Disclosures. Background. Objectives. Study Design 11/11/2012

Transcription

1 A Family Based Pedometer Walking Program in an Adolescent Population with Juvenile Idiopathic Arthritis Jill Blitz, DPT* 1, Sara Stern, MD* 2, Amber Richards MPT, PCS 1, Katherine Marzan, MD 1 *coauthors 1 Children s Hospital, Los Angeles 2 University of Utah Disclosures Background Quality of Life Grant- Arthritis Foundation Adolescents with JIA have a decreased activity level compared to their peers Exercise is important for ROM, strength, bone density and endurance Walking programs are effective in adults with arthritis Pedometers are accurate measures of activity in adults and adolescents Pedometer-based walking programs in adolescents with JIA have not been studied Objectives 1. Determine whether a family based pedometer walking program improves exercise tolerance in adolescents with JIA and lower extremity involvement. 2. Assess whether the addition of an educational program further increases exercise tolerance in adolescents with JIA and lower extremity involvement. Study Design Study Location: Children s Hospital Los Angeles Rheumatology Clinic Inclusion Criteria: JIA patients lower extremity involvement ages years 1

2 Study Design Outcome measures included: 6 min walk test (6MWT) Pre and post HR Borg rate of perceived exertion BMI Joint disease activity VAS- Pain CHAQ Satisfaction survey The participants were evaluated at 4 time points 1st visit: Baseline measurements Begin Phase 1 Patients encouraged to incorporate walking into their daily routine (6 weeks) 2 nd Visit: 6 week time point Measurements prior to start of second phase Second Phase: Randomized into 2 groups Group 1: Pedometer: Wear daily & record Exercise: Encouraged to walk daily with families 6 weeks Group 2: Pedometer: Wear daily & record Exercise: Encouraged to walk daily with families 3 minute educational seminar 6 weeks 3rd visit: 12 week time point Measurements prior to third phase Third Phase: Follow Through - Patients encouraged to continue to wear their pedometer and walk with their family - 8 weeks Study Design 4 th visit: 2 week time point Final measurements Satisfaction Survey First phase (6 weeks) Second phase Patients randomized into 2 groups (6 weeks) Recruitment and initial visit (n=27) Encouraged to walk +pedometer (n=9) Pedometer Third phase Follow-through (8 weeks) Pedometer (n=8) Pedometer 2

3 Meters 11/11/ patients participated 23 Female/4 Male 19 Latino 13 patients completed the study Mean Age: 16 ± 2 years 12 Female/1 Male 7 Latino JIA Diagnoses +Pedometer Polyarthritis 3 6 Oligoarthrits 1 Enthesitis-related 1 Arthritis Psoriatic Arthritis 1 1 Baseline measurements +Pedometer 6MWT m HR CHAQ.56 Borg RPE minute walk test + pedometer (n= 9) VAS-pain BMI Visit 1 Visit 2 Visit 3 Visit CHAQ Visit 1 Visit 2 Visit 4 Visit 3 + pedometer (n= 9) VAS- Pain Visit 1 Visit 2 Visit 3 Visit 4 +pedometer (n=9) 3

4 Steps walked with pedometer per day max average min +pedometer Patient Satisfaction Overall average Felt better about self Felt in better shape Will continue walking Increased walking Easy Fun At 6 weeks: Statistically significant increase in 6MWT Modest increase in exercise tolerance with each phase for both groups There were no differences in any outcome measures between groups At baseline the population that discontinued: Higher BMI Shorter 6MWT Smaller HR change Higher VAS scores Important Points Conclusion Factors in improving exercise tolerance An exercise program Accountability from the rheumatology team Program Feedback Fun Motivated them to walk more Easily implemented in clinic setting and is inexpensive In motivated adolescents, consistent support for a walking program by a Rheumatologist and Physical Therapist significantly increased exercise tolerance. Addition of a pedometer and education program maintained or increased exercise tolerance. 4

