Exercise prescription for arthritis and rheumatological problems
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Exercise Prescription for Arthritis and Rheumatological Problems. You & Your patient are supported. Common Conditions. Degenerative Knees Degenerative Hips Shoulder Stiffness Painful back conditions Painful neck conditions Polyarthritis- seropositive / seronegative. Associate Problems .

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Presentation Transcript


Common conditions
Common Conditions Problems

  • Degenerative Knees

  • Degenerative Hips

  • Shoulder Stiffness

  • Painful back conditions

  • Painful neck conditions

  • Polyarthritis- seropositive / seronegative


Associate problems
Associate Problems Problems

  • Lower limb

    • Wasting of the thigh and leg

    • Stiffness

    • Obesity

    • Home bound and dependent

  • Upper limb

    • Stiffness

    • Impaired self care and dependent

  • Spine

    • Stiffness

    • Impaired sitting and standing tolerance

  • Disease related

    • Neuropathy

    • medications


Worry of exercise in osteoarthritis
Worry of exercise in Osteoarthritis Problems

Increased physical activity exaggerate joint symptoms ?

Rejected by studies


Benefit of exercise in osteoathritic conditions
Benefit of exercise in osteoathritic conditions Problems

  • Alleviate pain, improve physical fitness, improves quality of life

  • Better ambulatory status

  • Less dependent

  • Self confidence

  • Social integration

  • Avoid unnecessary medications

  • Defer surgical need


Classic teaching recommended activities
Classic teaching - recommended activities Problems

  • Swimming, cycling

  • Mild calisthenics exercise which promote joint movements, limited pressure and impact in joints

  • Other low impact weight-bearing exercise such as walking and hydro-exercise would help to improve bone density and structure

  • Older adults-

    • Combination of aerobic exercise, strength-training exercise, balance and flexibility exercise

    • Start low and progress according to tolerance and preference



Am geriatric society panel on exercise oa1
Am Geriatric Society Panel on Exercise & OA Problems

  • 2001 June Consensus practice recommendations

  • Initial Evaluation & Assess

    • Pain severity

    • Physical impairments

    • Physical disabilities

  • Check

    • Medically stable

    • Without joint laxity

    • Willing to exercise

  • Exercise prescription

  • Re-evaluate at 4 wks

  • Monitor at 4-6 months, Encourage increasing physical activities


Exercise dose start
Exercise dose - Start Problems

  • Assess

    • motivation

    • Family & Community

    • PAR-Q/med-X

    • Problem orientated

    • Enjoyment

    • Achievements & reinforcement

  • Golden rules

    • Effectiveness

    • Accessibility

    • Safety

    • Individualised

    • Enjoyment

    • Regular evaluation


Components
Components Problems

  • Warm-up

    • Gentle flexibility

  • Conditioning

    • Aerobic activity

    • Strength-training

    • Static muscle stretching

  • Cool-down

  • Progression

    • Initial, improvement, maintenance


Exercise prescription plan
Exercise prescription plan Problems

  • Flexibility

    • Initial hold 5-15 seconds

    • Ultimate 3-5 stretches, hold 20-30 sec

  • Aerobic exercise

    • 20-30 minutes/day, 3-4 /wk

  • Strength-training exercise

    • Isometric

      • hold <6 sec, 20sec rest period, daily

      • Useful in acute phase

    • Isotonic

      • 6-15 repetitions, 2-3 / wk




Safe play
Safe Play Problems

  • Low back conditions

    • Avoid or minimise exercise that precipitates or exasperates

      • forced extreme flexion, extension, and violent twisting, correct posture, proper back exercise

  • Osteoporosis

    • Avoid exercise with high risks for fracture

      • Push-ups, curls-ups, vertical jump and trunk forward flexion,

    • Engage in low-impact weight-bearing activities and resistance training


Safe play1
Safe Play Problems

  • Arthritis – acute ( infective, rheumatoid, gout)

    • Treatment, plus judicious blend of rest, splinting and gentle movement

  • Arthritis – subacute

    • Progressive increase of active exercise therapy

  • Arthritis – chronic ( osteoarthritis )

    • Maintenance of mobility and strength, non-weight bearing exercises to minimise joint trauma ( e.g. cycling, aquatic activity etc.)


My practice
My practice Problems

  • Find out the obstacles

    • Support

      • Companion

      • Family

      • Skills

  • Set the goal (phase approach)

    • Enjoyment

    • Achievable

    • The rose garden

  • Caution about the fluctuations

    • Occasional attack of inflammations

    • Ways to deal with it


Upper limbs
Upper limbs Problems

  • Stress

    • Shoulder Range of Motion

      • Active

      • Active assisted

      • passive

    • Balance muscle training

      • Multiple directions

      • Static

      • dynamic


Knees
Knees Problems

  • Stress

    • Full Range of motion, especially full extension

  • Mild pain

    • Active ROM, 10 rep

    • Flexibility and static exercise, 10 rep x 6 sec

    • Dynamic exercise, Quads & Hamstring 10 rep

    • Low-impact activities 20 min, 3x/wk


Backs
Backs Problems

  • Stretching

    • Pectorals, back extensors, hamstrings, psoas

  • Active ROM ex 10 x /day

  • Dynamic ex

    • Trunk & hip muscle 5-8 rep

  • Aerobic ex

    • 20 min 3 x /wk


Issues of different exercise
Issues of different exercise Problems

  • Brisk walk, Jogging

  • Swimming

  • Aerobic dance

  • TaiChi


Brisk walk jogging hiking
Brisk walk, jogging, hiking Problems

  • Preparation

    • Park, podium, gym

      • Surface, terrain

    • Shoe wear, clothing

  • Warm up

  • Pacing

  • Warm-down

  • Issues of knee brace

  • Advise on control of flare up

  • Caution about the yellow flag

    • Increase swelling, morning stiffness


Swimming
Swimming Problems

  • Swimmer vs. Non-swimmer

  • Community resources

  • Hydro exercise vs. lap-swimming

  • Style

    • Breast stroke – Knee ROM required

    • Free style – Shoulder Rom required


Taichi
Taichi Problems

  • Proved to be good in aerobic ability, muscle strength & Balance

  • Community resource

  • Demanding on

    • Knees

    • Co-ordination

  • Stress on the need of warm up

  • Stress enjoyment


Osteoarthritis

Individualized treatment Problems

Comorbid conditions

Patient's needs and expectations

Types of treatment

Non-pharmacological

Patient education

Exercise Therapy

Assistive devices

PT & OT

Weight management

Supplements

Pharmacological

Simple analgesics

NSAID

COX-2 inhibitor

Local analgesics

Intra-articular corticosteroid

Intra-articular hyaluronic acid­like product

Surgery

Arthroscopic debridement or joint lavage

Osteotomy for mal-alignment of the knee or hip

Arthroplasty

Osteoarthritis


Important charts
Important charts Problems

“Supplementary Information on Writing an Exercise Prescription”


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