一项为期6个月的运动计划对幼年特发性关节炎患儿增加骨骼和肌肉力量的可行性及安全性研究。
Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis.
作者信息
Houghton Kristin M, Macdonald Heather M, McKay Heather A, Guzman Jaime, Duffy Ciarán, Tucker Lori
机构信息
Division of Rheumatology, K4-123 ACB, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
出版信息
Pediatr Rheumatol Online J. 2018 Oct 22;16(1):67. doi: 10.1186/s12969-018-0283-4.
BACKGROUND
Arthritis in childhood can be associated with muscle weakness around affected joints, low bone mass and low bone strength. Exercise is recognized as an important part of management of children with juvenile idiopathic arthritis (JIA) but the exercise prescription to best promote bone and muscle health is unknown. We therefore aimed to: 1. assess feasibility and safety of a 6-month home- and group-based exercise program for children with JIA; 2. estimate the effect of program participation on bone mass and strength, muscle function and clinical outcomes and 3. determine if any positive changes in bone and muscle outcomes are maintained 6 months later.
METHODS
We recruited 24 children with JIA who were part of the Linking Exercise, Physical Activity and Pathophysiology in Childhood Arthritis (LEAP) study to participate in a 6-month home-based exercise program involving jumping and handgrip exercises, resistance training and one group exercise session per month. We assessed lumbar spine bone mass (dual energy X-ray absorptiometry), distal tibia and radius bone microarchitecture and strength (high-resolution peripheral quantitative computed tomography), muscle function (jumping mechanography, dynamometry) and clinical outcomes (joint assessment, function, health-related quality of life) at baseline, 6- and 12-months. Adherence was assessed using weekly activity logs.
RESULTS
Thirteen children completed the 6-month intervention. Participants reported 9 adverse events and post-exercise pain was rare (0.4%). Fatigue improved, but there were no other sustained improvements in muscle, bone or clinical outcomes. Adherence to the exercise program was low (47%) and decreased over time.
CONCLUSION
Children with JIA safely participated in a home-based exercise program designed to enhance muscle and bone strength. Fatigue improved, which may in turn facilitate physical activity participation. Prescribed exercise posed adherence challenges and efforts are needed to address facilitators and barriers to participation in and adherence to exercise programs among children with JIA.
TRIAL REGISTRATION
Data of the children with JIA are from the LEAP study (Canadian Institutes of Health Research (CIHR; GRANT# 107535 ). http://www.leapjia.com/.
背景
儿童关节炎可能与受累关节周围的肌肉无力、低骨量和低骨强度有关。运动被认为是幼年特发性关节炎（JIA）患儿管理的重要组成部分，但最佳促进骨骼和肌肉健康的运动处方尚不清楚。因此，我们旨在：1. 评估一项为期6个月的针对JIA患儿的家庭和小组运动计划的可行性和安全性；2. 评估参与该计划对骨量、骨强度、肌肉功能和临床结局的影响；3. 确定骨骼和肌肉结局的任何积极变化在6个月后是否得以维持。
方法
我们招募了24名参与儿童关节炎运动、体力活动与病理生理学关联（LEAP）研究的JIA患儿，参加一项为期6个月的家庭运动计划，包括跳跃和握力练习、阻力训练以及每月一次的小组运动课程。我们在基线、6个月和12个月时评估腰椎骨量（双能X线吸收法）、胫骨远端和桡骨骨微结构及强度（高分辨率外周定量计算机断层扫描）、肌肉功能（跳跃力学、测力计）和临床结局（关节评估、功能、健康相关生活质量）。使用每周活动日志评估依从性。
结果
13名儿童完成了6个月的干预。参与者报告了9起不良事件，运动后疼痛罕见（0.4%）。疲劳有所改善，但肌肉、骨骼或临床结局没有其他持续改善。运动计划的依从性较低（47%），且随时间下降。
结论
JIA患儿安全地参与了一项旨在增强肌肉和骨骼强度的家庭运动计划。疲劳得到改善，这反过来可能有助于参与体育活动。规定的运动带来了依从性挑战，需要努力解决JIA患儿参与和坚持运动计划的促进因素和障碍。
试验注册
JIA患儿的数据来自LEAP研究（加拿大卫生研究院（CIHR；资助编号107535）。http://www.leapjia.com/ 。
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