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