Arthritis Flashcards
What characterises arthritis?
Pain, Impaired physical function, fatigue, adverse change in body compositions (66% of individuals with OA overweight or obese at time of disease onset)
Define the two types of arthritis and their pathophysiology.
1) Osteoarthritis: Progressive local degenerative disc disease affecting one or more synovial joints (most commonly hands, hips, spine and knees). Progression from being overweight/obese, hsitory of joint injury or surgery, genetic predisposition, aging, female sex, and certain occupations.
2) Rheumatoid arthritis: Chronic, systemic, inflammatory autoimmune disease of unknown etiology causing swelling, of the joint lining (synovitis), damage to articular cartilage and support ligaments, and may lead to bony erosions; and, systemically, results in significant fatigue, muscle loss, fatigue, increased risk of osteoporosis with increased CVD risk due to atherosclerotic progression.
How treatment options are there for arthritis and what is the optimal approach?
1) Analgesics
2) NSAIDs (Oral or topical)
3) Disease modifying anti-rheumatic drugs (DMARDS) (RA)
4) Biologic therapies (block the activity of proteins involved in inflammation)
5) Glucorticosteroids
6) Physical therapy
7) Exercise
8) Joint replacement
Multi-disciplinary approach
What are the benefits of exercise in arthritis?
1) Body composition (inflammation and reduced PA increase sarcopenia)
2) Minimising functional decline or improving functional capacity
3) Reduce falls risk
4) Attenuate pain and joint stiffness
5) Reduce comorbidities (CVD, T2DM, Metabolic syndrome, and Osteoporosis)
6) Improve quality of life
7) Improving mental health
What are the 5 exercise testing considerations for patients with arthritis?
1) Acute inflammation is a contraindication to maximal stress testing
2) Cycle/Arm ergometry better - least painful modality should be chose
3) Allow time for a warm-up at each individual’s functional status (very light/light)
4) Monitor pain levels using a validated intensity scale such as Borg CR10
5) Muscle strength and endurance can be measured using standard protocols but need to be aware pain may inhibit maximum voluntary muscle contraction via neural inhibition of muscle fiber recruitment
What is the most common barrier to exercise in arthritis patients and how is this overcome?
Pain and further joint damage - individuals with arthritis need to be reassured that exercise is not only safe but also widely consistently reported to reduce pain, fatigue, inflammation, and disease activity.
What considerations need to be made when designing a exercise prescription for a patient with arthritis?
1) Gradually progress to exercise intensities and volumes that provide clinically significant benefits
2) Pain and joint integrity
3) Personal preference (mode and intensity)
4) Functional limitation
What are the FIIT recommendations for aerobic exercise in individuals with arthritis?
F: 3-5 day/week
I: Moderate to vigorous as tolerate (405+ HRR)
T: 150 minutes moderate or 75 minutes vigorous or equivalent combination in bouts of 10 minutes or more
T: Low joint stress such as walking, cycling, swimming or aquatic exercise
What are the FIIT recommendations for resistance exercise in individual’s with arthritis
F: 2-3 non consecutive days
I: 60-80% 1RM or 50-60% 1RM in those unaccustomed
T: Healthy adults values: 8-12 repetitions, 1-3 sets for all major muscle groups
T: Machine, free weight, resistance bands, tubing, body weight
What are the FIIT recommendations for flexibility training in individuals with arthritis?
F: Daily
I: Tightness/Stretch without pain - progress ROM only with little or no joint pain
T: 10 repetitions for dynamic movements, static stretch for 10-30 seconds and repeat two to four times
T: Active, static, PNF of all major muscles with a focus on musculature crossing the effected joint`
What are the 8 exercise training considerations in individual’s with arthritis?
1) Improve CRF without joint pain
2) High impact activities need to be approach cautiously
3) Deconditioned and individual’s with a lot of pain can break up sedentary behaviour and start with movement of 5 minutes or less
4) Flexibility training enhances ROM and counteracts negative effects of arthritis
5) Balance training (pain, coordination, protective reflex, proprioception) as individuals at increased falls risk including static (standing on one foot) and dynamic (walking, changing direction, stepping over obstacles)
6) 5-10 min warm-up and cooldown critical for reducing pain (light aerobic work and movement through full ROM.
7) Increase prescription with gen pop guidelines (5-10 minutes, every 1-2 weeks, over first 4-6 weeks)
8) Regular progression of resistance training is critical for improving muscle strength and endurance gain but joint pain needs considering.
Why is resistance training important for individuals with arthritis?
Improves physical function and reduces chronic pain through local (enhanced dynamic stability, attenuated joint forces) and systemic changes (decreased inflammation, elevated endogenous opioids)
What are the 7 special exercise training considerations for individual’s with arthritis?
1) Avoid strenuous activity with acute flare ups but can still undertake full ROM exercises and break up sedentary behaviour
2) Make them aware that DOMs and joint pain are different and that this pain is gradually reduced with exercise
3) Specific exercises should be replaced with similar exercise if they exacerbate joint pain
4) Encourage exercise during peak activity of pain medication or when pain is least severe
5) Appropriate shoes with good shock absorption - shoe specialists best
6) Incorporate functional exercises such as sit-to-stand, step-ups, stair-climbing, and carrying to improve neuromuscular control, balance, and enhanced ability to perform ADLs
7) Pool-based exercise: water temp of 21 to 31 Celsius aids in muscle compliance and reducing pain
