Comparison Of The Effects Of Two Different Exercise Training Based On Internal And External Focus In Children and Adolescents With Rheumatic Diseases

NCT ID: NCT07138157

Last Updated: 2025-08-22

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-05-01
• Study Completion Date: 2025-12-30

Brief Summary

The study aims to compare the effects of two different exercise programs, based on distinct focus strategies, on physical fitness and fatigue in children and adolescents with rheumatic diseases. Participants will include individuals diagnosed with Juvenile Idiopathic Arthritis (JIA), Juvenile Dermatomyositis (JDM), and Familial Mediterranean Fever (FMF), monitored at Istanbul University, Istanbul Faculty of Medicine, in collaboration with Istanbul University-Cerrahpaşa, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation. After baseline assessments, participants will be randomly allocated into two groups. One group will receive an exercise program with commands and instructions emphasizing external focus, while the other group will follow a program emphasizing internal focus. Both exercise interventions will last for 8 weeks, consisting of two online supervised sessions and one home-based session per week under family supervision. Final evaluations will be conducted at the clinic after completion of the intervention period.

Detailed Description

Juvenile Idiopathic Arthritis (JIA), Juvenile Dermatomyositis (JDM) and Familial Mediterranean Fever (FMF) patients who were monitored at Istanbul University Istanbul Faculty of Medicine under the supervision of Istanbul University-Cerrahpaşa, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation will be included in this study. Demographic data of the participants, including age, weight, height, body mass index, age of onset of the disease, time elapsed before diagnosis, duration of symptoms, family history, will be recorded. Participants' physical fitness, muscle strength and functions, physical activity levels, fatigue and pain levels will be evaluated face-to-face at the beginning and at the end of the 8-week exercise program. The FitnessGram test battery will be used for the physical fitness assessment. The 'Fatigue Severity Scale' will be used to assess the fatigue levels of the participants. Physical activity levels will be evaluated separately in children and adolescents using the 'Physical Activity in Adolescents Questionnaire' and the 'Physical Activity in Children Questionnaire'. In all cases, pain severity will be questioned using the 'Visual Analog Scale'. All participants will be given a 6 Minute Walk Test to measure their functional capacity, 30 Seconds Sit to Stand Test to measure their lower extremity strength.

Following to first evaluation, the patients will be randomly assigned to two groups. In the first group, the exercise program will be applied as the basis of external focus in the commands and exercise instructions directed to the patient, while in the second group, the exercise program will be applied as the basis of internal focus. Exercise training in both groups lasted 8 weeks; It will be applied 3 days a week, two sessions each week under the supervision of an online physiotherapist and one session with online family supervision. Online training sessions will be conducted via Google Meets. In the first group, the exercise program will be applied based on the external focus, while in the second group, the exercise program will be applied on the basis of the internal focus. The same exercise program will be applied in both groups, but in the first group, the commands given during the exercises will encourage the participants to focus their attention on the effect of the movement, while the commands given in the second group will encourage the participants to focus their attention on the body part performing the movement. In the squat exercise, for instance, the first group is instructed to "Bend over as if sitting on a chair until the sign in front is no longer visible" represents an external focus command, whereas the command "Bend over by bending the knees without disturbing the straightness of the back" represents an internal focus command.

Exercise training in both groups last 8 weeks; two sessions each week online via Google Meets and third session will be held under family supervision. At the end of 8 weeks, participants will be called back to the clinic for a final evaluation.

Conditions

Juvenile Dermatomyositis; Rheumatic Diseases; Juvenile Idiopathic Arthritis (JIA); Familial Mediterranean Fever (FMF)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

External Focus of Attention Group

In this group, the exercise program will be implemented using external focus in the commands and exercise instructions. During exercise, external focus commands are designed to direct attention toward the impact of the movement or an external stimulus. For example, during the squat exercise, the command "Bend over as if sitting on a chair until the sign in front is no longer visible" represents an external focus command, whereas the command "Bend over by bending the knees without disturbing the straightness of the back" represents an internal focus command.

Group Type: ACTIVE_COMPARATOR

External Focus Exercises

Intervention Type: OTHER

The commands given during the exercises will encourage the participants to focus their attention on the effect of the movement/ external focus of attention

Internal Focus of Attention Group

In this group, the exercise program will be implemented using internal focus in the commands and exercise instructions. During exercise, internal focus commands are designed to direct attention toward the body part performing the movement or the movement itself. For example, during the squat exercise, the command "Bend over by bending the knees without disturbing the straightness of the back" represents an internal focus command, whereas the command "Bend over as if sitting on a chair until the sign in front is no longer visible" represents an external focus command.

Group Type: ACTIVE_COMPARATOR

Internal Focus Exercises

Intervention Type: OTHER

The commands given in the second group will encourage the participants to focus their attention on the body part performing the movement/ Internal focus of attention

Interventions

External Focus Exercises

The commands given during the exercises will encourage the participants to focus their attention on the effect of the movement/ external focus of attention

Intervention Type: OTHER

Internal Focus Exercises

The commands given in the second group will encourage the participants to focus their attention on the body part performing the movement/ Internal focus of attention

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Juvenile Dermatomyositis: Being diagnosed with JDM according to the Bohan and Peter Criteria by a pediatric rheumatologist
• Familial Mediterranean Fever: Having been diagnosed with FMF at least 6 months ago
• JIA: Having been diagnosed with JIA according to the ILAR classification
• Not having visual impairment or hearing impairment
• Being at a mental level that can adapt to the exercise program
• Having internet connection

Exclusion Criteria

• Having any systemic chronic disease other than JIA, FMF, or JDM
• Having any musculoskeletal disease or an orthopedic, neurological, psychological disease that may interfere with participation in exercise
• Having developed amyloidosis
• Having undergone surgery affecting the musculoskeletal system in the last 6 months
• Having visual impairment or hearing impairment
• Not having internet connection

• Minimum Eligible Age: 6 Years
• Maximum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Istanbul University

OTHER

Sponsor Role: collaborator

Istanbul University - Cerrahpasa

OTHER

Sponsor Role: lead

Responsible Party

Aleyna Yilmaz

Physiotherapist

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Istanbul University Cerrahpasa

Istanbul, Türkiye, Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

IstanbuIUC

Identifier Type: -

Identifier Source: org_study_id