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. Clinical Trial registration ClinicalTrials.gov; NCT06176846