Guide to physical activity and exercise in juvenile idiopathic arthritis (JIA)

Who is the leaflet for? What is its aim?

This leaflet is for children and young people with juvenile idiopathic arthritis. It offers advice and guidance on how the individual and their parents / carers should engage in activity and use this as part of the overall management of the condition.

Why is exercise important in JIA?

Juvenile idiopathic arthritis can impact upon a young person’s level of physical activity in a number of ways.

During an arthritis flare, the joints are inflamed and can be hot, painful and swollen. This can restrict the way in which the joints move and limit a young person’s participation in physical activities, such as school PE or sports. In addition, if the muscles are not being used because the person is in pain, they will lose mass (which is called muscle wasting) leading to weakness and reduced ability to perform active tasks (this is called deconditioning).

If an individual’s joints do not move in a normal way, either during a flare or even after it has been treated, their muscles may become stiff and the joints unable to bend or straighten fully (these are called joint contractures). It is therefore important to keep joints as mobile as possible to enable the child or adolescent to return to their usual activities, including sport, as soon as it is appropriate.

What types of physical activity can the child participate in?

Maintaining an active lifestyle whilst living with a chronic condition, such as JIA, is very important. The benefits include improved stamina, general fitness and self-confidence, enabling children and young people to socialise with friends and maintain a good level of independence.

The types of physical activity a young person can normally engage in are:

• Weight bearing exercise, such as walking, keep the bones and muscles strong.
• Cardiovascular exercise builds fitness levels. This might include attending sports clubs, running around with friends or completing online workouts.
• Functional activities of daily life, such as writing, drawing or painting, maintain stamina, strength and social interaction. Core stability exercises strengthen the muscles around the back and abdominals helping to support the joints in the back, arms and legs. Activities such as Pilates help with posture.
• When a young person’s arthritis is well controlled, they should be able to take part in all the sports and activities they enjoy.

Physical activity during a flare

We recommend low impact exercises, for example cycling or swimming, where less stress is put on the joints.

Avoid contact and high impact sports which may exacerbate pain and put stress on the affected joints.

The therapy team may provide prescribed exercise. This is an individual routine for the child to do at home, focussed on the particular areas where the arthritis is flaring, whilst also maintaining the muscles in the other parts of their body

How will JIA affect school?

• The health care team can communicate with PE teachers (or the relevant member of the school staff) to provide guidance on (or modifications to) appropriate activities that an individual with JIA can participate in.
• Communication with the school is important so members of staff understand the discomfort or difficulties the young person may have, as well as the importance of pacing (avoiding bursts of intense activities resulting in fatigue and inactivity). You may want to discuss additional helpful strategies, such as the pupil leaving lessons early to allow extra time to walk between different classrooms or allocating rest periods when walking over long distances around the school.

Which health-care professionals are involved in prescribing exercise?

Occupational therapist: a health professional who supports young people returning back to normal functional activities.

Physiotherapist: a health professional who will devise an appropriate exercise regime in accordance with the person’s needs.

What are the different types of exercise that may be prescribed?

The physiotherapist or occupational therapist will carry out a physical examination to determine the appropriate exercises. They will assess joint range of movement, muscle flexibility, muscle strength and functional ability such as writing. Then they will provide appropriate exercises tailored towards their patient’s physical needs, for example after a specific procedure such as a joint steroid injection.

The type of exercises prescribed by a therapist could include:

Active exercises where the muscle contracts and the joints are moved by the patient themselves. Active exercises help to maintain mobility in stiff joints. An example is bending and straightening the elbow.

Active assisted exercises involve using a piece of equipment to help the patient move their muscles and joints to achieve the best range of movement. Examples include rolling the hand on a ball to improve the range of movement at the wrist which helps them with normal tasks such as writing. These types of exercises could be carried out during set times of the day, such as in between homework tasks, or while watching TV.

Muscle strengthening: Strengthening exercises build up and keep muscles strong to help support and protect joints. An individual can use their own body weight to build strength, by doing a press-up, for example. A variety of equipment can also be used to help build muscle, including free weights, ankle/wrist weights, resistance bands and Theraputty to improve grip strength. The therapist will advise on the most appropriate exercise regime to complete.

Stretching: Stretching exercises can help maintain and improve range of movement in the joints and help to reduce stiffness and pain. There are two types:

• Static stretches – these involve moving the muscle to the end of a comfortable range and holding this position for a set amount of time. They often need to be repeated a number of times (or reps for short). They help to improve flexibility and prevent muscle contractures. It may be helpful to complete these exercises after a hot bath when the muscle is relaxed.
• Dynamic stretches – these are slow movements through a comfortable range but requiring effort (active muscle movement). These stretches are often used in warmup activities to prepare for a certain movement or action. Examples include lunging and squatting. They can also be useful if the young person is attempting to practise a sports-specific movement such as a kick in karate or a spin in dance.

Please be aware this leaflet is only a guide and patients should seek specific advice from their therapist.

Contacts / Further information

Physiotherapy outpatients – 01223 216633

Paediatric Rheumatology secretary – 01223 348577