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

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.