When pain gets in the way: Overcoming barriers to physical ... · When pain gets in the way: Overcoming barriers to physical activity When pain gets in the way: ... adults without

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APTA CSM 2015

Julie Keysor, PT, PhD

Lori Schrodt, PT, PhD

International Council on Active Aging Meeting November 20th, 2015

When pain gets in the way: Overcoming barriers to physical activity

When pain gets in the way:

Overcoming barriers to

physical activity

APTA CSM 2015

Disclosures

• Julie Keysor—None

• Lori Schrodt--None

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APTA CSM 2015

Objectives

• Identify key evidence-based principles of physical

activity among people with arthritis and complex

comorbidity conditions

• Apply evidence-based principles of physical activity

behavior change to begin and sustain the “let’s move”

conversation.

• Develop strategies that could be used within

individual areas of practice that apply the evidence-

based motivational strategies.

APTA CSM 2015

Presentations

1) Pain: conditions, types, considerations

2) Exercise barriers and tools for behavior

Change

3) Pain and comorbidities: Considerations

and evidence-based and evidence-

informed approaches

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APTA CSM 2015

Julie Keysor, PT, PhD

Pain: conditions,

types, considerations

APTA CSM 2015

All ages; both genders; all ethnicities

Boston University

XXX,000,000 million older adults reporting

chronic (persistent) pain

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APTA CSM 2015

Prevalent pain conditions in aging

APTA CSM 2015

Pain symptoms and meaning

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APTA CSM 2015

Pain and exercise

APTA CSM 2015

What is Arthritis?

The term arthritis is used to describe more than 100

rheumatic diseases and conditions that affect joints, the tissues which surround

the joint and other connective tissue

Pain, activity limitation, and participation restriction are

common

Boston University

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APTA CSM 2015

Types of Arthritis or Rheumatic Conditions

Most Common Conditions

• Osteoarthritis

• Rheumatoid Arthritis

• Fibromyalgia

• Lupus

• Gout

Others…

• Psoriatic arthritis

• Ankylosing spondylitis

• Juvenile arthritis

• Myositis

APTA CSM 2015

44% older adults with arthritis are inactive vs. 36% older

adults without arthritis (consider focusing on pain stats

13% of older adults with

arthritis do resistive

exercise

Shih et al., Am J Prev Med 2006;30(5):385-93

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APTA CSM 2015

Got Pain? Goal: Get Moving

• Start low impact activity (5-15 minutes)

• Progress activity: duration and intensity

• Posture and alignment are important!

• Monitor pain with activity

• Pain during or after activity MAY require

modification of activity (May be okay if

pain is not long lasting)

APTA CSM 2015

Aerobic Conditioning

• American College of Sports

Medicine Guidelines for

Older Adults

• 30 to 60 minutes per session

• 50-70% of heart rate reserve (HRR)

Low impact activity

• Short bouts of 10 minutes okay, particularly initially

• MOVE!

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APTA CSM 2015

Treatment—Strength Training

• Progressive resistance training

• American College of Sports Medicine Recommendations for

Older Adults

• –60-80% 1 RM, 8-12 reps, 1-3 sets, with 1-3 min rest

between sets.

• – For endurance training, use lighter loads (50-60%) with

higher reps (10-15 or more)

• Need to achieve enough resistance to improve strength and

need to progress to optimal strength

APTA CSM 2015

Overall Treatment

Considerations

• Posture and positioning

• Strengthen tissues without

overloading joint

• Pace activities (24-7 approach)

• Respect joint pain

• Teach people how to modify activity if pain is

present

Boston University

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APTA CSM 2015

Goals for People with Arthritis?

•Engage in gentle range of motion exercise,

gentle pool activity; no strengthening

•Most people with arthritis (that is

medically controlled) can engage in some

sort of strengthening and aerobic exercise

(may need to accommodate)

APTA CSM 2015

What are these treatment approaches

based on?

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Systematic Reviews

Osteoarthritis and Rheumatoid Arthritis

Outcomes Effect Level of Evidence

Aerobic

training

Pain

Function

Small-Moderate

Small-Moderate

Good

Good

Strength

training

Strength

Pain

Function

Moderate

Moderate

Small

Good

Good

Good

Ottowa Panel. Physical Therapy, 84: 2004 & 85: 2005; MOVE Consensus 2005;

Jamtvedt et al. Physical Therapy 88:2008; Fransen M., McConnell S. The

Cochrane Collaboration, 2009; Wang et al., Ann Inter Med 157: 2012

APTA CSM 2015

• Strongly recommended: (ACR 2012 Practice

Guidelines; EULAR 2013 Practice Guidelines;

OARSI 2014 Practice Guidelines)

• Aerobic and/or aquatic exercise

• Resistance exercises

Knee Osteoarthritis

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APTA CSM 2015

Other approaches—limited evidence of

benefit

• Knee bracing

• Orthotics

• Shoes

• Manual therapy

APTA CSM 2015

Caution: Red Flags

Uncontrolled disease activity

Current Severe Pain

Pain non-arthritis joints and tissues

Balance/ functional impairments

Patient not responding to exercise

Boston University

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APTA CSM 2015

RED FLAGS…who could help?

• Primary care

• Rheumatologist

• Physical therapist

• Gerontologist

• Occupational therapist

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But what I hear is “I’m in too much pain,” “it’s too hard to exercise.” “It doesn’t help.” “I don’t know how to get started?”

How do I start the conversation to Get Moving!

Boston University

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APTA CSM 2015

Tools other than hiding the remote!

Boston University

APTA CSM 2015

Exercise barriers and tools for behavior

Change

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Acknowledgements:

The National NIDRR Arthritis Rehabilitation Research and

Training Center

NIDRR PR/Award #H133B100003

Saralynn Allaire

Molly Vaughan

Mary Slavin

ENACT

Health and Disability Research Institute

Clinical Epidemiology Research and

Training Unit

APTA CSM 2015

12 miles north of

Boston…44 inches

of snow so far…12

more inches on the

way