Key elements for an achievable home exercise routine

Having outlined some of the problems, there remains the enduring fact that exercise in general helps children with arthritis, and a well planned, effective programme of daily exercises can be especially beneficial. An effective exercise routine achievable in the long term needs to be:

1. age appropriate, so that you choose relevant rhymes and games for a four year old which will be very different from those used for motivating an eight year old child.
2. creative, in order to stop the routine from becoming so grindingly boring that both adult and child stop doing it. Having themes for some activities, or doing new ones all help add interest to a very boring routine.
3. relevant and negotiated so that parent, child and therapist understand the resources available at home (like space, mats, other children’s needs, parents work commitments). It is also helpful for there to be a set of options, or contingency plans, so that you can try plan ‘B’ if plan ‘A’ does not work.
4. understood by those trying to do the exercises at home. The supervising parent, and his/her partner need to understand why the routine is necessary, and the specific aims of each movement. This is not rocket science, and most parents can understand simple explanations. For example ‘this exercise is to help build up the muscle strength at the top of her leg so that she has more stamina, which will help her walk for longer periods’. Where parents do not understand the aims or technique the exercises are less likely to be carried out. As the young person develops they too should be taught about why the exercises are important, and how they should be accurately carried out.
5. agreed by both parents, research shows that when only one parent is informed about the routine there is often serious disagreement between partners about how aggressively or accurately the routine should be carried out. From the beginning it may help to involve grandparents or other adults in learning about the routine. This means that the responsibility of the routine is shared rather than left to one adult (usually the mother), that supervising adults support one another, and together the family is more likely to deliver an achievable routine.
6. realistic, therapists may ask you to complete the routine every single day, and to complete it even if any joint is inflamed, swollen and painful. This may be the clinical ideal but in practice, you may find it more achievable to do it for week days only, or for batches of three weeks followed by a ‘therapy holiday’. If you do it in this planned way it is achievable by more families, and the whole family knows where they are in the routine. If you do it every day, it will become a considerable strain for the family but can be achieved by determined parents.