“Juvenile” meaning children aged between six months to 16 years, the term “idiopathic” means “of unknown origin”.

Approximately 300,000 children (infants to teenagers) in the U.S. suffer from some form of arthritis [1].

Juvenile idiopathic arthritis is the most prevalent one and it differs significantly from arthritis seen in adults.

Joint pain in children can be due to several reasons but if the pain persists for more than six weeks then it could be due to JIA.

The exact cause for the onset of the disease is still unclear but most of the researchers suspect it’s a two-step process.

First, they believe a genetic tendency makes a child more susceptible to JIA, second, an external factor like viruses, bacteria, diet, etc., may trigger its progression.

Other symptoms associated with JIA may include, fever, anemia, and adverse effects on the heart, lungs, eyes, and nervous system.

There are six types of JIA of which one is autoinflammatory and the rest are considered autoimmune diseases.

  • Systemic JIA is a polygenic autoinflammatory disease, marked by an increase in inflammatory markers and absence of antibodies makes this disease different from other (JIA). Physical signs include inflammation in joint or joints accompanied by a high fever and skin rash [2].
  • Oligoarticular JIA affects four or fewer joints, typically the large ones like the knees, ankles, elbows, etc. Uveitis (chronic eye inflammation) is more closely associated with oligoarticular JIA than any other JIA subtypes [3].
  • Polyarticular JIA affects five or more joints, mostly the small joints of the fingers and hands, but the jaw and weight-bearing joints can also be affected. It is again sub-divided into two types depending on the protein rheumatoid factor (RF) is present or absent [4].
  • Juvenile psoriatic arthritis, similar to psoriatic arthritis in adults this too affects the joints and occurs with psoriasis [5].
  • Enthesitis-related JIA affects mostly where the bone meets a tendon, ligament or other connective tissue characterized by a tenderness, known as “enthesitis”. It is more common in boys aged between 8 to 16 [6].
  • Undifferentiated arthritis is the term used to describe juvenile arthritis that does not fit into any of the above types, or when the symptoms span between two or more subtypes [7].

The treatment for JIA involves a combination of treatments to alleviate pain and inflammation and improving flexibility.

The current treatment consists of using non-steroidal anti-inflammatory drugs, biological and disease-modifying agents.

There is significant evidence that physical therapy benefits adults with arthritis and some evidence that children suffering from JIA can benefit from physical therapy interventions [8].

In this article, we focus on exercises that help relieve pain and strengthen muscles and joints in children suffering from juvenile idiopathic arthritis.

Benefits of Exercise in Juvenile Idiopathic Arthritis.

Physical activity/exercise is an important aspect of every children’s health and social development.

Studies show that Juvenile idiopathic arthritis (JIA) patients have decreased physical activity and a higher incidence of overweight and hypertension in later life [9] [10].

JIA patients have less muscle strength and endurance along with decreased aerobic capacity (needed for prolonged exercise) and anaerobic capacity (needed to perform the intense activity); therefore, they get tired faster than kids who don’t have arthritis.

Physical activity has many benefits and no significant adverse effects in children with JIA.

A study conducted in 2007 by Dr. Brian Feldman, University of Toronto, divided the children with JIA into two groups, 1.

A high-intensity activity like karate and cardio; and 2. A low-intensity activity like tai-chi and qigong.

The study showed that both the groups showed significant improvement both statistically and clinically in physical abilities, balance and overall confidence with physical activities [11].

Apart from these benefits, physical activities have been long proven to improve the emotional and psychosocial status of children.

Top Five Exercises for Juvenile Idiopathic Arthritis

Some studies suggest that physically active children with JIA showed have stronger bones, muscles, and joints and lower the risk of osteoporosis in adulthood as compared to those with less active children [12].

Regular exercises also help manage the weight and reduce the risk of heart attack and cholesterol level.

The most important facet is getting children to participate in a physical activity hence, it is very important to find an activity that the child enjoys and sticks to it. Following are the top five exercises that every child may enjoy.

1. Hydrotherapy

It is the best form of exercise for people suffering from arthritis due to less stress on joints and muscles.

Hydrotherapy in any style let it be swimming or water aerobics is equally beneficial for the JIA sufferers.

It helps in general strengthening of the muscles, improved balance and flexibility, increased cardiovascular fitness, thereby increasing endurance.

Exercising in a warm pool has an added advantage of soothing inflammation and sore joints.

Hydrotherapy for JIA can be similar to that for adults with arthritis with modification to personally suit one’s diseases and its severity.

Here’s a link to help get started with water aerobics for arthritis –

2. Cycling

Cycling is a powerful and low-impact exercise suitable for both children and adults equally.

It helps strengthen the leg muscles and is also a good cardiovascular exercise.

