Physiotherapy Strength-Training Interventions In Juvenile Idiopathic Arthritis : A Narrative Review

Abstract

Background: Juvenile idiopathic arthritis (JIA) frequently leads to muscle weakness, decreased bone density, fatigue, and diminished physical function in affected children [1]. Strength training guided by physiotherapy—including activities such as active virtual reality (AcVR), weight-bearing exercises, resistance training, and core stability work—may help address these challenges Objective: To review and synthesize evidence from 2017–2025 on physiotherapy-guided strength training interventions in children with JIA, focusing on safety, feasibility, musculoskeletal outcomes, functional benefits, and adherence challenges. Methods: A narrative review was conducted with systematic search principles across PubMed, PEDro, Web of Science, and Scopus (2017–June 2025). Randomized controlled trials (RCTs), feasibility studies, and pilot studies were included if they involved physiotherapist-supervised strength or resistance training interventions in JIA populations. Methodological quality was assessed using the Josephkin Kennedy KNN tool. A total of seven studies (n=143 participants) were included. Results: Strength training was consistently safe, with no serious adverse events reported. Improvements were observed in muscle structure (fascicle length, thickness, pennation angle), torque, bone mineral density, and functional performance (6MWT, stair climb, fatigue reduction). Adherence rates varied widely (47–95%), influencing outcomes. Digital interventions, internet-based platforms, and serious gaming showed promise in enhancing motivation and adherence. Physiotherapy-led strength training is safe and effective for improving musculoskeletal and functional outcomes in children with JIA. Adherence remains the primary barrier, underscoring the need for innovative, engaging, and scalable intervention strategies. Future research should focus on standardized protocols, longterm outcomes, and integration of digital tools to optimize rehabilitation.