Patients with paediatric rheumatic diseases can be hypoactive, which can be detrimental to disease symptoms and function
Several symptoms experienced by patients with paediatric rheumatic diseases might be mitigated by increasing physical activity levels
The systemic benefits of exercise training clearly outweigh the potential risks in paediatric rheumatic diseases
Health professionals are advised to assess and track physical activity levels and sedentary behaviour on a routine basis, as they are invaluable health risk parameters
The concept that 'exercise is medicine' should be extended to the field of rheumatology and officially embraced by its scientific and professional organizations
Over the past 50 years it has become clear that physical inactivity is associated with chronic disease risk. For several rheumatic diseases, bed rest was traditionally advocated as the best treatment, but several levels of evidence support the imminent paradigm shift from the prescription of bed rest to physical activity in individuals with paediatric rheumatic diseases, in particular juvenile systemic lupus erythematosus, juvenile idiopathic arthritis, juvenile fibromyalgia, and juvenile dermatomyositis. Increasing levels of physical activity can alleviate several symptoms experienced by patients with paediatric rheumatic diseases, such as low aerobic fitness, pain, fatigue, muscle weakness and poor health-related quality of life. Moreover, the propensity of patients with paediatric rheumatic diseases to be hypoactive — often due to social self-isolation, overprotection, and fear and/or ignorance on the part of parents, teachers and health practitioners — can be detrimental to general disease symptoms and function. In support of this rationale, a growing number of studies have demonstrated that the systemic benefits of exercise training clearly outweigh the risks in these diseases. In this sense, health professionals are advised to assess, track and fight against physical inactivity and sedentary behaviour on a routine basis, as they are invaluable health risk parameters in rheumatology.
Subscribe to Journal
Get full journal access for 1 year
only $17.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Blair, S. N. et al. A tribute to Professor Jeremiah Morris: the man who invented the field of physical activity epidemiology. Ann. Epidemiol. 20, 651–660 (2010).
Hawley, J. A. & Holloszy, J. O. Exercise: it's the real thing! Nutr. Rev. 67, 172–178 (2009).
Sigal, R. J., Kenny, G. P., Wasserman, D. H. & Castaneda-Sceppa, C. Physical activity/exercise and type 2 diabetes. Diabetes Care 27, 2518–2539 (2004).
Sofi, F. et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J. Intern. Med. 269, 107–117 (2010).
Ventura-Clapier, R., Mettauer, B. & Bigard, X. Beneficial effects of endurance training on cardiac and skeletal muscle energy metabolism in heart failure. Cardiovasc. Res. 73, 10–18 (2007).
Ekelund, U. et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 388, 1302–1310 (2016).
Eijsvogels, T. M., George, K. P. & Thompson, P. D. Cardiovascular benefits and risks across the physical activity continuum. Curr. Opin. Cardiol. 31, 566–571 (2016).
Franco, O. H. et al. Effects of physical activity on life expectancy with cardiovascular disease. Arch. Intern. Med. 165, 2355–2360 (2005).
Booth, F. W., Roberts, C. K. & Laye, M. J. Lack of exercise is a major cause of chronic diseases. Compr. Physiol. 2, 1143–1211 (2012).
Charansonney, O. L., Vanhees, L. & Cohen-Solal, A. Physical activity: from epidemiological evidence to individualized patient management. Int. J. Cardiol. 170, 350–357 (2014).
Engelen, L. et al. Who is at risk of chronic disease? Associations between risk profiles of physical activity, sitting and cardio-metabolic disease in Australian adults. Aust. N. Z. J. Public Health 41, 178–183 (2017).
Evenson, K. R., Butler, E. N. & Rosamond, W. D. Prevalence of physical activity and sedentary behavior among adults with cardiovascular disease in the United States. J. Cardiopulm. Rehabil. Prev. 34, 406–419 (2014).
Fishman, E. I. et al. Association between objectively measured physical activity and mortality in NHANES. Med. Sci. Sports Exerc. 48, 1303–1311 (2016).
