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Abstract Number: 861

A Family Based Pedometer Walking Program in an Adolescent Population with Juvenile Idiopathic Arthritis

Sara M. Stern1, Jill R. Blitz2, Amber Richards2 and Katherine AB Marzan3, 1Pediatric Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA, 2Rehab Services, Children's Hospital Los Angeles, Los Angeles, CA, 3Division of Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Adolescent patients, exercise, juvenile arthritis and pediatric rheumatology

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Session Information

Title: Pediatrics: Disease Flares

Session Type: Abstract Submissions (ARHP)

Background/Purpose: Walking programs are effective in adult arthritis but have not been studied in adolescents with arthritis.  The study’s objective was to evaluate the impact of a family based pedometer (PED) walking program and an educational program on the exercise tolerance of adolescent juvenile idiopathic arthritis (JIA) patients (Pts) with lower extremity involvement.

Methods: 27 Pts with lower extremity JIA were prospectively studied in a 2 phase exercise program.  In the 1st 6 week (wk) phase Pts were given typical guidance from a rheumatologist and physical therapist to increase their activity with daily walking.  Data was obtained at baseline, and after the 1st and 2nd 6 wk phases.  In the 2nd 6wk phase all Pts and family members received a PED to record their daily steps and were randomized into 2 groups.  One group attended a 30 min Arthritis Foundation Walk with Ease (WWE EP) educational program specifically adapted for adolescents and the other did not.  The 6 minute walk test (MWT) was the primary outcome measure to assess program effectiveness.  Secondary outcome measures included body mass index (BMI), Childhood Health Assessment Questionnaire (CHAQ), and visual analogue scale (VAS) for pain.

Results: 27 Pts (23 F: 4M) 11-19 yrs old (mean 16 yrs) participated.  19 were Latino (Lat) reflecting the population of the center.  13 completed the study.  All but 1 of the 14 Pts (12 Lat, p = 0.1) that discontinued the study did so between the 1st and 2nd visit prior to receiving a PED primarily due to 2nd thoughts about participating in an exercise program.  While no statistically significant differences were noted between Pts that discontinued and completed the study, those that discontinued had a trend towards higher BMI, shorter 6MWT, smaller HR change and higher VAS scores possibly reflecting a less motivated group. 

13 pts (7 Lat) with mean age of 16 ± 2 yrs completed the study (12F: 1M).  They generally had mild disease with a mean CHAQ of 0.65 ± 0.79 and mean VAS of 2.5 ± 3.6 cm.  5 Pts had active JIA at the initial visit and 3 other Pts had active JIA over the course of the study.  There was a significant increase in 6 MWT distance from baseline (458.0 ± 70.8 m) to the end (501.4 ± 59.8 m) of the 6wk initial phase (p = 0.029).  During the interventional 2nd phase, Pts maintained their improved exercise tolerance with a modest trend toward increased 6 MWT from 501.4 ± 59.8 m  to 504.7 ± 60.6 m (p = 0.76).  There were no differences in the 6 MWT between the Pts that received the education program (n=9) to those that did not (n=4) possibly due to small sample size (p = 0.93).  However, the WWE EP group at baseline visit appeared to have an overall higher exercise tolerance (6 MWT 478.1 ± 78.5 m vs 417.8 ± 27.2 m) and had a healthier initial BMI (23±5 vs 26±3).  In addition, Pts in the WWP EP group overall walked more steps per day while using their PED (2978 ± 3002 steps vs 1968 ± 1472 steps), although this was not statistically significant.

Conclusion: In motivated adolescents with JIA, an exercise program with consistent support from a physical therapist and rheumatologist significantly increased exercise tolerance.  The addition of a PED and modified WWE EP to a walking program helped Pts maintain or increase exercise tolerance.


Disclosure:

S. M. Stern,

Arthritis Foundation,

2;

J. R. Blitz,
None;

A. Richards,
None;

K. A. Marzan,
None.

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