Academic journal article Journal of the National Society of Allied Health

The Efficacy of Conventional Interventions versus Nontraditional High-Intensity Dynamic Exercise When Treating Adolescents with Juvenile Rheumatoid Arthritis

Academic journal article Journal of the National Society of Allied Health

The Efficacy of Conventional Interventions versus Nontraditional High-Intensity Dynamic Exercise When Treating Adolescents with Juvenile Rheumatoid Arthritis

Article excerpt

Introduction

Juvenile Rheumatoid Arthritis (JRA) is a chronic disease that is depicted by the imprecise, symmetric inflammation of the peripheral joints that results in the continuous obliteration of articular and peri-articular structures The etiology of JRA is unknown; however, it is believed that an infectious agent activating a genetically predisposed autoimmune response is the underlying cause of JRA. Bilberg, Ahlmen, and Mannerkorpi (2005) found that adolescents with juvenile rheumatoid arthritis have a decline in physical performance secondary to swelling, pain, fatigue, muscular weakness, and limited joint mobility. The decline in physical performance often results in physical inactivity and deconditioning. It is imperative, therefore, for adolescents with JRA to engage in physical activities that increase not only aerobic capacity, but also strength, endurance and mobility while decreasing pain and joint inflammation.

Munneke et al (2003) has described a conventional exercise program as low impact activities such as ROM, stretching, and aquatic exercises. Historically, these interventions have been deemed the best and safest form of treatment for individuals with JRA but recent evidence reveals that high intensity exercises may be as safe and more effective. The focus of this study was to investigate the efficacy of conventional interventions versus nontraditional high-intensity dynamic exercise when treating adolescents with JRA, based on evidence-based literature.

Review of Evidence-based Literature

An evidence-based study conducted by Salzman (2007) suggested that treatments involving aquatic therapy were the safest and most beneficial for adolescents with JRA. The treatment incorporated both hydrostatic and hydrodynamic principles which created buoyancy, therefore minimizing the downward force of gravity, while reducing joint stress or loads. This study also indicated that the viscosity of water permitted greater resistance, thus allowing patients to safely perform strengthening and resistant exercises. Furthermore, the study hypothesized that an aquatic therapy program for patients with JRA led to improved ventilation, blood circulation, and increased the aerobic capacity, strength, and endurance of the individual. Bilberg, Ahlmen, and Mannerkorpi (2005) observed that moderately intensive exercises in a temperate pool enhanced muscle strength and endurance. The results of the study demonstrated significant improvements for muscle endurance, strength, and flexibility within the treatment group compared with the control group.

Although aquatic programs have been recommended as the most frequently used intervention, some studies have argued that these programs have little or no significant impact for improving strength, endurance and mobility of patients while decreasing pain and joint swelling.

Takken et al (2003) evaluated the effects of an aquatic training program on 54 patients with oligoarticular or polyarticular JRA. These patients were randomly assigned into a control group and an experimental group. The results demonstrated that there was no significant improvement in the functional ability, quality of life, joint status, and physical fitness of the experimental group when compared with the control group who performed no exercise. A study by Eversden et al (2007) randomly examined 150 patients with JRA . The patients were categorized into two groups, one received hydrotherapy, the other land therapy. This study demonstrated that patients with RA had no significant improvement in physical functioning or quality of life despite reports of feeling better after a thirty-minute session of hydrotherapy for six weeks.

More recent research suggests that high intensity exercise programs are as safe but even more effective then conventional exercises for the treatment of patients with JRA.. Munneke et al (2003) described a high intensity exercise program which involved strengthening and physical training of the entire body musculature while causing fatigue. …

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