the use of the swimming pool, stationary bike, treadmill and Fitball. Most of the children participated without any significant problems or increase in disease activity. The children with severe hip disease dropped out of the program due to increased pain and arthritis symptoms. Some other children required modifications to the exercise program, but were then able to complete it.
The researchers stated that children should participate in physical training more than only once or twice a week in order to make significant improvements in function. The authors also noted that some families might have trouble fitting in frequent training sessions due to logistical and commuting issues and other constraints on family time. The authors recommended finding training centers close to the family home and also incorporating home-based exercise programs such as videotapes to increase the frequency of participation in exercise training.
Exercise and physical activities benefit children with arthritis. It promotes flexibility, strength, endurance, weight management and gives children a social outlet. While lower impact activities like swimming are encouraged, team sports and higher impact activities can also be safe when children are not in a period of increased flares.