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Aerobic fitness in JIA

Clinical bottom line

Children with JIA have moderate to heavy impairment in physical fitness measured by maximum oxygen consumption. They are 22% less fit than their healthy companions.


Background

Children with JIA are likely to be less physically fit than children without the condition. The joint pain, stiffness, and sometimes deformity that come with JIA are likely to lead to low levels of physical activity, and therefore of fitness. The best measure of fitness is probably the maximum oxygen consumption during exercise during graded maximal exercise to volitional exhaustion.

Reference

T Takken et al.Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. Journal of Rheumatology 2002 29: 2643-2647.


Systematic review

The review sought studies in four databases, including a specialist sport study database, and reference lists also examined. The date of the last search was October 2001.

Only studies that directly measured VO2 peak in mL/kg/min, with descriptions of patients included and controls used. Patients had to have juvenile idiopathic arthritis.

Results

Though nine studies were identified in the original search, four were excluded because of duplicate publication, or incomplete reporting of methods and/or results. In the five included studies the age of children was four to 19 years, different subgroups of JIA were included, and VO2peak determination was direct, usually with a cycle. Oxygen consumption and carbon dioxide production were monitored during exercise. Fitness and VO2peak were measured during continuous graded exercise until subjects could not maintain the workrate.

In each of the studies, the mean VO2peak in children with JIA was lower than that in healthy children (Figure 1). The overall mean difference was 9 mL/kg/min, or 22% lower than healthy children without JIA.

Figure 1: VO2peak values in five studies comparing children with JIA with health children

Comment

The results suggest that children with JIA are about 22% less fit than their healthy companions.