Personalized, Physiotherapist-Guided Exercise Programs in JIA: Home-Based vs. Immersive 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 8 weeks under physiotherapist supervision. Functional capacity (6-Min 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-Min 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 the 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 paediatric rheumatology rehabilitation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; NCT06176846.