Hallal, P. C. et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 380, 247–257 (2012).
Haskell, W. L. et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39, 1423–1434 (2007).
Henson, J. et al. Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia 56, 1012–1020 (2013).
Lee, I. M. et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380, 219–229 (2012).
Larson, E. B. et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann. Intern. Med. 144, 73–81 (2006).
Gaskin, C. J. et al. Associations of objectively measured moderate-to-vigorous physical activity and sedentary behavior with quality of life and psychological well-being in prostate cancer survivors. Cancer Causes Control 27, 1093–1103 (2016).
Pedersen, B. K. & Saltin, B. Evidence for prescribing exercise as therapy in chronic disease. Scand. J. Med. Sci. Sports 16 (Suppl. 1), 3–63 (2006).
Booth, F. W., Gordon, S. E., Carlson, C. J. & Hamilton, M. T. Waging war on modern chronic diseases: primary prevention through exercise biology. J. Appl. Physiol. 88, 774–787 (2000).
Wen, C. P. et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 378, 1244–1253 (2011).
Basu, N. et al. Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study. BMC Med. 14, 122 (2016).
Wijndaele, K., Sharp, S. J., Wareham, N. J. & Brage, S. Mortality risk reductions from substituting screen-time by discretionary activities. Med. Sci. Sports Exerc. http://dx.doi.org/10.1249/MSS.0000000000001206 (2017).
Henriksen, E. J. Invited review: effects of acute exercise and exercise training on insulin resistance. J. Appl. Physiol. 93, 788–796 (2002).
Peterson, J. A. Get moving! Physical activity counseling in primary care. J. Am. Acad. Nurse Pract. 19, 349–357 (2007).
van den Hoek, J. et al. Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study. Rheumatol. Int. 37, 487–493 (2017).
Hao, Y. et al. Early mortality in a multinational systemic sclerosis inception cohort. Arthritis Rheumatol. 69, 1067–1077 (2017).
Bartels, C. M. et al. Mortality and cardiovascular burden of systemic lupus erythematosus in a US population-based cohort. J. Rheumatol. 41, 680–687 (2014).
de Salles Painelli, V. et al. The possible role of physical exercise on the treatment of idiopathic inflammatory myopathies. Autoimmun. Rev. 8, 355–359 (2009).
Baillet, A. et al. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials. Arthritis Care Res. (Hoboken) 62, 984–992 (2010).
Huffman, K. M. et al. Molecular alterations in skeletal muscle in rheumatoid arthritis are related to disease activity, physical inactivity, and disability. Arthritis Res. Ther. 19, 12 (2017).
Katz, P. et al. Role of sleep disturbance, depression, obesity, and physical inactivity in fatigue in rheumatoid arthritis. Arthritis Care Res. (Hoboken) 68, 81–90 (2016).
Alexanderson, H., Dastmalchi, M., Esbjornsson-Liljedahl, M., Opava, C. H. & Lundberg, I. E. Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum. 57, 768–777 (2007).
Gualano, B. et al. Resistance training with vascular occlusion in inclusion body myositis: a case study. Med. Sci. Sports Exerc. 42, 250–254 (2010).
Habers, G. E. & Takken, T. Safety and efficacy of exercise training in patients with an idiopathic inflammatory myopathy—a systematic review. Rheumatology (Oxford) 50, 2113–2124 (2011).
Cooney, J. K. et al. Benefits of exercise in rheumatoid arthritis. J. Aging Res. 2011, 681640 (2011).
de Jong, Z. et al. Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Ann. Rheum. Dis. 63, 1399–1405 (2004).
Hardy, L. L., Dobbins, T. A., Denney-Wilson, E. A., Okely, A. D. & Booth, M. L. Sedentariness, small-screen recreation, and fitness in youth. Am. J. Prev. Med. 36, 120–125 (2009).