5 Future Directions Wellness Program Educational modules Pedometers Squeeze balls Continue with research References 1. American Thoracic Society. ATS Statement: Guidelines for the Six-Minute Walk Test. March Arthritis Foundation. : Your Guide to Walking for Better Health, Improved Fitness and Less Pain. Arthritis Foundation. 2 nd Edition. (22). 3. Baker G, Gray S, Wright, A, Fitzimons C, Nimmo M, Lowry R, Mutrie N. The effect of a pedometer-based community walking intervention Walking for Wellbeing in the West on physical activity levels and health outcomes: a 12-week randomized controlled trial. Int. J of Behavioral Nutrition and Physical Activity. 28 Sept 5. 5: Bravata D, Smith-Spangler C, Sundaram V. Using Pedometers to Increase Physical Activity and Improve Health: A Systematic Review. JAMA. 27;298(19): Bruno M, Cummins S, Gaudiano L, Stoos J, Blanpied. Effectiveness of Two Arhtritis Foundation programs: Walking with Ease and YOU can break the Pain Cycle. Clinical Interventions in Aging. 26; (3) Craig CL, Tudor-Locke C, Cragg S, Cameron C. Process and Treatment of Pedometer Data Collection for Youth: The CANPLAY Study. Med Sci Sports Exerc. 29 Nov 23[ Epub ahead of print]. 7. Fantini F, Corvaglia G, Bergomi P, Gattinara M, Gerloni V, Lomater C, Mazzotti J, Calori G, Galli L. Validation of the Italian version of the Stanford childhood Assessment Questionanaire for measuring functional status in children with chronic arthritis. Clin. Exp Rheumatol. 1995/ Nove-Dec; 13(6): Gordan-Larsen P, McMurray R, Popkin B. Determinates of Adolescent Physical Activity and Inactivity Patterns. Pediatrics 2; 15;e Hassan J, van der Net J, Helders P, et al. Six-Minute Walk Test in Children with Chronic Conditions. Br J Sports Med. 28 May 16. doi:1.1136/bjsm Hohepa M, Schofield G, Kolt GS, Scragg R, Garrett N. Pedometer-determined physical activity level of adolescents: differences by age, sex, time of week, and transportation mode to school. J Phys Act health. 28;5 Suppl 1:S , Jargo R, Watsom K, Baranowski T, Zakeri I, Yoo S, Baranowski J, Conry K. Pedometer reliability, validity and daily activity targets among 1 to 15 year-old boys. J Sports Scu. 26 Mar;24(3): Klepper SE. Exercise in pediatric rheumatic diseases. Curr Opin Rheumatol. 28 Sep;2(5): Klepper SE. Measures of Pediatric Function. Arthritis & Rheumatism. Vol 49. No. 5S, October 15, 23, pp S5-S Lelieveld OT, Armbrust W, van Leeuwen MA, Duppen N, Geertzen JH, Sauer PJ, van Weert E. Physical activity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum. 28 Oct 15;59(1): Li A, Yin J, Au J, So, H, Tsasng T, Wong E, Fok T, Ng P. Standard Reference for The Six-Minute -Walk Test in Healthy Children Aged 7-16 years. Am J Respir Crit Care Med. 27 Jul15;176(2): Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of Juvenile idiopathic arthritis. Cyrr. Opin Rheumotol. 21 Mar;22(2): Martin SN, Crownover BK, Kovach FE. What s the best way to motivate patients to exercise? J Fam Pract. 21 Jan(1) Morris PJ. Physical activity recommendations for children and adolescents with chronic disease. Curr Sports Med Rep. 28 Nov- Dec;7(6): Neuberger G, Aaronson L, Gayewski B, Embretson S, Cagle P, Loudon J, Miller P. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Arthritis Rheum. 27 Aug57(6): References Jill Blitz, PT, DPT jblitz@chla.usc.edu Sara Stern, MD Sara.Stern@hsc.utah.edu Questions? RESULTS Borg scale + pedometer baseline 3 rd visit difference baseline 3 rd visit difference 6MWT HR CHAQ Borg/R PE 2. Neuberger G, Press A, Lindsley H, Hinton R. Cagle P, Carlson K, Scott S, Dahl J, Jramer B. