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Regular exercise can help children and teens manage their JIA. Learn more about different exercises including range of motion exercises, stretching, strengthening, and cardiovascular exercise.

Key points

• The body produces endorphins during exercise, which help to reduce pain, joint stiffness and anxiety.
• Different types of exercise include range of motion, stretching, strengthening and cardiovascular fitness.
• Speak to a doctor or physiotherapist to find the right type of exercise for your child so they can avoid injury.

Regular daily exercise can help improve a child’s sense of well-being, which may increase their energy level and help their sleep better. This is because during exercise, the body produces chemicals called endorphins. Endorphins help to reduce pain, joint stiffness, and anxiety. Children should select activities that are fun and that they can do with their friends and family.

Types of exercises

There are several different types of exercises that a child can do to help keep their joints healthy. These can help to reduce some of the symptoms they are having.

Range of motion exercises

Stretching

Strengthening exercises

Cardiovascular fitness

The child’s physiotherapist or doctor can advise about which exercises are right for them. Doing the wrong kind of exercise can actually cause more pain or problems!

There should be no restrictions on the types of sports and leisure activities a child can do. The one exception would be if they have severe joint damage or neck problems. The doctor can advise if they have any activity restrictions.

Range of motion exercises

Range of motion is the amount the joints can be moved in certain directions. When a joint has active arthritis, a child may tend to hold it in a ‘position of comfort.’ This position is usually bent. This can quickly lead to a loss of joint motion and a flexion contracture. A flexion contracture is when the joint has persistent limitation in joint movements with the joint stuck in a bent position.

Range of motion exercises help to reduce stiffness and improve joint motion. These are gentle exercises that can be performed safely. They can be done even when joints are painful and swollen. Range of motion exercises are important since most daily activities do not move the joints through their full range of motion.

These exercises are most effective if they are done daily. However, most people find this hard to do. Have your child choose the range of motion exercises that work on their stiffest joints and do them as regularly as possible. They may find it easier to do these exercises while taking a shower. Or they can try doing them by taking a quick break from homework or computer time.

A child does not need to do range of motion exercises for ALL of their joints ALL of the time. A physiotherapist can help with this.

Stretching

Stretching can reduce stiffness and help keep joints and muscles flexible. This can make everyday activities much easier. Stretching gradually expands range of motion by improving muscle flexibility. Stretching can also help a child to move more comfortably.

In order to help improve muscle flexibility, these exercises need to be done regularly.

Make sure your child warms up before they start stretching. Have them move around for five to 10 minutes first. They might like to do these stretches after having a hot shower or bath. Stretches should be done slowly and held for at least 20 seconds. No bouncing! Ideally, they should stretch at least three to five times per week to see improvements in flexibility. Talk to your child’s physiotherapist about some stretches they can do.

Why not try out yoga or pilates? They are activities that focus on muscle flexibility and stretching exercises. This may be a way to incorporate stretching in a more fun way. Maybe some of your child’s friends would like to do this too!

Strengthening exercises

Strengthening exercises can help to maintain or improve muscle strength. Strong muscles help to support joints, which is especially important for people with JIA. There are different types of strengthening exercises. Your child’s physiotherapist or doctor can help you determine which type is right for your child.

Isometric: In these exercises, the muscles tighten without moving the joint. This is safe. Because the joint does not move during these exercises, they are more comfortable to do when the joint is painful and swollen.

Isotonic: In these exercises, you use your muscles while moving the joint(s) through some range of motion. Isotonic exercises can be done with or without resistance added. Resistance can be added with the use of body weight. External weights such as ankle or wrist weights, or elastic exercise bands can also be added. A general rule of thumb is, if you can complete two sets of 10 repetitions of an exercise easily, you can add some resistance. Start with a low weight (1 lb to 5 lbs) or low-resistance band. Have your child build up slowly, as they are able.

It is important to be in the correct position when doing these exercises. A little bit of muscle soreness the next day is okay. However, these exercises should NOT make joints more sore or swollen.

Talk to your child’s physiotherapist or another exercise expert before starting a strengthening regime. Generally speaking, people with JIA will use the principles of low weight and higher repetitions. A good starting point may be 10 repetitions of an exercise, a brief rest, and then a repeat set of 10. Do this three to five times per week. This is the type of routine that we know will help improve muscle strength and endurance. However, anything that your child is able to do is better than nothing!

You and your child may be feeling overwhelmed by all of the exercises that you have been given. Talk to the physiotherapist about how to make this more realistic. You may want to rotate the exercises so your child is not doing all exercises every day. Or focus on one or two of the most important exercises for a period of time and then focus on others later. Look at what your child’s goals are and what exercises can help them to meet these goals.

Cardiovascular fitness

Cardiovascular fitness is the ability of the lungs to provide oxygen to the blood and heart, and to transport that oxygen to the cells in the body. It is also the ability of the body to do an activity like swimming or walking for an extended period of time.

Cardiovascular fitness is extremely important for everyone, including young people with JIA. It can help maintain a healthy weight, help control pain, and improve sleep and mood.

In order to improve cardiovascular fitness, an exercise must be intense enough to raise the heart rate and maintain it for a period of time. Any continuous activity will help. Swimming, water aerobics, brisk walking, in-line skating, dancing and cycling may be easier to do for children who have JIA.

If you are interested in learning more about heart rate, target heart rate and how to monitor the intensity of exercise, check out this link:

https://www.healthyfamiliesbc.ca/home/articles/canadas-physical-activity-guidelines

For suggestions on how to become more physically active, visit Health Canada website:

http://www.hc-sc.gc.ca/hl-vs/physactiv/index-eng.php

Tips for becoming physically active

• Start slow, build up gradually, and have fun!
• Recruit a friend or family member to exercise with. This will help to keep motivated.
• Set goals and work toward them.
• For additional advice or support, speak to the physiotherapist or other health care provider.