Making Movement Part of your Life:

Exercise and Arthritis

Daniel O’BrienLecturer, Physiotherapy

Department, AUT University

My Background

• Trained as a physiotherapist

(AUT University)

• Musculoskeletal Clinical

Practice (Private Practice /

Sports / Hospital / Teaching)

• My study (Masters and PhD)

My Research

• Clinical management of osteoarthritis (exercise adherence, treatment beliefs and best practice management)

• Cross-profession integration of healthcare student clinical education

Outline

Where does exercise and activity fit into living with arthritis Having a balanced exercise programme Progressing your exercise programme Signs to look for if you are over exercising Goal setting Making exercise part of your life Action and coping plans

Why Exercise?

Exercise can improve: Brain function Muscle strength Sleep health Joint range of motion Pain Body weight Mood Motivation…

Where does exercise and activity fit into the overall picture of the

treatment of arthritis?

The Management Scale (Osteoarthritis)

Lifestyle and dietary changes

Exercise and manual therapy

Non-opioid analgesics and NSAIDs

Opioid analgesics

Surgery

The Management Scale (Other Forms of Arthritis)

Lifestyle and dietary changes

Disease Modifying Drugs

Exercise and manual therapy

Analgesic medication

Surgery

Self-Management

Management of Arthritis Should be a ‘Team Approach’

• You

• GP

• Rheumatologist

• Surgeon

• Psychologist / Psychotherapist

• Physiotherapist

• Practice Nurse

• Counselor

• Occupational Therapist

• Fitness Instructor

A Balanced Exercise Programme

• Cardiovascular• Strength • Stretching (Flexibility)• Balance (Control)

Cardiovascular

• Aerobic exercise• Vary intensity• Vary the activity• Daily• Exercise snacking

Strengthening: Adding Resistance

• Strengthening exercises do not always meaning making big muscles

• Hypertrophy / endurance / power

• Between 5 to 25 repetitions, repeat 2 to 5 times, 2 to 3 times per week

• Add upper and lower body exercises

• Explore options of adding resistance, not all resistance exercises work for all people

Stretching / Flexibility

Stretching / Flexibility

• Warm up first (walking / cycling etc.)• Do a balance of upper and lower limb stretches• Protect the joint while stretching• Hold each stretch for 30 seconds (3 x 10 second

stretches is almost as good if you cannot hold them)

• 3 to 7 times per week

Balance / Control

Northglenn Community Fitness Programme

• Balance / control exercises can be stand alone or can be incorporated into other exercises (strength)

• Balance / control can be practiced on a regular basis (every day)

Balance / Control

Exercise: What is Too Much?

• Hurt not harm (change from baseline pain longer than 20 minutes post exercise)

• Joint swelling post exercise (can be upto 48 hours later)

Break

Goal Setting +• Can you explain it to some one in one or two sentences

(in 2014 I want to run a ½ marathon in under 1:40)

• SMART GoalsSpecific (Waitakere 1/2 Marathon)

Measureable (Complete it or not in the allocated time)

Achievable (Run half marathons before / 11 months to train)

Relevant (Improve my cardiovascular health)

Timed (Under 1:40 in October, 2014)

Creating an Exercise / Activity Programme +

• Think about a goal you want to achieve

• Write it out the exercise programme

• Seek advice as needed

• Pace yourself (you can not do everything all at once)

• Ask your self the following questions regarding your exercise programme Is it balanced?

Is it achievable?

Will you enjoy it?

Creating an Exercise / Activity Programme +

Activity Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Running 25 min 30 min Rest day 50 min

Strength 25 min at the gym

25 min at the gym

Rest day

Stretches 10 min at the gym

10 min at the gym

Rest day

Other activities

Walking the kids to daycare

Rest day

Safe Progressions When Exercising (Challenging Yourself)

• Change one thing at a time Duration (i.e. time you are walking for)

Resistance (i.e. carrying a backpack)

Activity (i.e. replacing walking with stair climbing)

Complexity (i.e. walking on rough surfaces)

Intensity (i.e. walking up hill)

• Think about small steps (<10% per week)

• Think about volume (all the activity you are doing) over a 7 day

period

Making Exercise / Activity Part of your Life +

• Take the stairs not the lift

• Park a little further away and walk

• Take the coffee to go and walk for a bit rather than sitting in the cafe

• Have exercise snacks (i.e. 3x 10 minute periods of exercise per day)

• Work it into your day and plan to be active

Factors that Improve Adherence to Exercise (Behaviour Change)

• Pick something that you will

enjoy

• Do the right exercises (seek

advice)

• Exercise with others

• Keep it simple

• Make sure it is achievable

• Put supported mechanisms in

place

Implementation Intentions: Making a Plan and Sticking to it

‘Implementations intentions are planning process which describe how, when and where the desired behaviour will occur’ (Golwitzer, 1998)

ThinkImplement

ation Intention

Action

Creating an Action Plan

Action Plan Running

When Monday, Wednesday, Friday and Sunday

Where To the park and back

How long 25 minutes (50 minutes on Sundays)

Who with My dog

(Schwarzer et al., 2006; Sniehotta et al., 2005)

Creating a Coping Plan

What are the possible

obstacles to completing

my exercises?

How will I overcome

these?

Creating a Coping Plan +Action Plan Running Coping

When Tuesday, Thursday and Sunday • On the days when the weather is too poor to run outside I will use my exercise bike for 15 minutes instead

• On the days when my knee is too painful to run I will ice my knee and then do my ROM exercises instead

Where To the park and back

How long 25 minutes (50 minutes on Sundays)

Who with My dog

(Schwarzer et al., 2006; Sniehotta et al., 2005)

Summary

Make a planPick exercise and activity your enjoy (make it fun)Do it with someone (where ever possible) Be realistic and keep it simpleMake it a balanced exercise programmeDon’t over do it

Resources (Page 7)

Shameless Plug: Research Participants

People with OA of the hip and/or knee who have not had surgery and are happy to be interviewed regarding

their experience of management of their condition

dobrien@aut.ac.nz