Exercise Prescription for Arthritis and Rheumatological Problems

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Exercise Prescription for Arthritis and
Rheumatological Problems
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You Your patient are supported
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Common Conditions

• Degenerative Knees
• Degenerative Hips
• Shoulder Stiffness
• Painful back conditions
• Painful neck conditions
• Polyarthritis- seropositive / seronegative

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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

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Worry of exercise in Osteoarthritis

• Increased physical activity exaggerate joint
  symptoms ?
• Rejected by studies

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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

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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

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Am Geriatric Society Panel on Exercise OA
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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

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Exercise dose - Start

• Assess
• motivation
• Family Community
• PAR-Q/med-X
• Problem orientated
• Enjoyment
• Achievements reinforcement

• Golden rules
• Effectiveness
• Accessibility
• Safety
• Individualised
• Enjoyment
• Regular evaluation

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Components

• Warm-up
• Gentle flexibility
• Conditioning
• Aerobic activity
• Strength-training
• Static muscle stretching
• Cool-down
• Progression
• Initial, improvement, maintenance

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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
• Useful in acute phase
• Isotonic
• 6-15 repetitions, 2-3 / wk

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Programme For Osteoarthritis
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Programme For Osteoarthritis
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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

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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.)

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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

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Upper limbs

• Stress
• Shoulder Range of Motion
• Active
• Active assisted
• passive
• Balance muscle training
• Multiple directions
• Static
• dynamic

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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

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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

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Issues of different exercise

• Brisk walk, Jogging
• Swimming
• Aerobic dance
• TaiChi

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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

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Swimming

• Swimmer vs. Non-swimmer
• Community resources
• Hydro exercise vs. lap-swimming
• Style
• Breast stroke Knee ROM required
• Free style Shoulder Rom required

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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

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Osteoarthritis

• Individualized treatment
• Comorbid conditions
• Patient's needs and expectations
• 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 acidlike product
• Surgery
• Arthroscopic debridement or joint lavage
• Osteotomy for mal-alignment of the knee or hip
• Arthroplasty

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Important charts

• Supplementary Information on Writing an
  Exercise Prescription

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