Why exercise?

Why should children with arthritis do exercises?

Children with arthritis need to do both general and specific exercises because

They help children maintain a better range of joint movement and joint mobility.
They help improve muscle stamina, strength and suppleness so that as the child grows their joints continue to mature in correct alignment with each other.
They help build up bone density and strength which is especially important while the skeleton is developing and to counteract osteoporosis.
They help the child keep a fit and healthy heart, lung, digestive and other body systems.
They increase energy levels and improve sleep patterns.
They can be enjoyable, sociable and confidence building.

Current dilemmas for exercises at home

A daily routine of exercises can make a big difference in maintaining movement and in preventing joint contractures (when the joints get fixed in one position). In specialist physiotherapy departments physiotherapists have been able to work daily with children with contractures and after some weeks help the child regain normal movement. Specialist physiotherapists have developed expertise in helping children with severe arthritis and their families over many years.

In America, Canada and the United Kingdom there is a tradition going back more than thirty years of prescribing an aggressive programme of daily exercises for families to complete at home. However, there is little research evidence validating different ways to help families deliver an effective exercise programme at home in the long term. While working in a well equipped hospital physiotherapy gym, physiotherapists are able to motivate children and have the advantages of knowledge, authority, equipment, space, their uniform, and one-to-one attention. Group pressure among the children may also be an advantage. At home, the situation is utterly different, and in order to succeed with the exercise programme parents need extra training, support and assistance.

The 2001 Brighton study examined in detail many of the difficulties reported by families which were in keeping with those reported in other contemporary and earlier studies[2]. The findings from these studies indicated that many families soon stop trying to do the exercises, while others invest considerable time, energy and effort to do them but their efforts are rarely monitored by therapists. Therefore the exercises undertaken may be ineffective or incorrect. The research also showed that the exercises focussed parent/child conflict, had an emphasis on illness and performance, excluded siblings, and were emotionally very demanding for parents, children and siblings. Families reported they were only given a leaflet to guide them about how to do the exercises or were only shown once how to do the exercises.

A very few therapists insist that the full programme of thirty repeated movements for each exercise should be completed by families. Most other therapists adopt a more creative approach to help the families use a variety of games and activities which would also achieve the aims of the exercise routine. Most clinicians have been aware of considerable difficulties families encounter and try to work within realistic parameters of the family resources and circumstances.

[2] Barlow J,Harrison K, Shaw KL (1998) The experience of parenting in the context of Juvenile Idiopathic Arthritis. Clinical Child Psychology & Psychiatry 3(3), pages 445-463, Rapoff M (1982) Compliance of pediatric patients with medical regimens: a review and evaluation. In Stuart R (Ed), Adherence, generalisation, and compliance in behavioural medicine. New York, Bruner/Mazel, pages 79-124