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Building a Successful Exercise Program In The EDS Population

EDNF 2011 Conference. Building a Successful Exercise Program In The EDS Population. Kathleen Zonarich, PT. Initial Considerations:. Get approval from your doctor or physical therapist before starting any exercise program.

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Building a Successful Exercise Program In The EDS Population

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  1. EDNF 2011 Conference Building a Successful Exercise Program In The EDS Population Kathleen Zonarich, PT

  2. Initial Considerations: • Get approval from your doctor or physical therapist before starting any exercise program. • This presentation is meant for those with Classic or Hypermobility EDS (HEDS). If there are any cardiac/vascular issues, please discuss appropriate exercise levels with your doctor, specific to you. • This presentation is only meant to serve as a general template for an Individual Exercise Program. The specific exercises mentioned are not intended to be used by everyone. (consult your PT/doctor)

  3. Benefits of Exercise for the General Population: • Combats chronic diseases such as: • Osteoporosis • Diabetes • Hypertension • High cholesterol • Maintains weight • Increases energy levels

  4. Benefits of Exercise for the General Population (cont.): • Improves mood • Better sleep • Fun • Decreases stress • Boosts immune system • Enhances physical relationships • Benefits of Exercise for the General Population also apply to the EDS Population!

  5. Recommendations for the General Population: • Aerobic Exercise: • 2 hours and 30 minutes per week of moderate intensity aerobic exercise ; or • 1 hour and 15 minutes per week of vigorous aerobic exercise AND • Muscle Toning/Strengthening: • 2 or more days a week (Landr0, 2010)

  6. Exercise Guidelines for the Disabled Population: • Research (Lee, 2003) indicates that individuals with disabilities may have benefits from as little as 30 minutes of slow exercise per day/ 5 days a week • Start out slowly, build your program at your own pace • Over time your body will adapt to your exercise routine, therefore you need to change your program to continue to challenge yourself (Lee, 2003)

  7. Overall Exercise Goals for the EDS Population: • Increase Function • Limit Disability • Use Appropriate Pacing /Sequencing • Follow “Success before progress” model (Kerr, 2004)

  8. Specific Goals for Exercising in the EDS Population: • Maintain/Regain normal range of motion • Correct and prevent movement dysfunction by re-training of: • Postural control • Postural alignment • Proprioception • Balance (Kerr, 2004)

  9. Specific Goals of Exercising in the EDS Population (cont): • Achieving joint stability: • Neutral joint position is most stable • Core stability needs to be developed first • Proximal to distal stability should follow • Create and Follow an Individualized Exercise Program (Kerr, 2004)

  10. Basic forms of muscle action: • Isometric • Istonic • Isokinetic

  11. Types of Exercise: • Aerobic • Anerobic • Resistive • Against gravity • Free weights • Therabands • Body weight

  12. Components of a Balanced Exercise Program for the EDS Population: • Warm up • Strengthening • ROM/Flexibility • Cardio • Balance • Proprioception • Coordination • Cool Down

  13. Types of exercise that work well for the EDS population: • Aquatic- warm water better (90 degrees) • Tai Chi • Low- impact Cardio (aerobic) • Pilates • Yoga • Wii

  14. Exercise guidelines related to EDS: • Get approval from your doctor/therapist to start a “normal exercise program” • Normal ROM- perform exercise in normal range of motion. AVOID: hyperextension • Resistive exercises- can make joint instability more severe • Isometric ex- if too much force is applied, it can be bad for hypermobile joints • High impact- not recommended • Proper form/body mechanics are essential (Levy, 2010)

  15. Tips for successful exercising: • Do the exercises in front of a mirror • Progress when you have success with current level • “No pain, no gain” – NOT for EDS • Okay to have muscle soreness up to two days after exercise, but you should not feel new pain or an increase in pain • Slow and steady wins the race • Have control throughout movement; if something doesn’t feel right, stop

  16. Exercise Program Sample 1 (HEDS – 12 year old girl) • 12 year old girl • No Physical Education in school • Frequent joint dislocations, especially at knees • Weak core muscles • Severe pronation of feet • Varying joint pain throughout body on daily basis

  17. Exercise Program 1: Guidelines • Begin with no resistance due to joint instability and frequent dislocations • Core exercise to be the main focus, then develop exercise for extremities • Low reps to begin, progress to higher reps then drop reps down and increase resistance slightly, build back up to higher reps • Focus to be in this order: • Stabilization • Proximal • Distal (Tinkle,2010)

  18. Exercise Program 1: Core(start with 5 reps each) • Pelvic tilt • Abdominal crunches with arms crossed over chest • Rotational abdominal crunches with arms crossed over chest • Prone leg lifts • Prone opposite leg/arm lifts • Prone superman • Prone plank - 10 seconds • Side plank - 10 seconds

  19. Exercise Program 1: Legs(start with 5 reps each) • Short arc quads • Wall squats • Straight leg raise (supine) • Standing exercises (hold on to kitchen sink as needed) • Hip flexion • Hip abduction • Hip extension • Ham curls • Heel raises

  20. Exercise Program 1: Arms(Start with 5 reps each)Standing Position • Arm circles • Wall push ups • Ball exercises: (small light weight playground ball) • Rowing • Circles (clockwise and counter clockwise) • Push ball up over head • Push ball out in front • Full arc in front overhead and down to hips • Bicep curls • Shoulder height abduction/adduction

  21. Exercise Program 1: Balance(stand at kitchen sink/hold on as needed) • Start with 30 second holds if able • Stand on one leg • Stand on one leg with eyes closed • Standing tree pose • Star fish against the wall • Warrior • Raise up on toes

  22. Exercise Program 1: Frequency • How Often: • Cardio 2-3 days per week • Exercises 3 times per week with one day rest between each specific exercise type • General Considerations: • Exercises do not have to be done in one block of time • If you are at a lower level, break up the exercises throughout the day or alternate arms and legs on different days, etc.

