EXERCISE FOR OA Flashcards
what is the most sedentary disease population
Arthritis
> 60% of people with RA have ____
Rheumatoid cachexia
What is rheumatoid cachexia
lean muscle loss that is replaced by fat - can have normal BMI
What causes rheumatoid cachexia
Inflammatory process leading to hypermetabolism and in turn the proteins breakdown in the body
Rheumatoid cachexia has associations with
advanced age
poor diet
inactivity
Muscle physiology/activation is impaired during joint pain/flares, what does this cause?
Residual weakness post flares
How do you counter the post-flare weakness
Progressive resistance training and biological medication
Individuals with RA are up to ___% more likely to suffer CV event
60%
Which other artritis population has an elevated risk of a CV event
Axial spondylitis - 50%
What is the key driver causing the increased risk of a CV event in people with RA and axial spondylitis
Systemic inflammation - need medication
3 main benefits of exercise in OA populations
- Increased muscle strength may modify biomechanics = decreased joint loading rate or localised stress in the articular cartilage
- Strengthening exercises play an important role in delaying progression of knee OA (QUAD)
- Improved fitness may enhance quality of life by allowing a greater range of available daily tasks, thereby improving physical function
What should be a consideration for exercising with RA
- Not during acute flare up `
- want to spare large joints with considerable damage
For AxSpA is land or water exercise recommended
land
What are the current recommendations on sitting
get up every 20-30 mins
Accumulate 2h/day
Goal = 4h/day
5 benefits to exercise in people with arthritis
Increased... - Aerobic capacity - Function - Strength - Bone density Decreased... - Joint damage - pain, depression - Fatigue - disease activity - morbidity & mortality
What are the exercise precautions for people with arthritis
- Dont do so much that you aggravte symptoms
- In RA, unstable joints are vulnerable to deforming forces
- Swollen joints are at risk for capsular stretching; ligamentous rupture with uncontrolled inflammation
- Tendinopathies
- osteoporotic bones at risk of fracture
What are exercise red flags for people with arthritis
- Sudden severe pain and/or joint deformity, or inability to move joint (#, tendon rupture)
- Unable to weightbear
- Neurological signs in extremities (C1-C2 instability in longstanding RA) or progressive weakness despite exercise
- SOB/chest pain with minor exertion (CV distress, RA lung)
What are exercise yellow flags for people with arthritis
- Worsening pain, fatigue or AM stiffness
- Joints becomes swollen, hot or red soon after exercise (within 24hrs)
- Chronic pain
- Low motivation, fear of making joints worse
What may cause a joints to become swollen, hot or red soon after exercise (within 24hrs)
- Re-Ax whether exercise is appropriate intensity
- IA Flare?
- In OA - may require better pain control to increase activity
What is the FITT for ROM?
F - Daily
I - Full, pain free range
T - 5-10 reps
T - active or self-assisted, non-weightbearing
What is the FITT for aerobic exercise
F - 4-7 days/week
I - moderate
T - 150 min/wk bouts of 10 min or more or high intensity interval training if tolerated
T - whole body, dynamic
What is moderate intensity
50-70% HR max (60-85% for CV fitness)
or
RPE 3-5 on 10 point scale
Talk test (able to talk but not sing)
What is the 2-hour pain rule
if post-exercise pain lasts more than 2-3 hours probably over-did it
How can you advice client to prevent overdoing it and manage pain
- Slower progression, more breaks
- Different exercise
- pre-medicating
- Ice/heat
- Difference between joint pain and muscle soreness
What does arthrogenic muscle inhibition occur with
Articular swelling INflammation Pain joint laxity Structural damage
What is arthrogenic muscle inhibition caused by
change in the discharge of sensory receptors in damaged joint = decreased motor neuron excitability
What does Arthrogenic muscle inhibition contribute to
muscle atrophy
What is the muscle dysfunction seen with arthrogenic muscle inhibition
- Quads weakness, hamstrings & glute max/med
- hip pain = hip abductor, extensory, rotator weakness
- Can develop secondary mechanical orthopedic issues with weakness (PFPS, should impingement,etc.)
What is the FITT for strengthening
F - 2-3 days/week, non-consecutive days
I - moderate (3-5 RPE)
T - 8-15 reps, 1-2 sets, work to fatigue
T - 8-10 major muscle groups, dynamic, functional
What is the FITT for flexibility
F - min of 2-3 days/week, daily for problem muscle groups
I - Feel resistance, no pain
T - 20-30s hold, 203 repetitions
T - static or dynamic
Which joints do you have take caution with stretching
effused
What is the FITT for balanace
F - 4-7 days/week
I - moderate (challenging)
T - 10 min/day or more
T - static, dynamic
How should you modify exercise for painful, unstable joints
Decrease load/intensity
Incorporate proprioceptive exercises
Wear brace/splint
How should you modify exercise for restricted, fused joints
Pain free ROM
If concentric painful try eccentric/lower load/isometric
How should you modify exercise recent joint surgeries
Follow precautions
How do you minimize joint stress in exercise
Newer supportive/cushioned shoes
Avoid hand squeeze ball
Avoid hopping/jumping or twisting on fixed foot even in pool
Apply resistance proximal to painful/unstable joints, sit rather than stand
