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Effects of Structured Exercise Training in Children and Adolescents With Juvenile Idiopathic Arthritis

Klepper, Susan, PT, MS, PhD; Mano Khong, Taryn Tamiko, PT, DPT; Klotz, Rachel, PT, DPT; Gregorek, Adrienne Odmark, PT, DPT; Chan, Y Chee, PT, DPT, CSCS; Sawade, Samantha, PT, DPT

doi: 10.1097/PEP.0000000000000555

Purpose: To examine safety and efficacy of exercise training (ET) for juvenile idiopathic arthritis (JIA) to improve physical fitness, pain, functional capability, and quality of life.

Methods: Ovid Medline, PubMed, CINAHL, PEDro, and Web of Science were searched from 1995 to April 2018 to find English-language articles examining effects of ET in JIA, ages 4 to 21 years. Quality of evidence/strength of clinical recommendations were assessed using the Cochrane GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results were reported using the 2009 Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) checklist for health care interventions.

Results: Nine papers met inclusion criteria. A total of 457 individuals with JIA, ages 4 to 19.9 years, received ET or alternate activity, wait-list, or no intervention. Moderate-quality evidence supports Stott Pilates and underwater knee-resistance exercise. No adverse effects of ET were reported.

Conclusions: Moderate-quality evidence exists for ET (30-50 minutes, 2-3 times/week, 12-24 weeks) to decrease pain, improve range of motion, knee strength, functional capability, and quality of life in JIA.

The purpose of this review was to update the evidence for safety and efficacy of structured exercise training in a variety of settings for children and adolescents with juvenile idiopathic arthritis.

Program in Physical Therapy-retired (Dr Klepper), Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York; University of Utah Health (Dr Mano Khong), South Jordan, Utah; Lucille Packard Children's Hospital (Dr Klotz), Palo Alto, California; Westside Dance Physical Therapy (Dr Gregorek), New York, New York; Sloane Stecker Physical Therapy (Dr Chan), New York, New York; University of Colorado School of Medicine/Children's Hospital Colorado (Dr Sawade), Aurora, Colorado.

Correspondence: Susan Klepper, PT, MS, PhD, Program in Physical Therapy-retired, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY 10032 (

At the time this article was written, Dr Klepper was a faculty member in the Department of Rehabilitation and Regenerative Medicine, Physical Therapy, Columbia University Medical Center, New York, New York.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Copyright © 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association