Participation in leisure and physical activity among children and adolescents with juvenile idiopathic arthritis

Background: Juvenile idiopathic arthritis (JIA), one of the most common chronic childhood autoimmune diseases, is a heterogeneous inflammatory condition characterised by joint inflammation (i.e. active disease), chronic pain, fatigue and morning stiffness, which may interfere with age-appropriate daily activities (i.e. leisure and physical activity, mobility and self-care), both at home and at school.  Involvement in leisure and physical activity is beneficial to the health and development of all children and adolescents, and has also shown to help mitigate the effects of disease among those with chronic conditions such as JIA.  Despite the benefits of leisure participation this subject remains vastly understudied in JIA.   Objective: The aim of this thesis was to assess participation in leisure and physical activity among children and adolescents with JIA, as well as identify associated disease-related, personal and environmental factors.   Methods: The assessment of patterns and exploration of potential predictors of participation in leisure and physical activity in children and adolescents with JIA was completed through a systematic review of the literature, analysis of survey data from a nationally representative sample of Canadian children with arthritis (age range = 5 to 14 years, nweighted = 4350), as well as the standardized assessment of leisure with the Children’s Assessment of Participation and Enjoyment (n=107) and the objective measurement of physical activity with accelerometer (n=76) among a clinical sample of children (age range = 8 to 11 years) and adolescents (age range = 12 to 17 years) with JIA followed at the Rheumatology clinic at the Montreal Children’s Hospital, McGill University Health Center.  Clinical data were also compared to normative data and children and adolescents without JIA.  We explored factors associated with participation in leisure and physical activity using multiple linear regression models and hierarchical analysis. Results: Children and adolescents with JIA participated in an array of leisure activities; however involvement was least frequent in active physical and skill-based leisure activities compared to other types of activity.  Those with JIA were generally less physically active than healthy peers without JIA, and most with JIA did not meet national recommendations for physical activity.  Boys with JIA were more likely to engage in physical activities, and less likely to take part in social, skill-based and self-improvement activities than girls with JIA.  In general, being a boy, older age, greater mastery motivation for gross motor skills, higher socio-economic status and being of Canadian cultural background were associated with increased participation in more physical activities.  Preference for skill-based activities, higher maternal education and being a girl were associated with increased participation in skill-based activities.     Conclusion: Participation in leisure and physical activity in JIA is a complex concept and is mostly explained by personal and environmental factors.  The identification of factors associated with leisure participation and physical activity is of utmost importance in JIA as it may aid health care professionals to tailor meaningful intervention plans based on preferred activities, improve adherence to treatment and help promote healthier lifestyles.

Keyphrases: Participation, Juvenile Idiopathic Arthritis, Leisure, Physical Activity, Accelerometer, Intrinsic and Extrinsic Determinants, International Classification of Functioning Disability and Health, Cross-Sectional Study, Hierarchical Regression Analysis