Exercise Prescription in Arthritis Management Flashcards
Those w/ _______ belong to the MOST sedentary chronic disease population
- Highest proportion of overweight/obese than other chronic diseases
- At risk for developing other comorbidities - diabetes, HTN, metabolic syndrome, CV disease, early mortality
In IA: Can develop osteoporosis due to inflammation & immobility, or corticosteroid use
In RA specifically: >60% have rheumatoid cachexia (lean muscle loss replaced by fat, can have normal BMI), ↑ w/ advanced age
Muscle physiology/activation is impaired during joint pain/flares = residual weakness post flares
- Progressive resistance training & biologic medications are important for these patients
Arthritis
Individuals w/ RA up to 60% more likely to suffer CV event
Individuals w/ axial spondylitis (including AS) up to 50% ↑ risk of CV events
Systemic inflammation is key driver (need medication!!) compounded by inactivity
Inflammatory Arthritis CV Risk
↑ muscle strength may modify biomechanics = ↓ joint loading rate or localized stress in the articular cartilage
Strengthening exercises play an important role in delaying progression of knee OA
Improved fitness may enhance quality of life by allowing a greater range of available daily tasks, thereby improving physical function
OA Exercise Benefits
Non-surgical management of knee OA
Core tx:
- Land-based exercise
- Weight management
- Strength training
- Water-based exercise
- Self-mgmt & education
OARSI Guidelines
High intensity exercise in _______ _______ - SAFE!
Resistance training, biking, stepping & stair walking
↓ progression of radiologic small joint damage (more pronounces in feet vs hands)
Less disease activity & use of glucocorticoids, improved function & aerobic fitness
Rheumatoid Arthritis
Ages 18-64 should accumulate at least 150mins of mod-to-vig intensity aerobic physical activity per week, in bouts of 10mins or more
Muscle & bone strengthening using major muscle groups at least 2x/week
Canadian Physical Activity Guidelines
Aerobic Activity:
- 150-300 mins/week of mod-intensity OR
- 75-150 mins/week of vig-intensity OR
- Equivalent combo of mod-and-vig intensity
+
Muscle Strengthening:
- At least moderate or greater intensity 2+ days/week
- Involve major muscle groups
When adults w/ chronic conditions/disabilities are not able to meet the above key guidelines, they should engage in regular physical activity according to their abilities
& should avoid inactivity
American Physical Activity Guidelines
Current recommendations: Get up every 20-30mins
Public Health England Recommendations - Desk Workers:
- Seated-based work should be regularly broken up w/ standing- based work (sit-stand desks or short active standing breaks)
- Initially work to accumulate 2hr/day of standing & light activity (light walking) during working hours, goal 4h/day
Education, self-monitoring, problem solving, restructuring social/physical environment most promising behaviour change techniques
Sitting Breaks
↑ aerobic capacity ↑ function (self-reported & performance) ↑ strength ↑ bone density ↓ joint damage ↓ pain, depression ↓ fatigue ↓ disease activity ↓ morbidity & mortality May improve efficacy of meds
Benefits of Physical Activity
Precautions & red flags
Current guidelines
Modifications
Monitoring
Progression
Adherence
Exercise Considerations
Inappropriate exercise can ↑ pain & reduce exercise confidence & adherence
- Exercise cannot make IA disease activity worse, but will aggravate symptoms if too much
In RA, unstable joints are vulnerable to deforming forces
Swollen joints at risk for capsular stretching; ligamentous rupture w/ uncontrolled inflammation
Tendinopathies common
Osteoporotic bones are risk for #s
Exercise Precautions
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 w/ minor exertion (CV distress, RA lung)
Exercise Red Flags
Worsening pain, fatigue or AM stiffness
Joint becomes swollen, hot or red soon after doing exercise (within 24hrs)
- Re-Ax. whether exercise at appropriate intensity
- IA flare? Can be purely coincidental. Modify based on energy & what can tolerate
- In OA - may require better pain control to ↑ activity
Chronic pain
- highly associated w/ depression, anxiety
- activity avoidance, expectation of passive Rx, catastrophization
Low motivation, fear of making joints worse
Rx w/ education & reassurance, patient-identified functional goals
Exercise Yellow Flags
Greatest issue with the arthritis population is __________ behaviour & lack of physical activity, second to ________ adherence - Need to be ACTIVE & SELF MANAGE
Arthritis pt’s should never be treated with solely passive approaches
Individuals w/ arthritis & pain become rapidly, severely deconditioned, particularly in IA if multi-joint flares past/present
Sedentary; Medication
Include:
- ROM
- Strengthening
- Aerobic
- Flexibility
- Balance & Coordination
FITT principles
Exercise Prescription
