Flashcards in Physical activity recommendations for children with specific chronic health conditions: Juvenile idiopathic arthritis, hemophilia, asthma and cystic fibrosis Deck (28):
What is the prevalence of JIA?
1 in 1000 children
How many subtypes of JIA are there?
What is the definition of chronic arthritis?
Presence of joint swelling or by two or more of the following:
1. Joint pain
3. Limited ROM
For at least 6wks
What constitutional signs or symptoms are associated with JIA?
2. Weight Loss
3. Growth failure
What extra-articular manifestations are associated with JIA?
4. Hematopoietic involvement
What percentage of JIA persists to adulthood?
What are the potential benefits of exercise in JIA?
1. Improves aerobic fitness
2. Better muscle strength and function
3. Decreases disease activity
4. Improves self-efficacy
5. Improves energy level
6. Improves quality of life
7. Reduces pain and medication use
8. Optimize bone mineral density
9. Reduced obesity
What are the potential risks of exercise in JIA?
1. If cervical spine arthritis increased risk of spinal cord injury
2. If TMJ disease increased risk of dental injury
3. Possible risk of cardiovascular complications with exercise
4. If uveitis at increased risk of eye injury
What are the recommendations for exercise in JIA?
1. Can safely participate in sports without disease exacerbation.
2. Should participate in moderate fitness, flexibility and strengthening exercises.
3. Can participate in impact activities and competitive contact sports if their disease is well controlled and they have adequate physical capacity.
4. Should be encouraged to be physically active as tolerated. Those with moderate to severe impairment or actively inflamed joints should limit activities within pain limits.
5. Should gradually return to full activity following a disease flare.
6. Should take individualized training [especially for children with severe joint disease) within a group exercise format for physical/social benefit.
7. Physiotherapists on paediatric rheumatology health care teams should coordinate individual exercise programs.
8. Should have radiographic screening for C1-C2 instability before participation in collision/contact sports if they have neck arthritis. If present, further evaluation is required.
9. Should wear appropriately fitted mouth guards during activities with jaw and dental injury risk (per general population), especially if they have jaw involvement.
10. Should wear appropriate eye protection (per general population) during activities with ocular injury risk
What is the inheritance of hemophilia?
X linked recessive
What is the incidence of hemophilia?
1 in 5000
What are some clinical features of hemophilia?
1. Joint or muscle hemorrhage
2. Easy bruising
3. Synovitis and joint degeneration and arthritis
What are potential benefits of exercise in hemophilia?
1. Fewer bleeding episodes
2. Increased joint stability
3. Increased periarticular muscle strength
4. Improve bone mineral density
5. Aerobic exercise may have beneficial effect on coagulation
What are potential risks of exercise?
1. Risk of life threatening bleeding episode
2. Hemophilic arthropathy
What are the recommendations regarding exercise in children with hemophilia?
1. Should receive appropriate factor prophylaxis to reduce the risk of bleeding in sport.
2. Should undergo vigilant assessment of joint and muscle function before sport selection. If restrictions are required, physicians should counsel children and their families about safe alternatives.
3. Should be carefully assessed before allowing participation in contact or collision sports such as martial arts, hockey or football. Consultation with a sport medicine physician and/or paediatric hematologist may help.
4. Require written strategies (coach, parent or school) before sport participation to prevent or treat bleeds.
5. Should wear protective equipment, undergo physical therapy or take prophylactic factor replacement therapy.
6. Require factor replacement, ice, splinting and rest to manage acute bleeds. Physical activity should be avoided until joint pain or swelling has resolved. Return to sport requires individualized assessment and appropriate rehabilitation.
How many Canadian children have asthma?
What percentage of asthmatic patients experience exercise induced bronchospasm?
When does bronchoconstriction typically occur in patients with exercise induced bronchospasm?
8-15min after initiation of physical activity
Resolves within 60min
What are the potential benefits of exercise in asthma?
1. Decreased bronchial hyper-responsiveness
2. Decrease exercise induced bronchospasm severity
What are the potential risks of exercise?
1. May have increased flare triggers
What are the recommendations regarding asthma and exercise?
1. Are able to participate in any physical activity if symptoms are well controlled. Swimming is less likely to trigger EIB than running.
2. Should keep an accurate history of symptoms, trigger exposures, treatments and course of recovery from episodes of bronchospasm.
3. Should be diagnosed with EIB by a drop in FEV1 (10% to 15%) after a 6 min to 8 min exercise challenge and a positive response to beta-2 agonist medication. Eucapnic voluntary hyperventilation testing is recommended in athletes.
4. Should use leukotriene inhibitors, inhaled corticosteroids and/or long-acting beta-2 agonists for optimal long-term disease control, and avoid overuse of short-acting beta-2 agonists.
5. Should take inhaled beta-2 agonists 15 min to 30 min before exercise.
6. Should not scuba dive if they have asthma symptoms or abnormal PFTs.
7. Who compete nationally or internationally require a therapeutic use exemption with confirmation of asthma and/or EIB to use certain medications. Consultation with a sport medicine physician is suggested.
What is the inheritance of CF?
What is the incidence of CF?
1 in 3600 Caucasian live births
Where is the mutation in CF?
CF transmembrane conductance regulator complex, a complex chloride channel located in all exocrine tissues
What is the gold standard for diagnosis in CF?
Sweat chloride testing
What are the potential benefits of exercise in CF?
1. Slower deterioration in lung function
2. Greater survival rates
3. Improved exercise tolerance
4. Enhanced lung mucus clearance
5. Improved strength and endurance of respiratory muscle
6. Improved fat-free mass, weight gain, muscle strength, FEV1
What are potential risks of exercise in CF?
2. Cardiac dysfunction
3. Hyponatremic dehydration
4. CF-related diabetes may get hypoglycemia
5. Splenic rupture (if splenomegaly)