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

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

Increased physical activity exaggerate joint symptoms ?

Rejected by studies

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

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 & OA

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

Golden rules Effectiveness Accessibility Safety Individualised Enjoyment Regular evaluation

Assess

motivation

Family & Community

PAR-Q/med-X

Problem orientated

Enjoyment

Achievements & reinforcement

Components

Warm-up Gentle flexibility

Conditioning Aerobic activity Strength-training Static muscle stretching

Cool-down Progression

Initial, improvement, maintenance

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

Programme For Osteoarthritis

Programme For Osteoarthritis

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 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

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

Stress Shoulder Range of Motion

Active Active assisted passive

Balance muscle training Multiple directions Static dynamic

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

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

Brisk walk, Jogging Swimming Aerobic dance TaiChi

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

Swimmer vs. Non-swimmer

Community resources

Hydro exercise vs. lap-swimming

Style

Breast stroke – Knee ROM required

Free style – Shoulder Rom required

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 expe

ctations

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 acid like p

roduct Surgery

Arthroscopic debridement or joint lavage

Osteotomy for mal-alignment of the knee or hip

Arthroplasty

Important charts

“Supplementary Information on Writing an Exercise Prescription

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