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doi:10.1111/jpc.12733
ORIGINAL ARTICLE
Fundamental movement skills, physical fitness and physical activity among Australian children with juvenile idiopathic arthritis Gerben Hulsegge,1,2,3 Nicholas Henschke,1,4* Damien McKay,5,6,7 Jeffrey Chaitow,5 Kerry West,8 Carolyn Broderick6,9 and Davinder Singh-Grewal5,7,10 1 Musculoskeletal Division, George Institute for Global Health, 5Department of Rheumatology, Randwick and Westmead Campuses, Sydney Children’s Hospital Network, 6The Children’s Hospital Institute of Sports Medicine and 8Department of Physiotherapy, Children’s Hospital at Westmead, 7Discipline of Paediatrics and Child Health, University of Sydney, and Schools of 9Medical Sciences and 10Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia, 2EMGO Institute for Health and Care Research, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, and 3Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands, and 4Institute of Public Health, University of Heidelberg, Heidelberg, Germany
Aim: To describe fundamental movement skills (FMS), physical fitness and level of physical activity among Australian children with juvenile idiopathic arthritis (JIA) and compare this with healthy peers. Methods: Children aged 6–16 years with JIA were recruited from hospital rheumatology clinics and private rheumatology rooms in Sydney, Australia. All children attended an assessment day, where FMS were assessed by a senior paediatric physiotherapist, physical fitness was assessed using the multistage 20-metre shuttle run test, and physical activity and physical and psychosocial well-being were assessed with questionnaires. These results were compared with age- and gender-matched peers from the NSW Schools Physical Activity and Nutrition Survey and the Health of Young Victorians Study using logistic regression analysis. Results: Twenty-eight children with JIA participated in this study. There were no differences in the proportion of children who had mastered FMS between children with JIA and their healthy peers (P > 0.05). However, there was a trend for children with JIA to have poorer physical fitness and be less physically active than healthy peers. Parents of children with JIA indicated more physical and psychosocial impairments among their children and themselves compared with parents of healthy children (P < 0.05). Conclusions: This is the first study in Australia to compare FMS, physical activity and fitness in children with JIA and their peers. While older children with JIA appear to have poorer physical fitness and physical activity levels than their peers, there is no difference in FMS. Key words:
fundamental motor skills; juvenile idiopathic arthritis; physical activity; physical fitness.
What is already known on this topic
What this paper adds
1 Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and affects approximately 4 in every 1000 Australian children. 2 Several international studies have shown that children with JIA have impaired physical fitness. 3 To become physically active and enable participation in sports and games, it is essential that children master fundamental motor skills (FMS), such as sprinting, jumping, kicking, catching and throwing.
1 Compared to their healthy peers, children with JIA do not seem to have poorer fundamental motor skills. 2 Australian children with JIA show a trend towards poorer physical fitness and less physical activity compared with their peers. 3 Australian children with JIA and their parents experience significant physical and psychosocial impairments compared to their healthy peers.
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and affects approximately 4 in Correspondence: Dr Nicholas Henschke, University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, Heidelberg 69120, Germany. Fax: +496221565948; email: [email protected] Conflict of interest: All authors declare that they have no conflict of interest. Accepted for publication 10 August 2014.
every 1000 Australian children.1 Many children with JIA experience spontaneous remission; however, approximately half will have active disease that continues into adulthood.2 In childhood and adolescence, JIA often results in significant impairments such as persistent pain, limited range of joint motion, joint stiffness, growth disturbance and poor physical fitness.3,4 Several international studies have shown that children with JIA have impaired physical fitness (approximately 20%
Journal of Paediatrics and Child Health 51 (2015) 425–432 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
425
Movement skills in juvenile arthritis
G. Hulsegge et al.
decrease in aerobic and anaerobic capacity) and are less physically active than their healthy peers.5–7 This is of concern because regular physical activity through childhood and adolescence results in numerous short- and long-term health benefits.8 Together with the physical and psychosocial issues associated with JIA, reduced fitness can lead to considerable problems in performing activities of daily living9 and to reduced engagement in sports and games with other children. Importantly, low levels of physical activity in childhood and adolescence often track into adulthood, which can increase the risk of cardiovascular and other diseases.8,10 To become physically active and enable participation in sports and games, it is essential that children master fundamental motor skills (FMS), such as sprinting, jumping, kicking, catching and throwing.11 Children with poor FMS are often less motivated to engage in physical activities with their peers and as a result have decreased physical fitness.11–13 Currently, there is little data available to suggest whether children with JIA have poorer FMS than their healthy peers or whether their mastery of FMS is related to physical fitness. As children with JIA often have physical impairments such as limited joint motion that can limit their ability to master FMS, specific interventions targeting poor FMS may become an important component of their management. Evidence suggests that specific interventions to improve FMS in children, such as physical education and behavioural self-management, can both improve FMS and increase cardiorespiratory endurance.14,15 The objective of the current study is to describe FMS, physical fitness and physical activity among children with JIA to improve the understanding of the physical limitations of JIA and their consequences. More specifically, this study will be the first to compare these parameters in Australian children with JIA and their healthy peers. The secondary aim is to describe differences in physical and psychosocial well-being between these groups.