Pinhas-Hamiel, O. & Zeitler, P. “Who is the wise man? — The one who foresees consequences:”. Childhood obesity, new associated comorbidity and prevention. Prev. Med. 31, 702–705 (2000).
de Rooij, B. H. et al. Physical activity and sedentary behavior in metabolically healthy versus unhealthy obese and non-obese individuals — the Maastricht study. PLoS ONE 11, e0154358 (2016).
Pinto, A. J. et al. Physical (in)activity and its influence on disease-related features, physical capacity, and health-related quality of life in a cohort of chronic juvenile dermatomyositis patients. Semin. Arthritis Rheum. 46, 64–70 (2016).
Bohr, A. H., Nielsen, S., Muller, K., Karup Pedersen, F. & Andersen, L. B. Reduced physical activity in children and adolescents with Juvenile Idiopathic Arthritis despite satisfactory control of inflammation. Pediatr. Rheumatol. Online J. 13, 57 (2015).
Henderson, C. J., Lovell, D. J., Specker, B. L. & Campaigne, B. N. Physical activity in children with juvenile rheumatoid arthritis: quantification and evaluation. Arthritis Care Res. 8, 114–119 (1995).
Kashikar-Zuck, S. et al. Actigraphy-based physical activity monitoring in adolescents with juvenile primary fibromyalgia syndrome. J. Pain 11, 885–893 (2010).
Pinto, A. J. et al. Reduced aerobic capacity and quality of life in physically inactive patients with systemic lupus erythematosus with mild or inactive disease. Arthritis Care Res. (Hoboken) 68, 1780–1786 (2016).
Kashikar-Zuck, S. et al. Physical activity monitoring in adolescents with juvenile fibromyalgia: findings from a clinical trial of cognitive-behavioral therapy. Arthritis Care Res. (Hoboken) 65, 398–405 (2013).
Lelieveld, O. T. et al. Physical activity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum. 59, 1379–1384 (2008).
Cook, D. B., Nagelkirk, P. R., Poluri, A., Mores, J. & Natelson, B. H. The influence of aerobic fitness and fibromyalgia on cardiorespiratory and perceptual responses to exercise in patients with chronic fatigue syndrome. Arthritis Rheum. 54, 3351–3362 (2006).
Fernhall, B. & Agiovlasitis, S. Arterial function in youth: window into cardiovascular risk. J. Appl. Physiol. 105, 325–333 (2008).
Gunter, K. et al. Impact exercise increases BMC during growth: an 8-year longitudinal study. J. Bone Miner. Res. 23, 986–993 (2008).
Bar-Or, O. & Rowland, T. W. Pediatric Exercise Medicine: From Physiologic Principles to Health Care Application (Human Kinetics, 2004).
Sit, C. H. et al. Physical activity and sedentary time among children with disabilities at school. Med. Sci. Sports Exerc. 9, 292–297 (2017).
Maggio, A. B. et al. Reduced physical activity level and cardiorespiratory fitness in children with chronic diseases. Eur. J. Pediatr. 169, 1187–1193 (2010).
Pinto, A. J. et al. Poor muscle strength and function in physically inactive childhood-onset systemic lupus erythematosus despite very mild disease. Rev. Bras. Reumatol. Engl. Ed. 56, 509–514 (2016).
Houghton, K. M., Tucker, L. B., Potts, J. E. & McKenzie, D. C. Fitness, fatigue, disease activity, and quality of life in pediatric lupus. Arthritis Rheum. 59, 537–545 (2008).
Schanberg, L. E. et al. Premature atherosclerosis in pediatric systemic lupus erythematosus: risk factors for increased carotid intima-media thickness in the atherosclerosis prevention in pediatric lupus erythematosus cohort. Arthritis Rheum. 60, 1496–1507 (2009).
Paupitz, J. A. et al. Bone impairment assessed by HR-pQCT in juvenile-onset systemic lupus erythematosus. Osteoporos. Int. 27, 1839–1848 (2016).
Mina, R. et al. Effects of obesity on health-related quality of life in juvenile-onset systemic lupus erythematosus. Lupus 24, 191–197 (2015).
van Brussel, M. et al. Aerobic and anaerobic exercise capacity in children with juvenile idiopathic arthritis. Arthritis Rheum. 57, 891–897 (2007).
