Körperliche Aktivität und juvenile Arthritis

Zusammenfassung

Kinder und Jugendliche mit juveniler idiopathischer Arthritis (JIA) zeigen ein vermin-dertes Maß an körperlicher Aktivität. Die Fol-gen sind eine Verminderung der aeroben und anaeroben Leistungsfähigkeit mit deutlichen Defiziten der Muskelfunktion. Diese Defizite korrelieren eng mit den funktionellen Einschränkungen der Betroffenen und damit den Möglichkeiten zur Partizipation an Alltagstätigkeiten. Außerdem können sie zu langfristigen Schäden an den Gelenken beitragen, die Entwicklung einer adäquaten Knochenmasse verhindern und in Bezug auf die aerobe Leis-tungsfähigkeit das Risiko für kardiovaskuläre Schäden erhöhen. Neben der grundsätzlichen Ermunterung zu körperlicher Aktivität sollte deshalb ein gezieltes Training der Muskulatur Teil der Therapie sein. Voraussetzung hierfür ist eine optimale Kontrolle der Erkrankung. Grundsätzlich sollte ein Trainingsprogramm sowohl Elemente zur Steigerung der aeroben als auch anaeroben Leistungsfähigkeit enthalten. Studien haben gezeigt, dass Interventionen zur gezielten Steigerung von Muskel-kraft und -leistung bei Patienten mit JIA möglich sind und teilweise sogar mit einem besseren Krankheitsverlauf assoziiert sind.

Summary

Children and adolescents with juvenile idiopatic arthritis (JIA) show decreased levels of physical activity with a subsequent reduction in aerobic and anaerobic capacities and significant deficits of muscle function. These deficits are closely correlated with functional impairments and the ability to participate in daily activities. In addition they may contribute to long term joint damage, interfere with the accrual and maintenance of bone mass and with respect to aerobic capacities increase the risk for adverse cardiovascular outcomes. Specific interventions to improve muscle function are therefore an important aspect of therapy. The optimal control of the underlying disease is a prerequisite. Ideally, any intervention should combine elements to improve both anaerobic as well as aerobic capacities. Recent studies have shown that training modalities to specifically improve muscle force and power are well tolerated and may actually be associated with a favorable disease course.

