Exercise Prescription for Arthritis and Rheumatological Problems
Dec 23, 2015
Exercise Prescription for Arthritis and Rheumatological Problems
You & Your patient are supported
Common Conditions
Degenerative Knees Degenerative Hips Shoulder Stiffness Painful back conditions Painful neck conditions Polyarthritis- seropositive / seronegative
Associate Problems
Lower limb Wasting of the thigh and leg Stiffness Obesity Home bound and dependent
Upper limb Stiffness Impaired self care and dependent
Spine Stiffness Impaired sitting and standing tolerance
Disease related Neuropathy medications
Worry of exercise in Osteoarthritis
Increased physical activity exaggerate joint symptoms ?
Rejected by studies
Benefit of exercise in osteoathritic conditions
Alleviate pain, improve physical fitness, improves quality of life
Better ambulatory status
Less dependent
Self confidence
Social integration
Avoid unnecessary medications
Defer surgical need
Classic teaching - recommended activities
Swimming, cycling
Mild calisthenics exercise which promote joint movements, limited pressure and impact in joints
Other low impact weight-bearing exercise such as walking and hydro-exercise would help to improve bone density and structure
Older adults- Combination of aerobic exercise, strength-training
exercise, balance and flexibility exercise
Start low and progress according to tolerance and preference
Am Geriatric Society Panel on Exercise & OA
Am Geriatric Society Panel on Exercise & OA
2001 June Consensus practice recommendations Initial Evaluation & Assess
Pain severity Physical impairments Physical disabilities
Check Medically stable Without joint laxity Willing to exercise
Exercise prescription Re-evaluate at 4 wks Monitor at 4-6 months, Encourage increasing physical
activities
Exercise dose - Start
Golden rules Effectiveness Accessibility Safety Individualised Enjoyment Regular evaluation
Assess
motivation
Family & Community
PAR-Q/med-X
Problem orientated
Enjoyment
Achievements & reinforcement
Components
Warm-up Gentle flexibility
Conditioning Aerobic activity Strength-training Static muscle stretching
Cool-down Progression
Initial, improvement, maintenance
Exercise prescription plan
Flexibility Initial hold 5-15 seconds Ultimate 3-5 stretches, hold 20-30 sec
Aerobic exercise 20-30 minutes/day, 3-4 /wk
Strength-training exercise Isometric
hold <6 sec, 20sec rest period, daily Useful in acute phase
Isotonic 6-15 repetitions, 2-3 / wk
Programme For Osteoarthritis
Programme For Osteoarthritis
Safe Play
Low back conditions Avoid or minimise exercise that precipitates or
exasperates forced extreme flexion, extension, and violent
twisting, correct posture, proper back exercise
Osteoporosis Avoid exercise with high risks for fracture
Push-ups, curls-ups, vertical jump and trunk forward flexion,
Engage in low-impact weight-bearing activities and resistance training
Safe Play
Arthritis – acute ( infective, rheumatoid, gout) Treatment, plus judicious blend of rest, splinting and
gentle movement
Arthritis – subacute Progressive increase of active exercise therapy
Arthritis – chronic ( osteoarthritis ) Maintenance of mobility and strength, non-weight
bearing exercises to minimise joint trauma ( e.g. cycling, aquatic activity etc.)
My practice
Find out the obstacles Support
Companion Family Skills
Set the goal (phase approach) Enjoyment Achievable The rose garden
Caution about the fluctuations Occasional attack of inflammations Ways to deal with it
Upper limbs
Stress Shoulder Range of Motion
Active Active assisted passive
Balance muscle training Multiple directions Static dynamic
Knees
Stress
Full Range of motion, especially full extension
Mild pain
Active ROM, 10 rep
Flexibility and static exercise, 10 rep x 6 sec
Dynamic exercise, Quads & Hamstring 10 rep
Low-impact activities 20 min, 3x/wk
Backs
Stretching Pectorals, back extensors, hamstrings, psoas
Active ROM ex 10 x /day Dynamic ex
Trunk & hip muscle 5-8 rep
Aerobic ex 20 min 3 x /wk
Issues of different exercise
Brisk walk, Jogging Swimming Aerobic dance TaiChi
Brisk walk, jogging, hiking
Preparation Park, podium, gym
Surface, terrain Shoe wear, clothing
Warm up Pacing Warm-down Issues of knee brace Advise on control of flare up Caution about the yellow flag
Increase swelling, morning stiffness
Swimming
Swimmer vs. Non-swimmer
Community resources
Hydro exercise vs. lap-swimming
Style
Breast stroke – Knee ROM required
Free style – Shoulder Rom required
Taichi
Proved to be good in aerobic ability, muscle strength & Balance
Community resource Demanding on
Knees Co-ordination
Stress on the need of warm up Stress enjoyment
Osteoarthritis
Individualized treatment Comorbid conditions Patient's needs and expe
ctations
Types of treatment Non-pharmacological
Patient education Exercise Therapy Assistive devices PT & OT Weight management Supplements
Pharmacological Simple analgesics NSAID COX-2 inhibitor Local analgesics Intra-articular corticosteroid Intra-articular hyaluronic acid like p
roduct Surgery
Arthroscopic debridement or joint lavage
Osteotomy for mal-alignment of the knee or hip
Arthroplasty
Important charts
“Supplementary Information on Writing an Exercise Prescription
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