  23. Exercise Program Sample 2 (HEDS – 40 year old female) • 40 year old female • Chronic dislocations of hips • Bilateral knee pain • Pronation of both feet • Upper extremity weakness • Sub-luxing right shoulder • Desk job • Unsuccessful attempts to exercise in the past with increased pain

  24. Exercise Program 2: Guidelines • Begin with no resistance due to joint instability and frequent dislocations • Core exercise to be the main focus, then develop exercise for extremities • Low reps to begin, progress to higher reps, then drop reps down and increase resistance slightly, build back up to higher reps. Begin with 5 reps. • Focus to in this order: • Stabilize • Proximal • Distal (Tinkle, 2010)

  25. Exercise Program 2: Core • Supine • Pelvic tilt • Bridging • Knee roll • Arm reach between knees • Arm reach to opposite knee

  26. Exercise Program 2: Legs • Supine • Quad sets • Ham sets • Glut sets • Heel slides • Hooklying hip abduction/adduction • Hip abduction • Prone • Knee flexion • Sidelying • Hip extension

  27. Exercise Program 2: Arms • Supine • Shoulder Flexion • Shoulder abduction • Bicep curls • Internal/external rotation • Horizontal shoulder abduct/adduction • Sitting • Same as above will make it more challenging • Ball catch (closer to center of body is easier) • Prone • Elbow extension with arm hanging off bed

  28. Exercise Program 2: Balance • Sitting balance unsupported • Balloon toss • Ball toss (more challenging) • Standing balance (holding on to sink as needed) • Static stand • Eyes open/closed • Unilateral stand • Eyes open/closed • Low level yoga pose • Standing tree with toe on floor rather than at knee

  29. Exercise Program 2: Frequency • How Often: • Cardio: 2-3 days per week • Exercises: 3 day per week with 1 day of rest between each specific exercise type • General Considerations: • Exercising does not have to be done in one block of time • If you are at a lower level, break up the exercises throughout the day or alternate arms and legs on different days, etc.

  30. General Exercise Progression Guidelines: (in order of easiest to hardest) • Abdominals • Sitting on ball or chair reclined • On floor against gravity • Arms crossed over chest • Arms at side of head • Arms over head extended • Medicine ball at chest • Medicine ball with extended arms

  31. General Exercise Progression Guidelines: (in order of easiest to hardest) • Arms/Legs • Supported by surface (gravity eliminated) • Partial range of motion • Full range of motion • Against gravity range of motion • Use of body weight for resistance • Light weight resistance • Heavier weight resistance • Machines

  32. General Exercise Progression Guidelines:(in order of easiest to hardest) • Balance • Sitting • Sitting balance supported • Sitting balance unsupported • Dynamic sitting balance • Standing • Static • Supported • Unsupported • Hard surface to soft surface • Dynamic • Hard surface to soft surface • Bilateral to unilateral

  33. Resources on the Internet • Exerciseismedicine.org • Provides exercise videos and self assessment tool for individuals with diseases • Health.gov/paguidelines • 2008 Physical Activity Guidelines for Americans • www.myrafitkit.com • Provides personalized exercise program with demonstration (For the EDS population- flexibility should be only within normal range)

  34. Questions??? now or later….. kathleenzonarich@gmail.com

  35. Works Cited: • Kerr, PT, Rosemary. "Management of the Joint Hypermobility Syndrome: the Therapist's Contribution." Jointandbone.org. Joint and Bone: Musculoskeletal Disease Online, 30 Sept. 2004. Web. 3 July 2011. <http://www.reumatologia-dr-bravo.cl/para%20medicos/HIPERLAXITUD/www_jointandbone_org_RODGRAH.htm>. • Landro, Laura. "The Hidden Benefits of Exercise - WSJ.com." Business News & Financial News - The Wall Street Journal - Wsj.com. Wall Street Jounal, 5 Jan. 2010. Web. 03 July 2011. <http://online.wsj.com/article/SB10001424052748704350304574638331243027174.html>. • Lee, Thomas, and P. Skerrett. "ViewNewsletter." Harvard Heart Letter. Harvard Health Publication Newsletter, 15 Aug. 2003. Web. 03 July 2011. <http://harvardhealth.staywell.com/viewNewsletter.aspx?NLID=2>. • Levy, MD, Howard. "Ehlers-Danlos Syndrome, Hypermobility Type - GeneReviews - NCBI Bookshelf." Ncbi.nlm.nih.gov. National Center Biotechnology Institute: National Institute of Health, 14 Dec. 2010. Web. 03 July 2011. <http://www.ncbi.nlm.nih.gov/books/NBK1279/>. • Tinkle, Brad T. Joint Hypermobility Handbook: a Guide for the Issues & Management of Ehlers-Danlos Syndrome Hypermobility Type and the Hypermobility Syndrome. Greens Fork, IN: Left Paw, 2010. 94+. Print. • Images: http://office.microsoft.com/en-us/images/??Origin=EC790014051033&CTT=6&ver=12&app=powerpnt.exe

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