Personalized, physiotherapist-guided exercise programs in juvenile ıdiopathic arthritis: Home-based vs. ımmersive virtual reality (JiaFitXR)

Abstract

Objective: To compare the effects of two physiotherapist-guided, personalized, stepwise-adapted exercise interventions—a home-based program (HomeEX) and an immersive virtual reality (IVR) exergaming program (JiaFitXR)—on physical fitness, functional capacity, and physical activity in adolescents with juvenile idiopathic arthritis (JIA). Methods: This randomized controlled trial included 50 adolescents aged 13–18 years with JIA, randomly assigned (1:1) to HomeEX or JiaFitXR. Both programs targeted balance, strength, endurance, and agility, delivered twice weekly for eight weeks under physiotherapist supervision. Functional capacity (6-Minute Walk Test, Sit-to-Stand, Step-Up/Step-Down tests) and physical fitness (FitnessGram components, muscle strength, EMG activation, grip force) were assessed pre- and post-intervention by blinded physiotherapists. Analyses were performed using paired and independent t-tests and repeated-measures ANOVA, following the intention-to-treat principle. Results: Both physiotherapist-guided interventions significantly improved physical fitness, functional capacity, and daily activity (p<0.05). Greater gains in 1-Minute Sit-to-Stand, Step-Up, and Step-Down tests, as well as in lower extremity endurance and neuromuscular activation, were observed in the JiaFitXR group (p<0.05). The HomeEX group showed superior improvements in flexibility and upper extremity strength (p<0.05). Step counts increased similarly in both groups, while perceived exertion remained stable throughout the program. Conclusion: Both physiotherapist-guided exercise approaches effectively enhanced physical and functional outcomes in adolescents with JIA. The IVR-based intervention provided additional benefits in lower extremity endurance and engagement, supporting its potential as an innovative and motivating adjunct to pediatric rheumatology rehabilitation.