Materials and Methods
girls (Years 6–10) from schoolchildren involved in the 2004 NSW Schools Physical Activity and Nutrition Survey (SPANS) were used for comparison with the JIA group.16 Data from 5414 parents of 5–18-year-old Australian boys and girls from the Health of Young Victorians Study (HOYVS) were used to compare physical and psychosocial well-being with the JIA group.17
Testing procedure Eligible children with JIA were each tested on one occasion at the Children’s Hospital at Westmead. Clinical assessments were conducted by a paediatric rheumatologist with all other measurements conducted by a senior paediatric physiotherapist.
Clinical assessment The clinical assessment consisted of recording JIA subtype as diagnosed by the child’s rheumatologist, noting age of disease onset and current treatment, and conducting a clinical examination to determine active joint count. A joint was considered active if it was effused or displayed two of the following features: heat, limited range of movement, tenderness or stress pain. Average and worst pain in the last week were measured using a 100-mm visual analogue scale (VAS). Using the same protocol as described in the SPANS, FMS, physical fitness and level of physical activity were evaluated:
Fundamental motor skills Four locomotor skills (sprint run, vertical jump, side gallop and leap) and three object-control skills (catch, overhand throw and kick) were videotaped and assessed by a senior paediatric physiotherapist using a process-oriented checklist comprising five or six components for each skill (Appendix I).18 A skill was considered to be advanced if all or all but one of the skill components were performed correctly over at least four out of five trials. The reliability and validity of the instrument and its components have been established previously.19,20
Physical fitness
Participants Two consecutive series of children with JIA presenting to the rheumatology clinic at a large children’s hospital and private rheumatology rooms in Sydney, Australia, between January and March 2009 (first series) and between January and June 2011 (second series) were invited to participate in this study. Children were considered eligible for the study if they were aged between 6 and 16 years and were diagnosed with JIA by a paediatric rheumatologist. Exclusion criteria included the inability to follow instructions or the inability to perform exercise independently. Children were enrolled only after full and informed consent. This study was approved by the Children’s Hospital at Westmead’s Human Ethics Committee.
Control data Anthropometric and FMS data from 4638 boys and girls (Years 2–10), aerobic fitness data from 3720 boys and girls (Years 4–10), and self-reported physical activity from 2750 boys and 426
Aerobic capacity was measured using the multistage 20-metre shuttle run test, a valid and reliable test for the prediction of VO2max.21 Children completed a 20-metre shuttle run, the rate of which was determined by an accompanying recording, identical to that used in the SPANS study. The stage reached by the participants was determined by the last stage they successfully completed within the time frame. This was determined by voluntary stopping due to fatigue or failure to reach the 20-metre mark in the allocated time on two consecutive occasions. The stage reached was then converted into laps completed for analysis.
Level of physical activity The modified version of the Adolescent Physical Activity Recall Questionnaire (APARQ) was used to assess physical activity. The APARQ is validated in Australian adolescents and measures participation in organised and non-organised sports, games and other activities.22 According to the Physical Activity Recommendations for Children and Young People, children need at
Journal of Paediatrics and Child Health 51 (2015) 425–432 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
G. Hulsegge et al.
Movement skills in juvenile arthritis
Total children presenting (n = 179) - Rheumatology clinics (n = 119) - Private rheumatology rooms (n = 60)
Excluded - Not diagnosed with JIA (n = 85)
Total children with JIA (n = 94)
Fig. 1 Flowchart of children presenting to the rheumatology clinic and private rheumatology rooms during the study period. JIA, juvenile idiopathic arthritis.
