Intervenção Fisioterapêutica Baseada em Exercícios na Artrite Idiopática Juvenil: Uma Revisão Sistemática

Abstract

Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disease characterized by persistent joint inflammation, with a significant impact on function and quality of life. Non-pharmacological treatment is primarily based on physical exercise. However, the heterogeneity of interventions and the lack of specifications regarding exercise types, target muscles, and modes of application, as well as the scarcity of high-quality studies, hinder the development of standardized protocols to guide clinical practice. Therefore, the objective of this review was to evaluate the effects of exercise-based physiotherapeutic interventions in children and adolescents with JIA, compared to other therapeutic approaches, in order to provide an updated, evidence-based synthesis that may contribute to clinical decision-making and future research in the field. Studies were retrieved from MEDLINE, PubMed, CINAHL, Scielo, and Embase, with the last search conducted in April 2025. The included studies comprised clinical trials, randomized controlled trials, and pilot studies comparing various exercise-based physiotherapeutic interventions in children/adolescents with JIA. Standard methodological procedures recommended by the PEDro scale were adopted. A total of 8 studies were included, involving 386 participants, of whom 156 were allocated to the experimental groups. The interventions described included hydrotherapy, core stabilization exercises, aerobic training, Pilates, and exergames. It was concluded that low-impact exercises focusing on strength, mobility, stabilization, and aerobic activity are effective in the treatment of JIA. However, differences in methodological rigor and the absence of standardized protocols still limit more precise recommendations. The main limitations identified were the small number of studies that included psychological evaluation as an outcome measure and the heterogeneity of participants regarding disease activity phase, medication use, and whether intra-articular injections were administered before or during treatment.