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
  • Degenerative Knees
  • Degenerative Hips
  • Shoulder Stiffness
  • Painful back conditions
  • Painful neck conditions
  • Polyarthritis- seropositive / seronegative
associate problems
Associate 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

Increased physical activity exaggerate joint symptoms ?

Rejected by studies

benefit of exercise in osteoathritic conditions
Benefit of exercise in osteoathritic conditions
  • 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
  • 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
  • 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
  • Assess
    • motivation
    • Family & Community
    • PAR-Q/med-X
    • Problem orientated
    • Enjoyment
    • Achievements & reinforcement
  • Golden rules
    • Effectiveness
    • Accessibility
    • Safety
    • Individualised
    • Enjoyment
    • Regular evaluation
components
Components
  • Warm-up
    • Gentle flexibility
  • Conditioning
    • Aerobic activity
    • Strength-training
    • Static muscle stretching
  • Cool-down
  • Progression
    • Initial, improvement, maintenance
exercise prescription plan
Exercise prescription plan
  • 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
  • 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
  • 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
  • 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
  • Stress
    • Shoulder Range of Motion
      • Active
      • Active assisted
      • passive
    • Balance muscle training
      • Multiple directions
      • Static
      • dynamic
knees
Knees
  • 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
  • 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
  • Brisk walk, Jogging
  • Swimming
  • Aerobic dance
  • TaiChi
brisk walk jogging hiking
Brisk walk, jogging, hiking
  • 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
  • Swimmer vs. Non-swimmer
  • Community resources
  • Hydro exercise vs. lap-swimming
  • Style
    • Breast stroke – Knee ROM required
    • Free style – Shoulder Rom required
taichi
Taichi
  • 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

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

“Supplementary Information on Writing an Exercise Prescription”

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