L9b: Exercise Prescription for Osteoarthritis Flashcards
~8% of Australians reported to have _____ in 2007
OA
Knees, followed by hips, are the most commonly affected _______ joints
OA
____ is the dominant symptom for OA
Pain
______ does not adversely affect joint pain in most older people with OA
Exercise
What are 6 clinical observations for OA?
- Focal destruction of articular cartilage
- Changes in subchondral bone structure
- Formation of osteophytes (bony spurts)
- Joint space narrowing
- Micro-fractures
- Joint swelling
Severity of _____ does not correlate strongly with the structural changes observed in x rays for OA.
pain
______ should not be viewed as a contraindication for exercise participation
Pain
What are 5 symptoms of OA?
- Pain
- Joint stiffness
- Instability
- Swelling
- Muscle weakness
What are 4 disabilities of OA?
Physical and psychological disabilities and impaired quality of life
- Physical
- Psychological
- ↓ QoL
- Difficulty performing ADLs
What are 4 co-existing morbidities?
- Obesity
- Heart disease
- Hypertension
- Diabetes
What is the result of OA?
Majority of older people with OA do not achieve recommended levels of physical activity
_______ considered the cornerstone of conservative management for OA
Exercise therapy
Both ________ and _______ exercise can reduce pain and improve function and health status in OA.
strengthening; aerobic
______ should be individualised and patient-centred taking into account factors in OA.
Exercise therapy
To be effective, _______ should include advice and education to promote a positive lifestyle change with an increase in physical activity in OA.
exercise program
In OA, _______ and _____ are equally effective and patient preference should be considered
group exercise; home exercise
In OA, _____, ______, ______, _____ and ______ muscles are important for function and should be particularly targeted. In fact, Muscle weakness can contribute to joint ______ which can exacerbat OA signs, symptoms & functional disability
Quadriceps; hip abductors, hip extensors; hamstringsand calf; instability
What intensity are isometric contractions?
Low to moderate intensity
What intensity are isotonic contractions?
Low to high intensity (as tolerated)
What is an example of an exercise to target hamstrings?
What are 2 examples of an exercise to target quads?
What is important to remember in OA exercise for strengthening?
Avoid substantial joint loading (avoid high impact loading)
What are the 2 characteristics of a single-leg standing in terms of OA (hip abductor strength)?
- High acetabular pressures
- ↑ pressure → further cartilage damage (Sometimes can affect the bone)
What are the 2 characteristics of a single-leg standing in terms of OA (hip abductor strength)?
High acetabular pressures
↑ pressure → further cartilage damage
Fo knee OA, which exercises should be prescribed to strength knee extensors?
- Open versus closed kinetic chain
- Gravity assisted or resisted
- High-or low-intensity training (resistance/load)
- High intensity: greater strength gains, ↓ time to complete exercises
- Low intensity: less likely to overload joints and exacerbate symptoms
_____(Clear/No clear) evidence showing that WB exercises are more harmful than non-WB exercise in OA
No clear
What are 3 factors that determine the choice of which exercises are prescribed?
- Patient comfort
- Pain tolerance
- Irritability of symptoms
What are 5 features as a rule of thumb for OA exercise prescription?
As a rule of thumb, consider:
- Use of gravity minimised
- Respective joint loading
- Patient position (lying, seated, standing)
- Resistance (theraband, free weights)
- Comfort always comes 1st (has an effect on exercise and long term outcomes)
Reduced _____ associated with pain & loss of function in OA
range of joint motion (ROM)
Compression & decompression of cartilage needed to stimulate _____ and repair
remodelling
What are the 2 guidelines for static stretching for painful OA?
- Initially, static stretch to subjective sensation of resistance Progress static stretch to full range of motion
- Initially, static stretch to subjective sensation of resistance
What are the guidelines for static stretching for pain from the American geriatric Society? What is the progression?
• 1 stretch per muscle group • 5-15 secs per stretch • Once daily Progression • Full ROM • 3-5 per muscle group • 20-30 secs per stretch 3-5 times a week
What are 2 examples of aerobic exercises?
- Weight loss
- Walking, cycling, seated stepper
What is an example of balance re-training?
Tai Chi
What is an example of sensory training?
Joint proprioception (joint receptors)
What are 3 important things to remember for exercise prescription for obesity?
- Aquatic exercise (hydrotherapy) to minimise joint loading
- Seated, strength training better tolerated than weight-bearing aerobic exercise?
- Strength training to ↓loss of lean muscle mass during dietary-induced weight loss
Why is walking not a suitable exercise for slow walkers with OA?
increase acetabular pressure
MSK ____ and ____ are falls risk factors.
pain; weakness
What are 5 precautions to exercise for OA patients?
- Avoid strenuous exercise during acute flare-ups and periods of inflammation
- Avoid exercises/positions which excessively load the joints
- Adequate warm-up and cool down periods for minimising pain after exercise
- Some mild pain/discomfort to be expected after exercise –patient must understand this is normal
- Patient education –lifestyle (e.g. physical activity, diet), disease, benefits of exercise
What are the training parameters for exercise prescription for older patients with OA pain?