The repetitive knee motion is especially good for arthritic knees and hip joints since it encourages the fluid production lubricating the joints and flushing away the waste products.

Some of the basic tips to remember are to always wear helmets while cycling outdoors.

Mounting and dismounting the bicycle can be tricky for some patients in such cases getting a custom-tailored cycle or using a recumbent bicycle is also advisable.

Slowly and progressively increase the distance, frequency, and speed of your rides.

Since just cycling while seating does not do much to help promote bone-density, experts advise a weight bearing device once you have reached an optimal level of competency to help strengthen the leg muscles.

Many experts suggest that cycling on a regular basis can help prevent muscle atrophy thus delaying the onset of arthritis.

Here’s a Video link that helps explain the Benefits of Cycling with Arthritis-

3. Stretching

Many healthcare professionals recommend stretching for juvenile idiopathic arthritis.

Many experts suggest doing some stretches first thing in the morning along with finger curling, mild wrist bending, and thumb stretching as well.

Some of the best practices for stretching exercises are yoga, tai-chi, qigong and using of resistance bands.

These exercises have been proved to be extremely helpful in relieving the symptoms like back stiffness, pain and inflammation.

Yoga if practiced properly can offer gentle stretching and flexibility apt for children with arthritis.

It is important to practice mindfully and listen to their own bodies if any pose causes pain in any way, it should not be practiced.

Start slowly and preferably with a certified yoga instructor after getting consent from your doctor. Apart from stretching breathing exercises of yoga also offers a range of benefits.

Tai-chi and qigong originated thousands of years ago in China as a martial art when practiced regularly is comparable to resistance training and brisk walking and is said to improve both lower-body and upper-body strength.

There are many studies that show Tai-chi and qigong can significantly lower the pain and physical impairment in people suffering from arthritis especially knee osteoarthritis [13] [14].

Apart from relieving pain and improving balance and flexibility the slow and graceful movements of Tai chi and qigong also help reduce stress and anxiety [15] [16].

Resistance bands or tubes are very popular in various physical therapies and rehabilitation for patients with arthritis.

They are used extensively for isotonic exercises wherein the band is gently stretched through the range of motion of the joint.

Almost all the band exercises can be performed with minimal modifications to better suit the patient and the severity of the pain. The resistance bands are an excellent way to begin strength training.

Here’s a Video to Practice Yoga-

4. Physiotherapy

Physiotherapy is personalized to reflect the type of juvenile idiopathic arthritis the child has and the severity of the disease.

Typically, it involves a range of motion exercises to restore joint flexibility and build muscle strength and endurance.

A physiotherapist works along with the pediatric rheumatologist and suggests an appropriate physiotherapy program and recommend exercises suited to the child’s specific condition.

Here’s a Video to understand the Role of Physiotherapy in JIA

5. Recreational Sports

Physical activity and exercise must be a part of the daily routine for every child. It helps improve mood and confidence thereby increasing the child’s independence.

Research shows that children with controlled arthritis can safely participate in sports and exercise programs.

It is very difficult to commit a child to any particular exercise or physical therapy regimen.

Therefore, children with JIA should be encouraged to participate in different games and sports with other children.

Besides every kid loves to run, jump and enjoy a good ball game rather than mundane boring exercises.

Nowadays parents can safely send their kids with JIA to the arthritis camps with special attention to activities and sports tailored to every children’s arthritis.

These types of initiatives are very important to help boost the child’s morale and learn to be independent and cope with the disease.

General Precautions to keep in mind before engaging in any form of physical activity

  • Always consult the doctor and physical therapist before starting or modifying any of the activity.
  • Start the day with light stretching since morning stiffness and the sore joint is common in JIA.
  • Take warm water baths to soothe muscles and pain eat a healthy diet rich in calcium.
  • Start with low-impact activity like swimming, cycling, walking, yoga, etc.
  • Allow the body to rest during flare-ups.
  • Always wear protective gears while practicing outdoor activities like cycling, hiking, running, etc.
  • Maintain and practice a routine.

Conclusion

Children with arthritis face many challenges in finding the right activity that suits their need and is equally enjoyable.

Both parents and kids with JIA live in constant fear of hurting or damaging the already affected joint or muscles.

But there has been increasing studies and research that suggest physical activity in any form is safe and has proven to be more beneficial than harmful.

It helps improve their confidence and mood, along with increased flexibility and endurance.

The primary goal of it all is to induce remission of arthritis.

Physical therapy also focuses on preserving children’s quality of life by making it possible for them to participate in the day to day activities like sports, school, and social activities.

With proper care and attention, most children with JIA live a fairly normal and healthy life.

Further studies are needed to assess the practicality of various programs and long-term effects of exercise in children and adolescents with JIA.

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