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PHTH 565 RHEUMATOLOGY > EXERCISE FOR OA > Flashcards

EXERCISE FOR OA Flashcards

1
Q

what is the most sedentary disease population

A

Arthritis

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2
Q

> 60% of people with RA have ____

A

Rheumatoid cachexia

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3
Q

What is rheumatoid cachexia

A

lean muscle loss that is replaced by fat - can have normal BMI

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4
Q

What causes rheumatoid cachexia

A

Inflammatory process leading to hypermetabolism and in turn the proteins breakdown in the body

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5
Q

Rheumatoid cachexia has associations with

A

advanced age
poor diet
inactivity

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6
Q

Muscle physiology/activation is impaired during joint pain/flares, what does this cause?

A

Residual weakness post flares

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7
Q

How do you counter the post-flare weakness

A

Progressive resistance training and biological medication

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8
Q

Individuals with RA are up to ___% more likely to suffer CV event

A

60%

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9
Q

Which other artritis population has an elevated risk of a CV event

A

Axial spondylitis - 50%

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10
Q

What is the key driver causing the increased risk of a CV event in people with RA and axial spondylitis

A

Systemic inflammation - need medication

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11
Q

3 main benefits of exercise in OA populations

A
  • 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
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12
Q

What should be a consideration for exercising with RA

A
  • Not during acute flare up `

- want to spare large joints with considerable damage

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13
Q

For AxSpA is land or water exercise recommended

A

land

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14
Q

What are the current recommendations on sitting

A

get up every 20-30 mins
Accumulate 2h/day
Goal = 4h/day

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15
Q

5 benefits to exercise in people with arthritis

A 
Increased...
- Aerobic capacity 
- Function 
- Strength 
- Bone density 
Decreased... 
- Joint damage 
- pain, depression
- Fatigue 
- disease activity 
- morbidity & mortality
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16
Q

What are the exercise precautions for people with arthritis

A
  • 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
17
Q

What are exercise red flags for people with arthritis

A
  • 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)
18
Q

What are exercise yellow flags for people with arthritis

A
  • 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
19
Q

What may cause a joints to become swollen, hot or red soon after exercise (within 24hrs)

A
  • Re-Ax whether exercise is appropriate intensity
  • IA Flare?
  • In OA - may require better pain control to increase activity
20
Q

What is the FITT for ROM?

A

F - Daily
I - Full, pain free range
T - 5-10 reps
T - active or self-assisted, non-weightbearing

21
Q

What is the FITT for aerobic exercise

A

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

22
Q

What is moderate intensity

A

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)

23
Q

What is the 2-hour pain rule

A

if post-exercise pain lasts more than 2-3 hours probably over-did it

24
Q

How can you advice client to prevent overdoing it and manage pain

A
  • Slower progression, more breaks
  • Different exercise
  • pre-medicating
  • Ice/heat
  • Difference between joint pain and muscle soreness
25
Q

What does arthrogenic muscle inhibition occur with

A 
Articular swelling 
INflammation 
Pain 
joint laxity 
Structural damage
26
Q

What is arthrogenic muscle inhibition caused by

A

change in the discharge of sensory receptors in damaged joint = decreased motor neuron excitability

27
Q

What does Arthrogenic muscle inhibition contribute to

A

muscle atrophy

28
Q

What is the muscle dysfunction seen with arthrogenic muscle inhibition

A
  • 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.)
29
Q

What is the FITT for strengthening

A

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

30
Q

What is the FITT for flexibility

A

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

31
Q

Which joints do you have take caution with stretching

A

effused

32
Q

What is the FITT for balanace

A

F - 4-7 days/week
I - moderate (challenging)
T - 10 min/day or more
T - static, dynamic

33
Q

How should you modify exercise for painful, unstable joints

A

Decrease load/intensity
Incorporate proprioceptive exercises
Wear brace/splint

34
Q

How should you modify exercise for restricted, fused joints

A

Pain free ROM

If concentric painful try eccentric/lower load/isometric

35
Q

How should you modify exercise recent joint surgeries

A

Follow precautions

36
Q

How do you minimize joint stress in exercise

A

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

PHTH 565 RHEUMATOLOGY (7 decks)

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