Working with Clients with Osteoarthritis

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Rheumatologic disorders tend to be chronic and incurable however most can. be effectively managed with proper treatment programs Osteoarthritis OA is. the most common joint disorder in the United States affecting an estimated 27. million Americans Lawrence et al 2008 Cartilage degeneration is the. hallmark of OA The cartilage ulceration that begins superficially can extend. into deeper layers affecting the subcondral bone Eventually bone spurs i e. osteophytes may develop in the affected joint and focal inflammation may be. observed Ling Rudolph 2006 The most commonly affected joints include. weight bearing joints such as the knee hip and spine as well as the small. joints of the hand, Characterized by joint pain morning stiffness joint instability late stage and. buckling knee joint and sometimes loss of function of the affected joint OA. can be debilitating As a fitness professional knowledgeable about OA the. disease process and the most effective exercise interventions you will be. uniquely positioned to meet the needs of millions of people with early and mild. OA who aim to safely lead a rewarding and low pain physically active lifestyle. This continuing education course which includes the online interactive course. and PDF of the Strength Exercise Progressions list will arm you with the tools. you need to get started and design a safe effective and motivating exercise. program for your clients who suffer from OA,OSTEOARTHRITIS OVERVIEW. The pathogenesis of primary or idiopathic OA is poorly understood Old age. female gender previous injury to a joint high bone mass genetic. predisposition increased body mass index BMI participation in weight. bearing sports e g elite running and occupations that require prolonged. standing lifting moving of heavy objects or handling vibration tools as in. construction all increase risk Lane 2007 while moderate physical activity. decreases risk Manninen et al 2001 Other diseases such as. hemochromatosis hyperparathyroidism hypothyroidism acromegaly. hyperlaxity syndromes Paget s disease gout and chondrocalcinosis can also. lead to what is known as secondary OA Lane 2007, While the initial events that lead to OA are not well delineated OA. likely begins with degradation of articular cartilage a tough material that. cushions and protects the bone ends The degradation may be stimulated by. high circulating levels of proinflammatory cytokines and other inflammatory. cells The result is that the cartilage that once allowed bones to smoothly. glide over one another and that effectively absorbed the shock of physical. movement becomes damaged and ineffective This can cause pain swelling. and diminished range of motion Bones may eventually rub against one another. during movement Sometimes small deposits of bone known as osteophytes. begin to grow at the edge of the joint causing more pain and damage when. they break off and float into the joint space OA of the medial knee is. depicted in Figure 1 below,Figure 1 Osteoarthritis of the Medial Knee. Reference Felson D T 2006 Osteoarthritis of the knee New England Journal of Medicine 354 8 841 848. The best practice treatment recommendations for people with OA are. based on expert opinion and a limited number of imperfect research studies of. short duration and small sample size Core treatments include education to. increase understanding of the disease and dispel myths such as the pervasive. belief that exercise further damages osteoarthritic joints exercise including. muscle strengthening aerobic fitness and flexibility training to maintain. mobility and weight loss to limit joint stress Adjunct interventions include. non pharmacological pharmacological and surgical treatments Conaghan et. al 2008 see Figure 2 below,Figure 2 Osteoarthritis Treatments.
Reference Conaghan P G Dickson J Grant R L et al 2008 Care and management of osteoarthritis in adults. summary of NICE guidance British Medical Journal 336 502 503. EXERCISE AND OSTEOARTHRITIS, Exercise is an important component in the management of OA In fact expert. panels have convened to develop consensus guidelines on the role of exercise. in the treatment of OA based on the latest research and expert opinion These. include the MOVE guidelines Roddy et al 2005 and the OARSI. recommendations Zhang et al 2008 The main conclusions of the MOVE. consensus all of which emphasize the important role of exercise in treating. OA are summarized below in Figure 3, Figure 3 The MOVE Consensus Recommendations for the Role of Exercise in the. Management of Osteoarthritis of the Hip or Knee, 1 Both strengthening and aerobic exercise can reduce pain and improve function and. health status in patients with knee OA and presumably hip OA. 2 There are few contraindications to the prescription of strengthening or aerobic. exercise in patients with hip or knee OA, 3 Prescription of both general aerobic fitness training and local strengthening. exercises is an essential core aspect of management for every patient with hip or. 4 Exercise therapy for OA of the hip or knee should be individualized and patient. centered taking into account factors such as age co morbidity and overall mobility. 5 To be effective exercise programs should include advice and education to promote a. positive lifestyle change with an increase in physical activity. 6 Group exercise and home exercise are equally effective and patient preference should. be considered, 7 Adherence is an important predictor of long term outcome from exercise in patients.
