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24-03-2020 | Physical activity | Editorial | Article

Exercise recommendations for children with juvenile idiopathic arthritis

Sangeeta Sule


Juvenile idiopathic arthritis is the most common childhood rheumatic disease and can cause severe joint swelling, pain, and stiffness, with resultant muscle weakness and atrophy. The American College of Rheumatology recommends physical activity for all patients with arthritis, including range-of-motion exercises to preserve joint mobility, low-resistance exercises, and aerobic exercises to maintain muscle mass, bone health, and fitness. The American Academy of Pediatrics recommends that children, adolescents, and young adults should engage in at least 60 minutes of moderate or vigorous aerobic physical activity per day. These recommendations also specify that children should engage in vigorous activity on at least 3 days per week, and in muscle and bone strengthening activities on at least 3 days per week.

Can children with juvenile idiopathic arthritis exercise?

Conventionally, children with juvenile idiopathic arthritis avoided exercise because of fear of either aggravating the arthritis or causing harm to the muscles or bones. Research has shown that children with juvenile idiopathic arthritis can participate in exercise without risk of flare. However, children with juvenile idiopathic arthritis may have gross motor delays that affect sports readiness. Children with cervical spine arthritis may be at increased risk for spinal cord compression, especially during contact sports. Radiographic evaluation should be considered to assess for C1-C2 stability prior to engaging in contact or collision sports. Children with temporomandibular joint arthritis should use appropriate mouth guards when they are engaged in activities that could cause jaw or dental injury risk. Aerobic fitness has been shown to be decreased in patients with long-standing juvenile idiopathic arthritis, potentially making endurance sports more difficult.

Which exercises are suitable for children with juvenile idiopathic arthritis?

Any type of exercise will help get children moving and improve their cardiovascular endurance and overall health. In a recent study of a six-month home-based exercise program with jumping and handgrip exercises, resistance training, and one group exercise session per month, patients noted improvement in fatigue. Strengthening and jumping exercises with 20-minute sessions of jump rope, core-strengthening and arm/shoulder-strengthening have been shown to improve total bone mineral density compared with controls who did not exercise. Pilates, stretching, and proprioceptive exercises improved quality of life and function, and decreased fatigue compared with children who did not exercise. Slow motion resistance training has also been studied in juvenile idiopathic arthritis and showed improvement in fatigue but no change in disease activity scores.

These studies show that exercises are well tolerated in the juvenile idiopathic arthritis population. The biggest challenge in these studies was adherence. In these studies, even with a motivated patient population, compliance ranged from 47% to 78%. The highest adherence was with supervised exercise, such as with a physical therapist, rather than home-based.

How to get children with juvenile idiopathic arthritis to exercise

In a study of perceived barriers and facilitators to a home-based exercise program in which children with juvenile idiopathic arthritis and their parents were interviewed, parental support, enjoyment, time pressures, and physical ailments were the main themes that influenced adherence to an exercise program.

The goal is to choose an exercise or sport that the child enjoys, and which fits in with the lifestyle of the family. Making the exercise a family affair can also improve adherence. Going out for a walk or a bicycle ride with the family can be enjoyable, and gets the whole family moving.


Children with juvenile idiopathic arthritis can, and should, exercise. Exercise improves quality of life, muscle strength, and bone density– helping these children lead strong, healthy lives.

About the author

Sangeeta Sule

Sangeeta Sule is Chief of Rheumatology at Children’s National Medical Center and Associate Professor of Pediatrics at George Washington University School of Medicine and Health Sciences. Disclosures

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