Not eligible (n = 66) - Not aged 6–16 years (n = 29) - Not able to exercise (n = 6) - Unable to attend testing (n = 15) - Not contactable (n = 6) - Refused or not interested (n = 10)
Enrolled and tested (n = 28)
least 60 min of moderate-intensity to vigorous activities every day.23 After assigning rate of energy expenditure in metabolic equivalents (METS) to physical activities using the Compendium of Physical Activities, the children were labelled as active (≥3.0 METS for at least 60 min every day) or inactive (
doi:10.1111/jpc.12733
ORIGINAL ARTICLE
Fundamental movement skills, physical fitness and physical activity among Australian children with juvenile idiopathic arthritis Gerben Hulsegge,1,2,3 Nicholas Henschke,1,4* Damien McKay,5,6,7 Jeffrey Chaitow,5 Kerry West,8 Carolyn Broderick6,9 and Davinder Singh-Grewal5,7,10 1 Musculoskeletal Division, George Institute for Global Health, 5Department of Rheumatology, Randwick and Westmead Campuses, Sydney Children’s Hospital Network, 6The Children’s Hospital Institute of Sports Medicine and 8Department of Physiotherapy, Children’s Hospital at Westmead, 7Discipline of Paediatrics and Child Health, University of Sydney, and Schools of 9Medical Sciences and 10Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia, 2EMGO Institute for Health and Care Research, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, and 3Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands, and 4Institute of Public Health, University of Heidelberg, Heidelberg, Germany
Aim: To describe fundamental movement skills (FMS), physical fitness and level of physical activity among Australian children with juvenile idiopathic arthritis (JIA) and compare this with healthy peers. Methods: Children aged 6–16 years with JIA were recruited from hospital rheumatology clinics and private rheumatology rooms in Sydney, Australia. All children attended an assessment day, where FMS were assessed by a senior paediatric physiotherapist, physical fitness was assessed using the multistage 20-metre shuttle run test, and physical activity and physical and psychosocial well-being were assessed with questionnaires. These results were compared with age- and gender-matched peers from the NSW Schools Physical Activity and Nutrition Survey and the Health of Young Victorians Study using logistic regression analysis. Results: Twenty-eight children with JIA participated in this study. There were no differences in the proportion of children who had mastered FMS between children with JIA and their healthy peers (P > 0.05). However, there was a trend for children with JIA to have poorer physical fitness and be less physically active than healthy peers. Parents of children with JIA indicated more physical and psychosocial impairments among their children and themselves compared with parents of healthy children (P < 0.05). Conclusions: This is the first study in Australia to compare FMS, physical activity and fitness in children with JIA and their peers. While older children with JIA appear to have poorer physical fitness and physical activity levels than their peers, there is no difference in FMS. Key words:
fundamental motor skills; juvenile idiopathic arthritis; physical activity; physical fitness.
What is already known on this topic
What this paper adds
1 Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and affects approximately 4 in every 1000 Australian children. 2 Several international studies have shown that children with JIA have impaired physical fitness. 3 To become physically active and enable participation in sports and games, it is essential that children master fundamental motor skills (FMS), such as sprinting, jumping, kicking, catching and throwing.
1 Compared to their healthy peers, children with JIA do not seem to have poorer fundamental motor skills. 2 Australian children with JIA show a trend towards poorer physical fitness and less physical activity compared with their peers. 3 Australian children with JIA and their parents experience significant physical and psychosocial impairments compared to their healthy peers.
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and affects approximately 4 in Correspondence: Dr Nicholas Henschke, University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, Heidelberg 69120, Germany. Fax: +496221565948; email: [email protected] Conflict of interest: All authors declare that they have no conflict of interest. Accepted for publication 10 August 2014.
every 1000 Australian children.1 Many children with JIA experience spontaneous remission; however, approximately half will have active disease that continues into adulthood.2 In childhood and adolescence, JIA often results in significant impairments such as persistent pain, limited range of joint motion, joint stiffness, growth disturbance and poor physical fitness.3,4 Several international studies have shown that children with JIA have impaired physical fitness (approximately 20%
Journal of Paediatrics and Child Health 51 (2015) 425–432 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
425
Movement skills in juvenile arthritis
G. Hulsegge et al.
decrease in aerobic and anaerobic capacity) and are less physically active than their healthy peers.5–7 This is of concern because regular physical activity through childhood and adolescence results in numerous short- and long-term health benefits.8 Together with the physical and psychosocial issues associated with JIA, reduced fitness can lead to considerable problems in performing activities of daily living9 and to reduced engagement in sports and games with other children. Importantly, low levels of physical activity in childhood and adolescence often track into adulthood, which can increase the risk of cardiovascular and other diseases.8,10 To become physically active and enable participation in sports and games, it is essential that children master fundamental motor skills (FMS), such as sprinting, jumping, kicking, catching and throwing.11 Children with poor FMS are often less motivated to engage in physical activities with their peers and as a result have decreased physical fitness.11–13 Currently, there is little data available to suggest whether children with JIA have poorer FMS than their healthy peers or whether their mastery of FMS is related to physical fitness. As children with JIA often have physical impairments such as limited joint motion that can limit their ability to master FMS, specific interventions targeting poor FMS may become an important component of their management. Evidence suggests that specific interventions to improve FMS in children, such as physical education and behavioural self-management, can both improve FMS and increase cardiorespiratory endurance.14,15 The objective of the current study is to describe FMS, physical fitness and physical activity among children with JIA to improve the understanding of the physical limitations of JIA and their consequences. More specifically, this study will be the first to compare these parameters in Australian children with JIA and their healthy peers. The secondary aim is to describe differences in physical and psychosocial well-being between these groups.
