Arthritis Flashcards
Differentiate between Osteoarthritis and Rheumatoid Arthritis?
Osteoarthritis is a local degenerative disease type (effects a single joint), and effects the weight bearing joints such as hands, spine, hip and knees with features that relate to exercise include joint pain, osteophytes and should be done earlier in day as fatigue and repeated activity hasn’t set in yet.
Whereas Rheumatoid Arthritis is an inflammatory systematic disease type (effects multiple joints and even organs) and effects the wrists, hands, knees, feet and cervical spine and the features that relate to exercise include morning joint stiffness, acute and chronic inflammation, chronic pain and loss of joint integrity and should be done later in the day due to joint stiffness.
What are the risk factors of OA?
Wear and tear, Genetic, Age, Obesity, Abnormal joint motion, bone and joint alignment, inflammation and nutritional and metabolic conditions.
What are clinical features of OA?
Limited ROM, Pain (analgesics prescribed), Early morning joint stiffness which improves with movement, osteophytes and crepitus (creaking sound).
What are the key exercise considerations for the two different types of arthritis?
1) Pain and discomfort will vary so adapt to symptoms
2) Lower aerobic capacity, muscle strength, flexibility, proprioception & balance than arthritis sufferers
3) Less physical activity results in higher risk of CVD
4) Older and obese population more at risk
5) specific exercises that promote balance, like dancing, tai chi, yoga or ball sports should be included
6) Non-weight bearing exercises may be better suited i.e. swimming and cycling (to not add stress to joints)
7) High impact movements should be avoided as it adds additional stress
8) Avoid highly repetitive activities, poorly controlled or rapid movements, training joints that are not effected by pain will offset detrimental effects of complete inactivity and exercising inflamed joints may accelerate degeneration (RA)
Goals of exercise programmes for OA?
1) Restoring and maintaining the best possible function in OA joints and prevents further degeneration.
2) Protect the joint from damage by reducing stress on the joint (i.e. low impact).
3) Restore, maintain & improve walking capacity & ability to perform ADL tasks.
4) Reduce the risk of co-morbid conditions related to inactivity.
Which health and fitness tests would you commence prior to exercise for arthritis suffers?
1) Health related fitness testing includes morphological (body composition & other anthropometric data – BMI, waist or WHR – important to screen for co-morbidities due to increased risk of obesity due to intolerance of physical activity)
2) Cardiorespiratory (6 min. walk monitor HR & RPE) tests V02 max and VO2peak, Musculoskeletal (strength & muscular endurance) – 1, 8, 12-RM or functional strength measurement),
3) Flexibility (goniometry assess functional ROM & symmetry,
4) Motor function (gait & balance)
5) Functionality of affected joints (strength & flexibility).
Aerobic exercise programme
Activities include walking, rowing, cycling, swimming, water aerobics and dance. Prescription: is 60 – 80% HRpeak or 40 – 60% VO2max, with 11-13 REP, 3-5 days/ weeks, 5 – 10 mins. (progress to 30 mins / session).
Aerobic Exercise – Rationale & Considerations?
Rationale:
Improves weight control with consequent pain reduction.
Lessens disability & improves performance of ADLs.
Improves sense of well-being (& help in pain management?)
Increase VO2max, peak work & endurance
Prevent weight gain
CAD avoidance
Considerations:
Avoid prolonged one-legged stance & rapid stop-go actions if symptomatic hip or knee problem.
Low impact modes may be better tolerated.
Start with 10 – 15 mins. progress to 30 – 45 mins.
Strength exercise programme
Exercises include circuit training, weight machines, free weights, elastic bands, isometric exercise. Prescription: use pain tolerance to set %MVC, 1 set of 2 / 3 reps progress to 10 / 12 reps and 2 – 3 days / week.
Strength Exercise – Rationale & Considerations?
Rationale:
Increase muscle strength thereby preventing de-conditioning of muscles that keep the joint stable (increases joint stability).
Muscle weakness leads to reduced joint proprioception with consequent reduction in stability (improve strength = improved balance).
Lessens disability as ADLs performed more easily.
Increase 1, 8 or 12-RM
Increase reps & resistance
Maintain / improve LBM (RA)
Considerations:
If pain prevents movement through certain ranges, the ROM should be limited to the pain-free zone, but subsequent attempts should be made to extend ROM, to prevent strength increases being limited to certain angles of movement.
Isometric exercises are less likely to exacerbate arthritis pain than Isotonic due to the movement. Multiple repetitions should be performed at a lower intensity than client is capable of achieving (possible risk of BP elevation if intensity is too high).
Flexibility exercise programme?
Flexibility exercise include stretching. Prescription: 1 – 2 sessions / day, Avoid over-stretching / hypermobility.
Flexibility rationale and consideration?
Rationale:
Decreases stiffness by counteracting the shortening of muscles, tendons & ligaments & joint capsules experienced in OA.
Increases or maintains pain-free ROM.
Considerations:
Use pain-free ROM as an index of intensity.
Explain why flexibility and strength exercises might need to be performed by arthritis suffered prior to aerobic/ cardiovascular forms of activity?
The muscles need to be conditioned I.e. the leg musculature as to not add additional stress on joints during the commencement of exercise.
Arthritis Medication?
1) Non-steroidal anti-inflammatory drugs (NSAID) e.g. aspirin, ibuprofen; Treatment: Reduce Inflammation, Pain relief; Side effects: Anaemia & GI bleeding, Upset digestive system;
2) Paracetamol (acetaminophen); Treatment: Pain relief; Side effects: Allergic reaction (rash / swelling),Flushing, low BP & fast HR,Blood disorders,Liver / kidney damage.
3) Disease-modifying anti-rheumatic drugs (DMARDs) e.g. metotrexate & anti-TNFs (tumour necrosis factor; Treatment: Reduce immune response; Side effects: Secondary organ disease
4) Glucocorticoids; Treatment: Control flare-ups in RA, Control OA; Side effects: Skeletal myopathy, truncal obesity, osteoporosis & anaemia, increased risk of fracture
What exercise recommendations for arthritic sufferers?
1) Joint Disease= Joint protection (reducing intensity/duration/frequency)
2) Select low-impact activities as high impact will further degeneration of the bones/Avoid stair climbing, contact sports, or activities involving rapid stop-go actions for those with symptomatic hip or knee problems.
3) Due to the condition having a greater prevalence in the lower legs, doing CV equipment such as arm ergometry would be more useful
4) Muscles should be conditioned prior to exercise through flexibility and ROM exercises (stretching) however avoid over stretching or hypermobility which can cause further damage to inflamed or unstable joints
5) Appropriate footwear to provide shock absorption