Giannini, M. J. & Protas, E. J. Comparison of peak isometric knee extensor torque in children with and without juvenile rheumatoid arthritis. Arthritis Care Res. 6, 82–88 (1993).
Takken, T., van der Net, J. & Helders, P. J. Relationship between functional ability and physical fitness in juvenile idiopathic arthritis patients. Scand. J. Rheumatol. 32, 174–178 (2003).
Kashikar-Zuck, S. et al. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics 133, e592–e600 (2014).
Kashikar-Zuck, S. & Ting, T. V. Juvenile fibromyalgia: current status of research and future developments. Nat. Rev. Rheumatol. 10, 89–96 (2014).
Maia, M. M. et al. Juvenile fibromyalgia syndrome: blunted heart rate response and cardiac autonomic dysfunction at diagnosis. Semin. Arthritis Rheum. 46, 338–343 (2016).
Takken, T. et al. The physiological and physical determinants of functional ability measures in children with juvenile dermatomyositis. Rheumatology (Oxford) 42, 591–595 (2003).
Takken, T., Spermon, N., Helders, P. J., Prakken, A. B. & Van Der Net, J. Aerobic exercise capacity in patients with juvenile dermatomyositis. J. Rheumatol. 30, 1075–1080 (2003).
Takken, T., van der Net, J., Engelbert, R. H., Pater, S. & Helders, P. J. Responsiveness of exercise parameters in children with inflammatory myositis. Arthritis Rheum. 59, 59–64 (2008).
Omori, C. H. et al. Exercise training in juvenile dermatomyositis. Arthritis Care Res. (Hoboken) 64, 1186–1194 (2012).
Prado, D. M. et al. Exercise in a child with systemic lupus erythematosus and antiphospholipid syndrome. Med. Sci. Sports Exerc. 43, 2221–2223 (2011).
Prado, D. M. et al. Exercise training in childhood-onset systemic lupus erythematosus: a controlled randomized trial. Arthritis Res. Ther. 15, R46 (2013).
Klepper, S. E. Exercise in pediatric rheumatic diseases. Curr. Opin. Rheumatol. 20, 619–624 (2008).
Gualano, B. et al. Evidence for prescribing exercise as treatment in pediatric rheumatic diseases. Autoimmun. Rev. 9, 569–573 (2010).
Takken, T., Van Der Net, J., Kuis, W. & Helders, P. J. Aquatic fitness training for children with juvenile idiopathic arthritis. Rheumatology (Oxford) 42, 1408–1414 (2003).
Epps, H. et al. Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis. Health Technol. Assess. http://dx.doi.org/10.3310/hta9390 (2005).
Singh-Grewal, D., Wright, V., Bar-Or, O. & Feldman, B. M. Pilot study of fitness training and exercise testing in polyarticular childhood arthritis. Arthritis Rheum. 55, 364–372 (2006).
Armbrust, W. et al. Internet program for physical activity and exercise capacity in children with juvenile idiopathic arthritis: a multicenter randomized controlled trial. Arthritis Care Res. (Hoboken) http://dx.doi.org/10.1002/acr.23100 (2016).
Baydogan, S. N., Tarakci, E. & Kasapcopur, O. Effect of strengthening versus balance-proprioceptive exercises on lower extremity function in patients with juvenile idiopathic arthritis: a randomized, single-blind clinical trial. Am. J. Phys. Med. Rehabil. 94, 417–424 (2015).
Dogru Apti, M., Kasapcopur, O., Mengi, M., Ozturk, G. & Metin, G. Regular aerobic training combined with range of motion exercises in juvenile idiopathic arthritis. Biomed Res. Int. 2014, 748972 (2014).
Mendonça, T. M. et al. Effects of Pilates exercises on health-related quality of life in individuals with juvenile idiopathic arthritis. Arch. Phys. Med. Rehabil. 94, 2093–2102 (2013).