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Research in Nursing & Health, : Olvera N, Bush J, Sharma S, Knox B, Butte N. BOUNCE: A community-based mother daughter healthy lifestyle intervention for low income latino families Obesity. 21 Feb; 18:S Rhodes R, Nayor P, McKay H. Pilot study of a family physical activity planning among parents and their children. J Behav Med. 29. Nov. Epub. 23. Rooney BL, Gritt LR, Havens SJ, Mathiason MA,Clough EA. Growing healthy families: family use of pedometers to increase physical activity and slow the rate of obesity. WMJ. 25 Jul;14(5): Ruperto N, Ravelli A, Pistorio, Malattia C, Cavuto S, Gado-West L, Toetorrelli A, Landgraf JM, Singh G, Martini A. Paediatric Rheumatology International Trials Organization Cross-cultural adaptation and psychometric evaluation of the Childhood health Assessment Questionaire (CHAQ) and the Child Health Questionnaire(CHQ) in 32 countries. Review of the general methodology. Clin Exp Rheumatol. Jul-Aug; (19)4: S Scherr J, Wolfarth B, Christke JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg s rating of perceived exerction and physiological measures of exercise intensity. Eur J Appl Physiol. 212 May Singh-Grewal D, Wright V, Bar-Or O, Feldman BM. Pilot Study of Fitness Training and Exercise Testing in Polyarticular Childhood Arthritis. Arthritis and Rheumatism. Vol 55, No 3, June 15 26, pp Taken T, Van Brussle M, Engelbert RH, van der Net J, Kuis W, Helders PJ. Exercise therapy in juvenile idiopathic arthritis; a Cochrane review. Eur J Phys Rehabil Med. 28 Sep;44(3): Takken T, van der Net J, Helders PJ. Do juvenile idiopathic arthritis patients benefit from an exercise program? A pilot study. Arthritis Care and Research : Takken T, van der Net J, Helders PJ. Relationship between functional ability and physical fitness in juvenile idiopathic arthritis patients. Scand J Rheumatology. 23;32(3): Tekken T, Hemel A, van der Net J, Helders. Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. J Rheumatology. 22 Dec;29(12): Talbot L, Gaines J, Huynh T, A Home-Based Pedometer Driven Walking Program to Increase Physical Activity in Older Adults with Osteoarthritis: A Preliminary Study. JAGS. 23;51: Tudor-Locke C, Bassett DR Jr. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 24;34(1) Tudor-Locke C, Lutes L. Why do pedometers work?: A reflection upon the factors related to successfully increasing physical activity. Sports Med. 29;39(12): Tudor-Locke C, Lee SM, Morgan CF, Beighle A, Pangrazi RP. Children s pedometer-determined physical activity during the segmented school day. Med Sci Sports Exerc. 26 Oct;38(1): Tudor-Locke C, McClain JJ, Hart TL, Sisson SB, Washington TL. Expected values for pedometer-determined physical activity in youth. Res Q Exerc Sport. 29 jun;8(2): Tudor-Locke C, Williams JE, Reis JP, Pluto D. Utility of pedometers for assessing physical activity: construct validity. Sports Med. 24;34(5): U.S. Department of Health and Human Services. Physical activity and Health A report of the Surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. Br j Sports Med. 28 Aug;(8): VASpain BMI

6 JIA Diagnoses Continued with study Discontinued study Polyarthritis 9 8 Oligoarthrits 1 Enthesitis-related Arthritis 1 3 Psoriatic Arthritis 2 2 Systemic Arthrtis 1 6