Exercise helps kids' arthritis
Research also links exercise to improved immune response

By LOIS BAKER
News Services Editor

New research on the effects of exercise on juvenile arthritis indicates it is OK-advantageous, in fact-for these kids to be kids.

Children with juvenile arthritis who took part in an eight-week individualized program of resistance exercise at UB significantly improved their ability to function, preliminary results have shown. And their pain, disability and use of medications decreased significantly.

photo by: Nanci J. Parisi Nadine Fisher helps Susanna Rowland, 7,who has juvenile arthritis, perform the resistance exercises that have improved her condition.

Nadine Fisher, assistant professor of occupational therapy and rehabilitation medicine, will present results of the study in Boston Tuesday at a joint meeting of the American College of Rheumatology and the Association of Rheumatology Health Professionals.

"We expected to see a change in the disease with exercise," Fisher said, "but we didn't expect to see so much "Some kids showed 200-percent improvement."

An accompanying investigation conducted by Jaya Venkatraman, associate professor of nutrition, also to be presented in Boston, revealed the cellular basis for these changes: Exercise produced a change in immune response. Juvenile arthritis is a form of rheumatoid arthritis, an autoimmune disease in which the body's immune system attacks joints and surrounding tissue.

The children who took part in the exercise program had significantly lower levels of cytokines-proinflammatory proteins-and higher levels of anti-inflammatory compounds in their plasma than those who did not, this study showed.

Fisher designed the exercise program and had shown its benefits in previous studies of elderly patients with osteoarthritis. An individualized resistance-exercise program had never been tried with children, however. Fisher knows of only one other study of exercise and juvenile arthritis, dealing with aerobic capacity. Fisher's study, which is half-completed, has involved 11 children with juvenile arthritis to date. Six took part in the exercise program and five served as "disease" controls. Another 13 children without arthritis served as normal controls. All were between the ages of 6 and 13.

To establish a baseline level of disability or deficit, Fisher and colleagues tested the strength and endurance of children's quadriceps and hamstrings, speed of muscle contraction, oxygen consumption, heart rate and blood pressure, and assessed pain, disability and general functional performance. Using that data, they designed a resistance program for each child randomly assigned to the exercise program.

All exercises, centered on the legs and based on resistance to avoid injury to joints, included pressing against a stationary object and lifting and holding weights for strength and endurance. Once the children adapted to the exercises, they were asked to increase the speed of weightlifting to improve coordination and balance.

Venkatraman and colleagues collected blood from all participants before and after initial testing, after the eight-week exercise program but before the final test, and after the final test.

Results showed that the exercisers' quadriceps' strength and endurance increased 48 percent and 32 percent, respectively; hamstring strength and endurance increased 99 percent and 59 percent respectively, and muscle-contraction speed increased 51 percent. Maximum systolic blood pressure, oxygen consumption and heart rate also increased.

Functional status of the group, a measure of physical capability, increased by 32 percent. Pain dropped nearly by half; disability and number of medications by a quarter.

The children with juvenile arthritis who did not participate in the exercise project experienced significant decreases in hamstring strength and endurance over the eight-week period, results showed. In addition, pain rose nearly 75 percent, disability by 10 percent and use of medications by 54 percent.

Additional researchers were Kathleen M. O'Neil, associate professor of clinical pediatrics, and Vylma Velazquez, pediatric fellow