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      Slow speed resistance exercise training in children with polyarticular juvenile idiopathic arthritis

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          Abstract

          Background: Juvenile idiopathic arthritis (JIA) is an inflammatory autoimmune disease that can cause severe impairment and disability. Exercise is recommended to preserve joint mobility and function. Our objectives were to assess the safety, feasibility, and effects of slow speed resistance exercise in children with polyarticular JIA.

          Methods: Patients were recruited from a pediatric rheumatology clinic at an urban hospital and randomized to exercise or control groups. In the intervention group, slow speed resistance exercise with individualized instruction by a certified trainer was performed 1–2 times per week for 12 weeks. The control group performed home-based aerobic exercise 3 days per week for 12 weeks. Pre and post-body composition measurements by dual-energy X-ray absorptiometry; aerobic fitness by peak oxygen uptake during cycle ergometry; isometric muscle strength; and quality of life measures were obtained.

          Results: In the exercise group, 9/17 (53%) completed any exercise training. Of these nine subjects, five (55%) completed all 12 weeks of the protocol. In the control group, 8/16 (50%) reported compliance with the recommended aerobic exercise training at least one time per week. Only 2 subjects (12%) reported exercising more than once per week. There was no significant difference between pre- and post-measurements in any category in the exercise group. There was also significantly elevated body fat in both groups with only 17% in the control group and 23% in the exercise group meeting recommended <30% total body fat levels.

          Conclusions: Children with JIA participated safely in this resistance exercise protocol. The exercise was well-tolerated with no serious adverse events noted. While individual subjects reported improvement in fatigue and improved energy, there was no statistical difference in pre- and post-exercise measures of body composition or quality of life. Identifying ways to improve adherence and encourage exercise in children with JIA is important.

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          Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis.

          The aim of this study was to compare aerobic and resistance training in children with cystic fibrosis (CF) admitted to hospital with an intercurrent pulmonary infection with a control group. The subjects were randomized into three groups on the first day of admission. The fat-free mass (FFM) was calculated, using the skin fold thickness from four sites (biceps, triceps, subscapular, and iliac crest). Pulmonary function tests were performed within 36 hr of admission and repeated on discharge from the hospital, and again at 1 month after discharge. All subjects performed an incremental treadmill exercise test, using a modified Bruce protocol. Lower limb strength was measured using a Cybex dynamometer. An assessment of quality of life was made using the Quality of Well Being Scale, as previously reported. Activity levels were measured using a 7-day activity diary, and subjects also wore an accelerometer on their hips. There were no significant differences between the three groups in terms of disease severity, and length of stay in hospital. Subjects in all three groups received intravenous antibiotics and nutritional supplementation as determined by the physician. Children randomized to the aerobic training group participated in aerobic activities for five sessions, each of 30-min duration, a week. The children randomized to the resistance training group exercised both upper and lower limbs against a graded resistance machine. Subjects in the control group received standard chest physiotherapy. Our study demonstrated that children who received aerobic training had significantly better peak aerobic capacity, activity levels, and quality of life than children who received the resistance training program. Children who received resistance training had better weight gain (total mass, as well as fat-free mass), lung function, and leg strength than children who received aerobic training. A combination of aerobic and resistance training may be the best training program, and future studies to assess optimal training programs for CF patients are indicated. Copyright 2002 Wiley-Liss, Inc.
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            Body fat percentile curves for U.S. children and adolescents.

            To date, several studies have been published outlining reference percentiles for BMI in children and adolescents. In contrast, there are limited reference data on percent body fat (%BF) in U.S. youth. The purpose of this study was to derive smoothed percentile curves for %BF in a nationally representative sample of U.S. children and adolescents. Percent fat was derived from the skinfold thicknesses of those aged 5-18 years from three cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES) IV (1999-2000, 2001-2002, and 2003-2004; N=8269). The LMS (L=skewness, M=median, and S=coefficient of variation) regression method was used to create age- and gender-specific smoothed percentile curves of %BF. Growth curves are similar between boys and girls until age 9 years. However, whereas %BF peaks for boys at about age 11 years, it continues to increase for girls throughout adolescence. Median %BF at age 18 years is 17.0% and 27.8% for boys and girls, respectively. Growth charts and LMS values based on a nationally representative sample of U.S. children and adolescents are provided so that future research can identify appropriate cut-off values based on health-related outcomes. These percentiles are based on skinfolds, which are widely available and commonly used. Using %BF instead of BMI may offer additional information in epidemiologic research, fitness assessment, and clinical settings. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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              Strength training by children and adolescents.

              Pediatricians are often asked to give advice on the safety and efficacy of strength-training programs for children and adolescents. This statement, which is a revision of a previous American Academy of Pediatrics policy statement, defines relevant terminology and provides current information on risks and benefits of strength training for children and adolescents.
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                Author and article information

                Journal
                Open Access Rheumatol
                Open Access Rheumatol
                OARRR
                rheu
                Open Access Rheumatology : Research and Reviews
                Dove
                1179-156X
                21 May 2019
                2019
                : 11
                : 121-126
                Affiliations
                [1 ]Division of Rheumatology, Children’s National Health System , Washington, DC 20010, USA
                [2 ]Department of Public Health, School of Public Health, University of Alabama at Birmingham , Birmingham, AB, USA
                Author notes
                Correspondence: Sangeeta D SuleChildren’s National Health System , 111 Michigan Avenue NW, Room W1-314, Washington, DC20010, USATel +1 202 476 6689Email ssule@ 123456childrensnational.org
                Article
                199855
                10.2147/OARRR.S199855
                6535082
                31191051
                9711da09-40a7-4e27-a602-aeac5f406197
                © 2019 Sule and Fontaine.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 29 December 2018
                : 16 April 2019
                Page count
                Figures: 1, Tables: 1, References: 27, Pages: 6
                Categories
                Original Research

                exercise,juvenile arthritis,body composition
                exercise, juvenile arthritis, body composition

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