Promoting Physical Activity in Children with Juvenile Idiopathic Arthritis through an internet-based program: results of a pilot randomized controlled trial.

Promoting Physical Activity in Children With Juvenile Idiopathic Arthritis Through an Internet-Based Program: Results of a Pilot Randomized Controlled Trial OTTO T. H. M. LELIEVELD,1 WINEKE ARMBRUST,2 JAN H. B. GEERTZEN,3 INEZ DE GRAAF,2 MIEK A. VAN LEEUWEN,1 PIETER J. J. SAUER,2 ELLEN VAN WEERT,3 AND JELTE BOUMA4 Objective. Patients with juvenile idiopathic arthritis (JIA) are less physically active than healthy peers. Therefore, we developed an Internet-based intervention to improve physical activity (PA). The aim of this study was to examine the effectiveness of the program in improving PA. Methods. PA was determined by activity-related energy expenditure, PA level, time spent on moderate to vigorous PA, and the number of days with >1 hour of moderate to vigorous activity, and was assessed with a 7-day activity diary. Aerobic exercise capacity was assessed by means of a Bruce treadmill test and was recorded as maximum endurance time. Disease activity was assessed by using the JIA core set. Adherence was electronically monitored. Results. Of 59 patients, 33 eligible patients were included and randomized in an intervention (n _ 17, mean _ SD age 10.6 _ 1.5 years) or control waiting-list group (n _ 16, mean _ SD age 10.8 _ 1.4 years). All patients completed baseline and T1 testing. PA significantly improved in both groups. Maximum endurance time significantly improved in the intervention group but not in the control group. In a subgroup analysis for patients with low PA (intervention: n _ 7, control: n _ 5), PA improved in the intervention group but not in the control group. The intervention was safe, feasible, and showed a good adherence. Conclusion. An Internet-based program for children with JIA ages 8–12 years directed at promoting PA in daily life effectively improves PA in those patients with low PA levels. It is also able to improve endurance and it is safe, feasible, and has good adherence. INTRODUCTION Children and adolescents with juvenile idiopathic arthritis (JIA) have reduced aerobic and anaerobic exercise capacity (1–3). There is also evidence that they are less physically active as compared with healthy peers (4,5). As a result, they may perceive difficulties in joining regular sport activities and in social interaction. It is unclear if this is the cause of the low exercise capacity or the result of it. Physical activity (PA) and physical fitness are interrelated (6). PA can be described as all leisure and non-leisure body movements resulting in an increased energy output from the resting condition (7). To become and remain physically fit, it is necessary to become physically active and to adopt and maintain a physically active lifestyle (8). Evidence is accumulating that PA is effective in the primary and secondary prevention of several chronic conditions (9 –11). PA is also associated with a reduction in all-cause mortality (11). There is evidence that in youth ages 6–16 years, PA controls body weight; reduces blood pressure in hypertensive youth; improves aerobic capacity, muscular strength, endurance, and skeletal health; reduces anxiety and depression; and improves self-concept (12). PA also has a positive effect on academic performance, concentration, memory, and classroom behavior (12). For children with JIA and other chronic diseases, it is recognized that they could take advantage of the same health benefits (13,14). Evidence supports the fact that PA . 1Otto T. H. M. Lelieveld, BSc, Miek A. van Leeuwen, MD, PhD: University Medical Center Groningen, Groningen, The Netherlands; 2Wineke Armbrust, MSc, Inez de Graaf, BSc, Pieter J. J. Sauer, PhD: Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands; 3Jan H. B. Geertzen, MD, PhD, Ellen van Weert, PhD: University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 4Jelte Bouma, PhD: University of Groningen, Groningen, The Netherlands. Address correspondence to Otto T. H. M. Lelieveld, BSc, Center for Rehabilitation, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands. E-mail: o.t.h.m.lelieveld@rev.umcg.nl. Submitted for publication September 28, 2009; accepted in revised form January 6, 2010. Arthritis Care & Research Vol. 62, No. 5, May 2010, pp 697–703 DOI 10.1002/acr.20085 © 2010, American College of Rheumatology ORIGINAL ARTICLE 697