Schlüsselwörter

JIA - Muskelfunktion - aerobe Leistung - anaerobe Leistung

Keywords

JIA - muscle function - aerobic power - anaerobic power

• Literatur

• 1 Klepper SE. Exercise and fitness in children with arthritis: evidence of benefits for exercise and physical activity. Arthritis Rheum 2003; 49: 435-443.
• 2 Takken T, Van Brussel M, Engelbert RH. et al. Exercise Therapy in juvenile idiopathic arthritis: a Cochrane Review. Eur J Phys Rehabil Med 2008; 44: 287-297.
• 3 Henderson CJ, Lovell DJ, Specker BL. Physical activity in children with juvenile rheumatoid arthritis: quantification and evaluation. Arthritis Care Res 1995; 8: 114-119.
• 4 Lelieveld OT, Armbrust W, van Leeuwen MA. et al. Physical activity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2008; 59 (10) 1379-1384.
• 5 van Brussel M, Lelieveld OT, van der Net J. et al. Aerobic and anaerobic exercise capacity in children with juvenile idiopathic arthritis. Arthritis Rheum 2007; 57 (06) 891-897.
• 6 Lelieveld OT, van Brussel M, Takken T. et al. Aerobic and anaerobic exercise capacity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2007; 57 (06) 898-904.
• 7 Roth J, Zajac A, Kallinich T. et al Functional assessment of the musculoskeletal system in JIA. Abstract American College of Rheumatology, Pediatric Rheumatology Conference. 2008. Keystone: Colora-do;
• 8 Bailey RC, Olson J, Pepper SL. et al. The level and tempo of children’s physical activities: an observational study. Med Sci Sports Exerc 1995; 27: 1033-1041.
• 9 Takken T, van der Net J, Helders PJ. Relationship between functional ability and physical fitness in juvenile idiopathic arthritis patients. Scand J Rheumatol 2003; 32 (03) 174-178.
• 10 Van der Net J, van der Torre P, Engelbert RH. Motor performance and functional ability in preschool – and early school-aged children with juvenile idiopathic arthritis: a cross sectional study. Pediatric Rheumatol Online J 2008; 6: 2
• 11 Oen K, Reed M, Malleson PN. et al. Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis. J Rheumatol 2003; 30 (04) 832-840.
• 12 Bowyer SL, Roettcher PA, Higgins GC. et al. Health status of patients with juvenile rheumatoid arthritis at 1 and 5 years after diagnosis. J Rheumatol 2003; 30 (02) 394-400.
• 13 Oen K, Malleson PN, Cabral DA. et al Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort J Rheumatol. 2002; 29 (09) 1989-1999.
• 14 Roth J, Tzaribachev N, Linge M, Kuemmerle-Deschner J. The Muskuloskeletal System in Juvenile Arthritis, a 4-year follow up. Rheumatology 2007; 46: 1180-1184.
• 15 Broström E, Nordlund MM, Cresswell AG. Plantar-and dorsiflexor strength in prepubertal girls with juvenile idiopathic arthritis. Arch Phys Med Rehabil 2004; 85 (08) 1224-1230.
• 16 Lechner DE, McCarthy CF, Holden MK. Gait deviations in patients with juvenile rheumatoid arthritis. Phys Ther 1987; 67 (09) 1335-1341.
• 17 Broström E, Haglund-Akerlind Y, Hagelberg S, Cresswell AG. Gait in children with juvenile chronic arthritis. Timing and force parameters. Scand J Rheumatol 2002; 31 (06) 317-323.
• 18 Nilsson J, Thorstensson A. Ground reaction forces at different speeds of human walking and running. Acta Physiol Scand 1989; 136 (02) 217-227.
• 19 van der Linden ML, Kerr AM, Hazlewood ME. et al. Kinematic and kinetic gait characteristics of normal children walking at a range of clinically relevant speeds. J Pediatr Orthop 2002; 22 (06) 800-806.
• 20 Fairburn PS, Panagamuwa B, Falkonakis A. et al. The use of multidisciplinary assessment and scientific measurement in advanced juvenile idiopathic arthritis can categorise gait deviations to guide treatment. Arch Dis Child 2002; 87 (02) 160-165.
• 21 Myer GD, Brunner HI, Melson PG. et al. Specialized neuromuscular training to improve neuromuscular function and biomechanics in a patient with quiescent juvenile rheumatoid arthritis. Phys Ther 2005; 85 (08) 791-802.
• 22 Herzog W, Longino D, Clark A. The role of muscles in joint adaptation and degeneration. Langenbecks Arch Surg 2003; 388 (05) 305-315.
• 23 Suter E, Herzog W, Leonard TR, Nguyen H. One-year changes in hindlimb kinematics, ground reaction forces and knee stability in an experimental model of osteoarthritis. J Biomech 1998; 31: 511-517.
• 24 Slemenda C, Brandt KD, Heilman DK. et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997; 127: 97-110.
• 25 Wu JZ. Herzog W Analysis of the mechanical behavior of chondrocytes in unconfined compression tests for cyclic loading. J Biomech 2006; 39 (04) 603-616.
• 26 Pepmueller PH, Cassidy JT, Allen SH, Hillman LS. Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum 1996; 39: 746-757.
• 27 Rauch F, Schoenau E. Changes in bone density during childhood and adolescence: an approach based on bone’s biological organisation. J Bone Miner Res 2001; 16: 1-8.
• 28 Frost HM, Schoenau E. The “Muscle Bone Unit” in children and adolescents: a 2000 overview. J Ped En-docr Metab 2000; 13: 571-590.
• 29 Schoenau E. Problems of bone analysis in childhood. Pediatr Nephrol 1998; 12: 420-429.
• 30 Schoenau E, Neu CM, Beck B. et al. Bone mineral content per muscle cross-sectional area as an index of the functional muscle-bone unit. J Bone Min Res 2002; 17 (06) 1095-1101.
• 31 Kotaniemi A, Savolainen A, Kautiainen H, Kroeger H. Estimation of central osteopenia in children with chronic polyarthritis treated with glucocorticoids. Pediatrics 1993; 91: 1127-1130.
• 32 Henderson CJ, Cawkwell GD, Specker BL. et al. Predictors of total body bone mineral density in non-corticosteroid treated prepubertal children with juvenile rheumatoid arthritis. Arthritis Rheum 1997; 40: 1967-1975.
• 33 Henderson CJ, Specker BL, Sierra RI. et al. Total body bone mineral content in non-corticosteroid treated postpubertal females with juvenile rheumatoid arthritis. Arthritis Rheum 2000; 43: 531-540.
• 34 Kotaniemi A, Savolainen A, Kroger H. et al. Weight-bearing physical activity, calcium intake, systemic glucocorticoids, chronic inflammation ad body constitution as determinants of lumbar and femoral bone mineral in juvenile chronic arthritis. Scand J Rheumatol 1999; 28: 19-26.
• 35 Bechtold S, Ripperger P, Dalla Pozza R. et al. Musculoskeletal and functional muscle-bone analysis in children with rheumatic disease using peripheral quantitative computed tomography. Osteoporos Int 2005; 16: 757-763.
• 36 Roth J, Palm C, Scheunemann I, Ranke MB. et al. Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry. Arthritis Rheum 2004; 50: 1277-1285.
• 37 de Jong Z, Munneke M, Lems WF. et al. Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a ran-domized, controlled trial. Arthritis Rheum 2004; 50 (04) 1066-1076.
• 38 Häkkinen A, Sokka T, Kautiainen H. et al. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann Rheum Dis 2004; 63: 910-916.
• 39 Maillard SM, Jones R, Owens CM. et al. Quantitative assessments of the effects of a single exercise session on muscles in juvenile dermatomyositis. Arthritis Rheum 2005; 53 (04) 558-564.
• 40 Singh-Grewal D, Schneiderman-Walker J, Wright V. et al. The effects of vigorous exercise training on physical function in children with arthritis: a ran-domized, controlled, single-blinded trial. Arthritis Rheum 2007; 57 (07) 1202-1210.
• 41 Oberg T, Karsznia A, Gäre BA, Lagerstrand A. Physical training of children with juvenile chronic arthritis. Effects on force, endurance and EMG response to localized muscle fatigue. Scand J Rheumatol 1994; 23 (02) 92-95.