Sandstedt, E., Fasth, A., Fors, H. & Beckung, E. Bone health in children and adolescents with juvenile idiopathic arthritis and the influence of short-term physical exercise. Pediatr. Phys. Ther. 24, 155–161 (2012).
Sandstedt, E., Fasth, A., Eek, M. N. & Beckung, E. Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial. Pediatr. Rheumatol. Online J. 11, 7 (2013).
Tarakci, E., Yeldan, I., Baydogan, S. N., Olgar, S. & Kasapcopur, O. Efficacy of a land-based home exercise programme for patients with juvenile idiopathic arthritis: a randomized, controlled, single-blind study. J. Rehabil. Med. 44, 962–967 (2012).
Van Oort, C., Tupper, S. M., Rosenberg, A. M., Farthing, J. P. & Baxter-Jones, A. D. Safety and feasibility of a home-based six week resistance training program in juvenile idiopathic arthritis. Pediatr. Rheumatol. Online J. 11, 46 (2013).
Takken, T. et al. Exercise therapy in juvenile idiopathic arthritis: a Cochrane Review. Eur. J. Phys. Rehabil. Med. 44, 287–297 (2008).
Stephens, S. et al. Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum. 59, 1399–1406 (2008).
Olsen, M. N. et al. Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome. Sleep 36, 509–516 (2013).
Sherry, D. D. et al. The treatment of juvenile fibromyalgia with an intensive physical and psychosocial program. J. Pediatr. 167, 731–737 (2015).
Kashikar-Zuck, S. et al. A qualitative examination of a new combined cognitive-behavioral and neuromuscular training intervention for juvenile fibromyalgia. Clin. J. Pain 32, 70–81 (2016).
Tran, S. T. et al. Preliminary outcomes of a cross-site cognitive-behavioral and neuromuscular integrative training intervention for juvenile fibromyalgia. Arthritis Care Res. (Hoboken) 69, 413–420 (2017).
Tran, S. T. et al. A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia. Pediatr. Rheumatol. Online J. 14, 43 (2016).
Omori, C. et al. Responsiveness to exercise training in juvenile dermatomyositis: a twin case study. BMC Musculoskelet. Disord. 11, 270 (2010).
Riisager, M., Mathiesen, P. R., Vissing, J., Preisler, N. & Orngreen, M. C. Aerobic training in persons who have recovered from juvenile dermatomyositis. Neuromuscul. Disord. 23, 962–968 (2013).
Habers, G. E. et al. Muscles in motion: a randomized controlled trial on the feasibility, safety and efficacy of an exercise training programme in children and adolescents with juvenile dermatomyositis. Rheumatology (Oxford) 55, 1251–1262 (2016).
Lupi-Herrera, E. et al. Takayasu's arteritis. Clinical study of 107 cases. Am. Heart J. 93, 94–103 (1977).
Oliveira, D. S. et al. Exercise in Takayasu arteritis: effects on inflammatory and angiogenic factors and disease-related symptoms. Arthritis Care Res. (Hoboken) http://dx.doi.org/10.1002/acr.23011 (2016).
Perandini, L. A. et al. Exercise training can attenuate the inflammatory milieu in women with systemic lupus erythematosus. J. Appl. Physiol. 117, 639–647 (2014).
Nader, G. A. et al. A longitudinal, integrated, clinical, histological and mRNA profiling study of resistance exercise in myositis. Mol. Med. 16, 455–464 (2010).
Benatti, F. B. & Pedersen, B. K. Exercise as an anti-inflammatory therapy for rheumatic diseases-myokine regulation. Nat. Rev. Rheumatol. 11, 86–97 (2015).
Perandini, L. A. et al. Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmun. Rev. 12, 218–224 (2012).
Safdar, A., Saleem, A. & Tarnopolsky, M. A. The potential of endurance exercise-derived exosomes to treat metabolic diseases. Nat. Rev. Endocrinol. 12, 504–517 (2016).
Alemo Munters, L. et al. Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis. Arthritis Res. Ther. 15, R83 (2013).
