Assessment of Aerobic Capacity and Other Cardiopulmonary Parameters in Children with Juvenile Idiopathic Arthritis

TL;DR

Children with juvenile idiopathic arthritis have reduced aerobic capacity and cardiopulmonary function compared to healthy children, which may increase their risk of cardiovascular disease.

Contribution

This study provides empirical evidence of reduced aerobic fitness and cardiopulmonary parameters in children with JIA, emphasizing the need for individualized exercise programs.

Findings

Children with JIA had significantly lower peakVO2 and other cardiopulmonary parameters compared to healthy controls.

Physically active JIA patients showed better aerobic fitness and VO2/WR relationship than inactive patients.

JIA patients reached ventilatory anaerobic threshold earlier and at lower VO2 values than healthy children.

Abstract

Introduction: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. It is believed that children with JIA have lower cardiopulmonary capacity and worse exercise tolerance. The gold standard for assessing physical fitness is aerobic fitness, commonly referred to as the maximum or peak oxygen uptake volume (peakVO2) measured during a maximum load exercise test. Reduced aerobic fitness may play a key role in predicting the health of JIA patients as it has been associated with cardiovascular diseases and increased adult mortality. Methods: The aim of this study was to assess the oxygen capacity of adolescents with JIA along with other cardiopulmonary parameters in order to determine a group of patients with increased risk of developing cardiovascular diseases in comparison with healthy individuals. Patients were assessed based on parameters such as age, sex, type of JIA, laboratory parameters, physical activity, and treatment. Results: Patients with JIA had lower median values of peakVO2 (29.05 vs. 38.02 mL/min/kg, p < 0.001), as well as other crucial cardiopulmonary parameters, such as O2 pulse, minute ventilation, oxygen uptake efficiency slope, and cardiac output than in the healthy control group. The ventilatory anaerobic threshold was achieved earlier and at lower VO2 values in children with JIA (p = 0.0001). Children with JIA also had lowered respiratory parameters such as maximal voluntary ventilation (p = 0.0031) and tidal volume (p = 0.0002). Patients who were physically active (moderate-intensity physical activity lasting at least 60 min per day) had significantly higher peakVO2 (p = 0.0099) and ΔVO2/ΔWR relationship (p = 0.0041) values than JIA patients who were not physically active. Conclusions: Children with JIA show moderate to severe physical impairment. Reduced physical fitness and a low level of activity might be associated with further deterioration of patient’s condition, which might contribute to increased risk of cardiovascular disease, social exclusion and deterioration of quality of life in this group of patients. Exercise programs that improve aerobic fitness and increase muscle strength should be individualized and modified based on the individual needs and capabilities of the patient.

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