Rheumatoid arthritis (RA) is an auto-immune disease that causes joint inflammation, due to immune system dysfunction. RA is characterized by symptoms of joint pain, stiffness, and swelling, as well as, muscle weakness around affected joints, a loss of bone mass, and impaired bone strength. In more extreme cases, RA can lead to structural joint damage or permanent joint deformity. In adults, this auto-immune disease effects 1% of the population, while juvenile rheumatoid arthritis (JRA) and juvenile idiopathic arthritis (JIA) are reported as the most common inflammatory pathologies found in children.
Interestingly, a number of children diagnosed with JRA or JIA eventually experience a spontaneous remission from the auto-immune disease, whereas 39-65% of children continue with the disorder into adulthood. Research suggests that, though treatment through medication is necessary to decrease pain, swelling, and stall potential structural joint damage, physical activity and structured exercise is an effective method in reducing and managing related symptoms. Because physical activity promotes the breakdown of fat tissue, increasing the immune systems anti-inflammatory and regulatory properties and increasing interleukin production from skeletal muscle, exercise is inherently thought to improve the joint inflammation symptoms associated with arthritis. Current research suggests exercise will improve arthritic patients quality of life by increasing functional movement ability and physical fitness, which is also well-accepted as a successful preventative measure against cardiovascular disease. Furthermore, regular resistance training has consistently shown to improve and prevent loss of bone mineral density, a component immensely important in growing adolescents, where bone deficits contribute to 1.5-3 times the likelihood of bone fractures.
When working with patients experiencing any form of RA, consideration should be made to the fact the majority of patients with this disease are rather sedentary. Adults, as well as, children diagnosed with forms of arthritis are less motivated to be physically active, due to the inflammatory pain they experience. Over time, excessive inactivity leads to a drastic decline in aerobic and anaerobic capacity, ultimately leading to further functional deterioration, increased weight gain and body fat mass, and an elevated risk for cardiovascular disease (later in life). Though living with forms of RA causes severe barriers to physical activity and exercise, research suggests physical inactivity may in fact exacerbate arthritic symptoms. In contrast, for patients diagnosed with RA, JIA, or JRA, adequate participation in physical activity has shown to improve arthritic symptoms, physical fitness capacity, functional movements in activities of daily living (ADL), muscular strength, joint range of motion (ROM), proprioception.
It is reported that most patients with RA avoid exercise due to the preconceived belief that exercise could further damage arthritic joints, though there is no documented evidence that suggests exercise is harmful to individuals with any form of arthritis, at any age range. That being said, many patients (or parents of children with JRA/JIA) may be uncertain and skeptical of the benefits of adhering to an exercise program, especially when experiencing disease-related pain or the discomfort associated with initial increases in physical activity. Patients beginning exercise with a previously low activity level will need to start slowly, to prevent discouragement from some movements being potentially difficult, and excessive soreness from delayed onset muscle soreness (DOMS), following training sessions. There may also be an increased need of support and reassurance with continuing an exercise regimen for patients with arthritis. Long-term success of any program relies on consistency, however, this attribute is lacking in the RA/JRA/JIA populations, due to biases towards exercise and the regular occurrence of joint pain.
In conclusion, research supports the implementation of several forms of exercise in the treatment and management of different forms of arthritis, including RA, JRA, and JIA, including aerobic exercise, corrective and rehabilitation exercise, and resistance training. Prescribing integrative, dynamic movements that incorporate multiple joints and resemble functional activities would be a valuable addition to patients training programs, to enhance muscular strength, neuromuscular coordination, bone mineral density, and joint range of motion. Furthermore, research believes exercises that promote these attributes may also assist in minimizing intensity of inflammation and reduce the occurrence of flare ups. In regards to children, it has been thoroughly acknowledged that physical activity is a fundamental aspect in the growth and development of pre-adolescent and adolescent youth. Guidelines suggest a minimum total of one hour of moderate intensity activity per day, and 2 hours per week of more structured activity (such as participation in sports or resistance training) for youth to encounter the physical and physiological benefits of exercise and physical activity through their developmental years.
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