Munters, L. A. et al. Endurance exercise improves molecular pathways of aerobic metabolism in patients with myositis. Arthritis Rheumatol. 68, 1738–1750 (2016).
Tarnopolsky, M. A. & Parise, G. Direct measurement of high-energy phosphate compounds in patients with neuromuscular disease. Muscle Nerve 22, 1228–1233 (1999).
van Brussel, M. et al. Muscle metabolic responses during dynamic in-magnet exercise testing: a pilot study in children with an idiopathic inflammatory myopathy. Acad. Radiol. 22, 1443–1448 (2015).
Habers, G. E. et al. Near-infrared spectroscopy during exercise and recovery in children with juvenile dermatomyositis. Muscle Nerve 47, 108–115 (2013).
Armstrong, N. & Fawkner, S. G. Non-invasive methods in paediatric exercise physiology. Appl. Physiol. Nutr. Metab. 33, 402–410 (2008).
Carson, V. et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl. Physiol. Nutr. Metab. 41, S240–S265 (2016).
van der Ploeg, H. P., Chey, T., Korda, R. J., Banks, E. & Bauman, A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch. Intern. Med. 172, 494–500 (2012).
Bjork Petersen, C. et al. Total sitting time and risk of myocardial infarction, coronary heart disease and all-cause mortality in a prospective cohort of Danish adults. Int. J. Behav. Nutr. Phys. Act. 11, 13 (2014).
Matthews, C. E. et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am. J. Clin. Nutr. 95, 437–445 (2012).
Quarmby, T. & Pickering, K. Physical activity and children in care: a scoping review of barriers, facilitators, and policy for disadvantaged youth. J. Phys. Act. Health 13, 780–787 (2016).
Shields, N., Synnot, A. J. & Barr, M. Perceived barriers and facilitators to physical activity for children with disability: a systematic review. Br. J. Sports Med. 46, 989–997 (2012).
Corder, K., Ekelund, U., Steele, R. M., Wareham, N. J. & Brage, S. Assessment of physical activity in youth. J. Appl. Physiol. 105, 977–987 (2008).
Chinapaw, M. J., Mokkink, L. B., van Poppel, M. N., van Mechelen, W. & Terwee, C. B. Physical activity questionnaires for youth: a systematic review of measurement properties. Sports Med. 40, 539–563 (2010).
Pinto, A. J. et al. Poor agreement of objectively measured and self-reported physical activity in juvenile dermatomyositis and juvenile systemic lupus erythematosus. Clin. Rheumatol. 35, 1507–1514 (2016).
Takken, T. et al. Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease. Eur. J. Clin. Nutr. 64, 1494–1500 (2010).
Stephens, S. et al. Validation of accelerometer prediction equations in children with chronic disease. Pediatr. Exerc. Sci. 28, 117–132 (2016).
van Sluijs, E. M., McMinn, A. M. & Griffin, S. J. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ 335, 703 (2007).
Camacho-Minano, M. J., LaVoi, N. M. & Barr-Anderson, D. J. Interventions to promote physical activity among young and adolescent girls: a systematic review. Health Educ. Res. 26, 1025–1049 (2011).
Sallis, J. F., Buono, M. J., Roby, J. J., Micale, F. G. & Nelson, J. A. Seven-day recall and other physical activity self-reports in children and adolescents. Med. Sci. Sports Exerc. 25, 99–108 (1993).
Tremblay, M. S. et al. Canadian sedentary behaviour guidelines for children and youth. Appl. Physiol. Nutr. Metab. 36, 59–71 (2011).
Australian Government Department of Health. Australia's Physical Activity & Sedentary Behaviour Guidelines for Children (5–12 years). (Commonwealth of Australia, 2014).
Sisson, S. B. et al. Volume of exercise and fitness nonresponse in sedentary, postmenopausal women. Med. Sci. Sports Exerc. 41, 539–545 (2009).
