Structured vs. Exergaming-Based Core Stabilization in Children With Juvenile Idiopathic Arthritis

Official title

Comparison of the Effects of Structured Core Stabilization Exercise Training and Exergaming-Based Core Stabilization Training in Children With Juvenile Idiopathic Arthritis

Overview

Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory, autoimmune, and chronic rheumatic disease of childhood (1). In individuals diagnosed with JIA, increased inflammation leads to joint swelling, tenderness, restricted range of motion, and pain (2,3). Over time, these symptoms may result in impaired movement and proprioception, reduced muscle strength, and gait abnormalities (2,3). Although ongoing medical treatment has been demonstrated to be highly effective in suppressing inflammation in children with rheumatic diseases, persistent pain despite treatment may limit mobility and contribute to the development of kinesiophobia. This condition may lead to the adoption of a sedentary lifestyle (4). A sedentary lifestyle may subsequently result in reduced functional capacity and physical fitness, increased risk of social isolation, and a decline in overall quality of life (5). According to the literature, physical activity in children with rheumatologic diseases has been shown to reduce inflammation, increase muscle strength, improve functional capacity and mental health, reduce fatigue, and enhance quality of life (6,7). Non-pharmacological therapeutic exercise interventions have been found effective in alleviating chronic disease-related symptoms in children and in preventing secondary complications (8). The effectiveness of exercise therapy in children with JIA has been demonstrated in several studies, with commonly used programs including balance, proprioception, resistance, and range of motion exercises (9). However, only a limited number of studies have incorporated core-focused stabilization exercises into treatment protocols for children with JIA. Although Core Stabilization Training (CST) initially gained popularity among athletes, it has since been integrated into rehabilitation programs and applied across various patient populations (10,11). CST is defined as the ability to control muscle activation in the lumbo-pelvic region, which is necessary for spinal stabilization and for transferring core strength from the trunk to the extremities. CST has been shown to positively affect standing, sitting, balance, postural stability, and gait (12). A review of the literature confirms that Core Stabilization Training (CST) has beneficial effects on quality of life, pain, cardiorespiratory fitness, and functional ability (13). In studies involving children with Juvenile Idiopathic Arthritis (JIA), CST interventions were typically applied over a period of 12 weeks, with 2-3 sessions per week. The outcomes observed in this population were consistent with findings in the broader literature, supporting the effectiveness of CST in children with JIA (14). Exergaming has emerged as an innovative approach to integrating physical activity into daily life (15). In the literature, exercise programs utilizing exergaming across various populations are frequently encountered. These studies have demonstrated multiple benefits of exergaming, including promoting physical activity, reducing perceived exertion, adapting physical activity to individual needs, and improving physical fitness (16). In children diagnosed with JIA, exergaming programs have shown improvements in physical performance and exercise skills, as well as significantly enhanced patient satisfaction (17). However, to date, no study has been identified in the literature that investigates the use of exergaming-based core stabilization training specifically in children with JIA. The aim of the study is to compare the effects of an exergaming-based core stabilization training program and a structured core stabilization training program on physical fitness and functional capacity in children with Juvenile Idiopathic Arthritis (JIA). The study is designed as a randomized controlled trial. Children diagnosed with JIA will be included and randomly assigned to one of two groups. One group will receive structured core stabilization training, while the other will receive core stabilization training through exergaming. Both interventions will be administered over a 12-week period, with sessions held twice per week, each lasting 45 minutes. To the best of available knowledge, this will be the first study to investigate the effectiveness of a core stabilization exercise program using exergaming in this population. This study is expected to contribute valuable insights to the literature on improving physical fitness and functional capacity in children with Juvenile Idiopathic Arthritis (JIA). Furthermore, it will provide the first clinical and scientific evidence regarding the innovative use of exergaming as a method for delivering core stabilization exercises.

Interventions

• Other Structured Core Stabilization Exercise Training
  This group is currently undergoing a structured core stabilization training program, consisting of supervised exercises conducted twice a week for 45 minutes per session over a 12-week period. The training is performed on a balance board to enhance postural control and trunk stability. The core-focused exercises include quadruped stabilization, extremity lifts in crawling position, planks, push-ups, mountain climbers, squats, single-leg squats, and lunges. These exercises are designed to streng
• Other Exergaming-Based Core Stabilization Training
  This group is currently participating in an exergaming-based core stabilization training program using the SEG-BOARD device, developed under the TÜSEB B Project. The program is conducted twice a week for 45 minutes per session over a 12-week period. Although the SEG-BOARD is not specifically designed for core stabilization, it is a general-purpose exergaming exercise platform. In this study, it is utilized to support core-focused training through interactive visual and auditory feedback that pro

Primary outcome measures

• 30-Second Sit-to-Stand Test (30STST) [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• 6-Minute Walk Test (6MWT) [Time frame: Change from Baseline and after the exercise program (12 weeks later).]
• 10-Step Stair Climb Test [Time frame: Change from Baseline and after the exercise program (12 weeks later).]

Secondary outcome measures (12)

• FitnessGram Physical Activity Test Battery-Curl-up Test [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• FitnessGram Physical Activity Test Battery-Push-up Test [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• FitnessGram Physical Activity Test Battery-Back Saver Sit and Reach Test [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• FitnessGram Physical Activity Test Battery-Trunk Lift Test [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• FitnessGram Physical Activity Test Battery-Progressive Aerobic Cardiovascular Endurance Running (PACER) [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• KFORCE Plates [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• KFORCE Muscle Controller [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• KBubble [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• Digitsole Pro® system [Time frame: Change from baseline and after the exercise program (12 weeks later).]
• Pain Assessment [Time frame: Assessed at the end of each of the 24 exercise sessions]
• Fatigue Assessment [Time frame: Assessed at the end of each of the 24 exercise sessions]
• Exercise Satisfaction Rating [Time frame: Evaluated at the end of the 12-week exercise program.]

Eligibility criteria

Inclusion criteria

• Being between the ages of 8 and 13
• Having been diagnosed with JIA at least 6 months prior
• Willingness to participate in the study

Exclusion criteria

• Having a balance problem due to vestibular or neurological conditions
• Having undergone surgery in the last 6 months that may interfere with exercise participation
• Inability to comply with the exercise program

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Istanbul University - Cerrahpasa — Istanbul

Identifiers

NCT: NCT07234747 · IremDIUC

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