Division of Rheumatology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo.
Pediatric Rheumatology Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Eneas de Carvalho Aguiar 647, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
Nat Rev Rheumatol. 2017 May 23;13(6):368-379. doi: 10.1038/nrrheum.2017.75.
Over the past 50 years it has become clear that physical inactivity is associated with chronic disease risk. For several rheumatic diseases, bed rest was traditionally advocated as the best treatment, but several levels of evidence support the imminent paradigm shift from the prescription of bed rest to physical activity in individuals with paediatric rheumatic diseases, in particular juvenile systemic lupus erythematosus, juvenile idiopathic arthritis, juvenile fibromyalgia, and juvenile dermatomyositis. Increasing levels of physical activity can alleviate several symptoms experienced by patients with paediatric rheumatic diseases, such as low aerobic fitness, pain, fatigue, muscle weakness and poor health-related quality of life. Moreover, the propensity of patients with paediatric rheumatic diseases to be hypoactive - often due to social self-isolation, overprotection, and fear and/or ignorance on the part of parents, teachers and health practitioners - can be detrimental to general disease symptoms and function. In support of this rationale, a growing number of studies have demonstrated that the systemic benefits of exercise training clearly outweigh the risks in these diseases. In this sense, health professionals are advised to assess, track and fight against physical inactivity and sedentary behaviour on a routine basis, as they are invaluable health risk parameters in rheumatology.
在过去的 50 年中，人们已经清楚地认识到，身体活动不足与慢性病风险有关。对于几种风湿性疾病，传统上主张卧床休息是最佳治疗方法，但有几个级别的证据支持从卧床休息向身体活动的范式转变，适用于儿科风湿性疾病患者，特别是青少年全身性红斑狼疮、青少年特发性关节炎、青少年纤维肌痛和青少年皮肌炎。增加身体活动水平可以缓解儿科风湿性疾病患者的许多症状，如低有氧健身、疼痛、疲劳、肌肉无力和健康相关生活质量差。此外，儿科风湿性疾病患者往往不活跃——通常是由于社会自我隔离、过度保护以及父母、教师和卫生保健人员的恐惧和/或无知——这可能对一般疾病症状和功能有害。为了支持这一原理，越来越多的研究表明，运动训练的系统益处明显超过这些疾病的风险。从这个意义上说，建议卫生专业人员定期评估、跟踪和对抗身体活动不足和久坐行为，因为它们是风湿病学中非常宝贵的健康风险参数。