Booth, F. W. & Laye, M. J. The future: genes, physical activity and health. Acta Physiol. (Oxf.) 199, 549–556 (2010).
Montero, D. & Lundby, C. Refuting the myth of non-response to exercise training: 'non-responders' do respond to higher dose of training. J. Physiol. http://dx.doi.org/10.1113/JP273480 (2017).
Faigenbaum, A. D. et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J. Strength Cond. Res. 23, S60–S79 (2009).
Timmons, B. W. Paediatric exercise immunology: health and clinical applications. Exerc. Immunol. Rev. 11, 108–144 (2005).
Rowland, T. Thermoregulation during exercise in the heat in children: old concepts revisited. J. Appl. Physiol. 105, 718–724 (2008).
Prescott, E. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur. Heart J. 27, 2904–2905 (2006).
Tremblay, M. S. et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int. J. Behav. Nutr. Phys. Act. 8, 98 (2011).
American College of Sports Medicine. Exercise is Medicine®: a global health initiative. Exercise is Medicine http://www.exerciseismedicine.org/ (2017).
van Brussel, M., van der Net, J., Hulzebos, E., Helders, P. J. & Takken, T. The Utrecht approach to exercise in chronic childhood conditions: the decade in review. Pediatr. Phys. Ther. 23, 2–14 (2011).
Bacon, M. C., Nicholson, C., Binder, H. & White, P. H. Juvenile rheumatoid arthritis. Aquatic exercise and lower-extremity function. Arthritis Care Res. 4, 102–105 (1991).
Singh-Grewal, D. et al. The effects of vigorous exercise training on physical function in children with arthritis: a randomized, controlled, single-blinded trial. Arthritis Rheum. 57, 1202–1210 (2007).
Myer, G. D. et al. Specialized neuromuscular training to improve neuromuscular function and biomechanics in a patient with quiescent juvenile rheumatoid arthritis. Phys. Ther. 85, 791–802 (2005).
We would like to thank Fundação de Amparo à Pesquisa do Estado de São Paulo (process 2015/03756-4), Conselho Nacional de Desenvolvimento Científico e Tecnológico (processes 305068/2014-8, 301805/2013-0, 303422/2015-7), Federico Foundation, Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP (NAP-CriAd), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for supporting the authors' work. We thank B. Saunders for proofreading this article. Also, we are grateful to all current and former students, health care providers and researchers working at the Laboratory of Assessment and Conditioning in Rheumatology (School of Medicine, University of São Paulo, Brazil), especially A. L. de Sá Pinto and F. Rodrigues Lima, who conceived and created this laboratory, which is primarily dedicated to investigate the effects of physical activity in rheumatologic diseases. We are also indebted to the patients and their parents who have taken part in our studies throughout the years.
The authors declare no competing financial interests.
- Physical inactivity
The failure to meet the specific physical activity guideline of ≥60 min of moderate-to-vigorous physical activity per day for paediatric populations.
- Physical activity
Any bodily movement produced by the skeletal muscles that results in energy expenditure.
A physical activity that is planned, structured, repetitive and purposeful, in the sense that improvement or maintenance of one or more components of physical fitness is an objective.
- Sedentary behaviour
Any waking behaviour that is characterized by an energy expenditure ≤1.5 metabolic equivalents (METs) while in a sitting or reclining posture.
A physical activity level that is lower than that of healthy peers matched by age, sex and cultural and socioeconomic background.
An athletic activity, often of a competitive nature, requiring skill or physical prowess.
About this article
Cite this article
Gualano, B., Bonfa, E., Pereira, R. et al. Physical activity for paediatric rheumatic diseases: standing up against old paradigms. Nat Rev Rheumatol 13, 368–379 (2017). https://doi.org/10.1038/nrrheum.2017.75
Acta Paediatrica (2020)
Nature Reviews Rheumatology (2020)
TNF blockade contributes to restore lipid oxidation during exercise in children with juvenile idiopathic arthritis
Pediatric Rheumatology (2019)
Modern Rheumatology (2019)
Advances in Rheumatology (2019)