Materials and Methods
girls (Years 6–10) from schoolchildren involved in the 2004 NSW Schools Physical Activity and Nutrition Survey (SPANS) were used for comparison with the JIA group.16 Data from 5414 parents of 5–18-year-old Australian boys and girls from the Health of Young Victorians Study (HOYVS) were used to compare physical and psychosocial well-being with the JIA group.17
Testing procedure Eligible children with JIA were each tested on one occasion at the Children’s Hospital at Westmead. Clinical assessments were conducted by a paediatric rheumatologist with all other measurements conducted by a senior paediatric physiotherapist.
Clinical assessment The clinical assessment consisted of recording JIA subtype as diagnosed by the child’s rheumatologist, noting age of disease onset and current treatment, and conducting a clinical examination to determine active joint count. A joint was considered active if it was effused or displayed two of the following features: heat, limited range of movement, tenderness or stress pain. Average and worst pain in the last week were measured using a 100-mm visual analogue scale (VAS). Using the same protocol as described in the SPANS, FMS, physical fitness and level of physical activity were evaluated:
Fundamental motor skills Four locomotor skills (sprint run, vertical jump, side gallop and leap) and three object-control skills (catch, overhand throw and kick) were videotaped and assessed by a senior paediatric physiotherapist using a process-oriented checklist comprising five or six components for each skill (Appendix I).18 A skill was considered to be advanced if all or all but one of the skill components were performed correctly over at least four out of five trials. The reliability and validity of the instrument and its components have been established previously.19,20
Physical fitness
Participants Two consecutive series of children with JIA presenting to the rheumatology clinic at a large children’s hospital and private rheumatology rooms in Sydney, Australia, between January and March 2009 (first series) and between January and June 2011 (second series) were invited to participate in this study. Children were considered eligible for the study if they were aged between 6 and 16 years and were diagnosed with JIA by a paediatric rheumatologist. Exclusion criteria included the inability to follow instructions or the inability to perform exercise independently. Children were enrolled only after full and informed consent. This study was approved by the Children’s Hospital at Westmead’s Human Ethics Committee.
Control data Anthropometric and FMS data from 4638 boys and girls (Years 2–10), aerobic fitness data from 3720 boys and girls (Years 4–10), and self-reported physical activity from 2750 boys and 426
Aerobic capacity was measured using the multistage 20-metre shuttle run test, a valid and reliable test for the prediction of VO2max.21 Children completed a 20-metre shuttle run, the rate of which was determined by an accompanying recording, identical to that used in the SPANS study. The stage reached by the participants was determined by the last stage they successfully completed within the time frame. This was determined by voluntary stopping due to fatigue or failure to reach the 20-metre mark in the allocated time on two consecutive occasions. The stage reached was then converted into laps completed for analysis.
Level of physical activity The modified version of the Adolescent Physical Activity Recall Questionnaire (APARQ) was used to assess physical activity. The APARQ is validated in Australian adolescents and measures participation in organised and non-organised sports, games and other activities.22 According to the Physical Activity Recommendations for Children and Young People, children need at
Journal of Paediatrics and Child Health 51 (2015) 425–432 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
G. Hulsegge et al.
Movement skills in juvenile arthritis
Total children presenting (n = 179) - Rheumatology clinics (n = 119) - Private rheumatology rooms (n = 60)
Excluded - Not diagnosed with JIA (n = 85)
Total children with JIA (n = 94)
Fig. 1 Flowchart of children presenting to the rheumatology clinic and private rheumatology rooms during the study period. JIA, juvenile idiopathic arthritis.
Not eligible (n = 66) - Not aged 6–16 years (n = 29) - Not able to exercise (n = 6) - Unable to attend testing (n = 15) - Not contactable (n = 6) - Refused or not interested (n = 10)
Enrolled and tested (n = 28)
least 60 min of moderate-intensity to vigorous activities every day.23 After assigning rate of energy expenditure in metabolic equivalents (METS) to physical activities using the Compendium of Physical Activities, the children were labelled as active (≥3.0 METS for at least 60 min every day) or inactive (
