Prevalence of Exercise Prescription and Clinical Justifications in Pediatric Rheumatology Patients with a Immigrant Background: A Single-Center Observational Study

Abstract

Aim: Pediatric rheumatic diseases, such as Juvenile Idiopathic Arthritis (JIA), fibromyalgia, muscle strain, and scoliosis, can significantly impact physical function and quality of life. Exercise therapy is an effective, evidence-based approach for managing musculoskeletal symptoms in these patients, but its use in pediatric rheumatology remains underexplored. This study aimed to evaluate the prevalence of exercise prescription, the underlying clinical justifications, and demographic characteristics of pediatric rheumatology immigrant-background pediatric patients referred to a physical therapy clinic. Material and Method: This prospective, cross-sectional study included pediatric patients with immigrant (0-22 years) referred from the pediatric rheumatology clinic to the physical therapy clinic of Ümraniye Training and Research Hospital between January 1 and December 31, 2024. Patient data, including age, gender, diagnosis, and treatment type, were analyzed using SPSS (v.26), with p<0.05 considered statistically significant. Results: A total of 190 patients were included (63% female, 37% male), with a mean age of 14.2±4.3 years. Exercise prescriptions were provided to 55% (n=105) of the patients. Male patients had a slightly higher exercise prescription rate (59%) compared to females (53%), though this difference was not statistically significant (p>0.05). Muscle strain (74%) and joint pain (69%) had the highest exercise prescription rates, while JIA patients had a lower rate (47%). Conclusion: Exercise prescriptions are more common in non-inflammatory conditions like muscle strain and joint pain, while JIA patients receive them less frequently, likely due to concerns over joint damage and disease activity. Future studies should assess the long-term impact of exercise in this population.

Keywords

• Pediatric rheumatology
• exercise prescription
• Juvenile Idiopathic Arthritis
• muscle strain
• physical therapy

Kaynakça

1. Wallace CA, Huang B, Bandeira M, et al. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheumatol. 2005;52:3554-62.
2. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390-2.
3. Weiss JE, Stinson JN. Pediatric pain syndromes and noninflammatory musculoskeletal pain. Pediatr Clin North Am. 2018;65:801-26.
4. Achar S, Yamanaka J. Back pain in children and adolescents. Am Fam Physician. 2020;102:19-28.
5. Takken T, van der Net J, Helders PJ. Do junvenile idiopathic arthritis patients benefit from an exercise program? A pilot study. Arthritis Rheum. 2001;45:81-5.
6. Ibrahim M.B, Labib M, Khozamy H, Badawy WM. Efficacy of physical activities on children with juvenile idiopathic arthritis: a randomized controlled trial. Bull Fac Phys Ther. 2020;25:6.
7. Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985). 2005;98:1154-62.
8. Gleeson M, Bishop NC, Stensel DJ, et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol. 2011;11:607-15.

9. Tarakcı E, Kısa EP, Arman N, Albayrak A. Physical activity and exercise in patients with pediatric rheumatic disease: a systematic search and review. Turk Arch Pediatr. 2021;56:179-86.
10. Vansant AF. The dilemma of the small sample size. Pediatr Phys Ther. 2003;15:145.
11. Lee J, Kim J, Cho M, et al. Effectiveness of fatigue-reducing ınterventions in pediatric rheumatic diseases: a systematic review. Cureus. 2023;15:e357163.
12. Gualano B, Bonfa E, Pereira RMR, Silva CA. Physical activity for paediatric rheumatic diseases: standing up against old paradigms. Nat Rev Rheumatol. 2017;13:368-79.
13. Liu WY, Li HM, Jiang H, Zhang WK. Effect of exercise training on health, quality of life, exercise capacity in juvenile idiopathic arthritis: a meta-analysis of randomized controlled trials. Pediatr Rheumatol. 2024;22:33.
14. Ivanović M, Ivanović U. Gender differences during adolescence in the motives for physical exercise, depression, anxiety and stress. EQOL Journal. 2018;10:17-27.
15. Portela-Pino I, López-Castedo A, Martínez-Patiño MJ, et al. Gender differences in motivation and barriers for the practice of physical exercise in adolescence. Int J Environ Res Public Health. 2019;17:168.
16. Lagestad P, van den Tillaar R, Mamen A. Longitudinal changes in physical activity level, body mass ındex, and oxygen uptake among Norwegian adolescents. Front Public Health. 2018;6:97.
17. World Health Organization. Physical activity. Geneva: WHO; 2020. https://www.who.int/news-room/fact-sheets/detail/physical-activity access date 22.04.2025.
18. Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health. 2020;4:23-35.
19. Farooq MA, Parkinson KN, Adamson AJ, et al. Timing of the decline in physical activity in childhood and adolescence: gateshead millennium cohort study. Br J Sports Med. 2018;52:1002-6.
20. Corder K, Winpenny E, Love R, et al. Change in physical activity from adolescence to early adulthood: a systematic review and meta-analysis of longitudinal cohort studies. Br J Sports Med. 2019;53:496-503.
21. Figueiredo CG, Santos VS, Madureira EV, et al. Most physical interventions for musculoskeletal pain in children and adolescents cannot be reproduced in clinical practice: a meta-research study of randomized clinical trials. BMC Musculoskelet Disord. 2024;25:698.
22. Gielen S, Adams V, Möbius-Winkler S, et al. Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol. 2003;42:861-8.