with knee or hip OA, 8 Strategies to improve and maintain adherence should be adopted e g long term. monitoring review and inclusion of spouse family in exercise. 9 Improvements in muscle strength and proprioception gained from exercise programs. may reduce the progression of knee and hip OA, Note statements with are supported by research those without are based primarily on. expert opinion, Reference Roddy E Zhang W Doherty M et al 2005 Evidence based recommendations for the role of exercise in. the management of osteoarthritis of the hip or knee the MOVE consensus Rheumatology 44 1 67 73. Despite the recognized importance of exercise in treating OA many. individuals with OA avoid physical activity due to severe joint pain and fear. that the exercise will further damage the affected joints In fact inactivity. can lead to further deconditioning and loss of strength flexibility and. endurance all components of fitness necessary to overcome the pain and. physical limitations associated with the disease As the severity of OA worsens. and mobility decreases physical function and the ability to engage in activities. of daily living such as walking climbing stairs getting in and out of a chair. lifting and carrying become increasingly difficult Education to dispel. common myths and misunderstandings regarding exercise and OA is critical. COMMON MISUNDERSTANDINGS,Myth There is nothing one can do with OA. Although there is no cure for OA proper exercise physical activities and. weight management strategies have been shown as effective treatments to. slow down the progression of joint damage and reduce the need for joint. replacement surgery People with most forms of arthritis can benefit greatly. from regular exercise Walking low impact aerobic exercise stationary cycling. and aquatic exercise have all been shown to be safe and effective in reducing. pain and improving joint mobility muscle strength aerobic capacity and. endurance Ottawa Panel 2005 More recently alternative exercises such as. yoga and Tai Chi have been shown to be helpful and safe in people with. arthritis Fransen et al 2003 Strong muscles help to stabilize affected joints. and reduce the impact forces through these and adjacent joints Radin Paul. 1971 Therefore a well designed exercise program may help to slow the. progression of the joint damage Finally many people with OA are overweight. which can be both a risk factor for developing the disease as well as a factor in. disease progression Bliddal Christensen 2006 Christensen et al 2007. Regular exercise can help individuals to maintain a healthy body weight and. reduce the impact and other joint stresses on the weight bearing joints. Myth Exercise makes my joint pain worse, Many people with OA do not exercise for fear of pain joint injury and.
worsening the condition This can lead to the cycle of reduced activity leading. to joint stiffness and muscle weakness altered biomechanics and increased. pain Together these contribute to decreased function and ability to perform. daily activities poor sleep patterns and fatigue reduced coping skills and. stress Regular exercise and physical activity can help to break this cycle and. contribute to less pain and a more active lifestyle. Myth I am too old to start exercising, Many older individuals have not formally exercised in many years and may feel. embarrassed or anxious about starting an exercise program especially if there. are much younger participants in the group Fitness professionals who work in a. group setting may encourage everyone to start slowly and monitor their body s. response to exercise It is useful to explain that some post exercise discomfort. is common when first starting a program that delayed onset muscle soreness. can occur in the untrained muscles and that this temporary and usually mild. discomfort differs from joint pain and flare ups made worse by exercise. BENEFITS AND RISKS OF EXERCISE, Exercise serves many important functions for individuals with OA including. improved physical function Fransen et al 2003 decreased joint swelling and. pain Fransen et al 2003 maintenance of cardiovascular status muscular. fitness and overall health weight loss and decreased depression and anxiety. Minor 2002 Exercise is rarely absolutely contraindicated in individuals with. OA People with the following unstable symptoms or conditions should carefully. weigh the risks and benefits of exercise with a treating physician Roddy et al. an acute febrile illness,a viral infection, history of pre existing cardiovascular disease including hypertrophic. obstructive cardiomyopathy significant aortic stenosis acute. myocarditis and exercise induced ventricular arrhythmia. At the same time exercise is inherently risky especially if a client overtrains. Signs of overtraining include, joint pain discomfort during the exercise session or pain that lasts more. than two hours after exercise and or exceeds pain severity before. increased joint swelling tightness immediately after or the day following. decreased range of motion,increased weakness, altered gait following participation in a weight bearing activity.
unusual or persistent fatigue, A well designed exercise program must be tailored to the individual s. current abilities and limitations to optimize safety and minimize the risk of the. making the condition worse For example clients should be taught to avoid. overexertion and extreme joint flexion balance rest and activity control. weight and eat sensibly and respect pain Stitik et al 2007 Individuals who. have undergone joint surgery for their OA should carefully follow the exercise. instructions and precautions provided by their surgeon and or physical. therapist A quality program also will center on the client s enjoyment and. satisfaction as long term exercise adherence is alarmingly low Hendry et al. 2006 and if exercise is not maintained its benefits eventually disappear. Pisters et al 2007,RECOMMENDATIONS FOR HEALTH SCREENING. The Initial Interview, The initial interview with a client offers an opportunity to assess the client s. commitment to exercise past health concerns and limitations relationship. with a physician and or physical therapist current understanding of OA and. exercise interests Several factors such as increased education history of. exercise participation a positive attitude towards exercise self efficacy. social support and perceived benefits increase the likelihood that a client will. adopt a regular exercise program while perceived frailty and poor health are. barriers Rhodes et al 1999 Using this information the fitness professional. can design an exercise program that highlights the client s strengths and. deemphasizes weaknesses and perceived limitations, Prior to starting an exercise program all clients should be screened for health. risks that prevent them from starting exercise One example of a screening tool. is the Pre Activity Readiness Questionnaire PAR Q Thomas et al 1992 The. PAR Q consists of seven questions Individuals who answer yes to one or more. questions should consult their family physicians prior to starting a fitness. In addition fitness professionals should ask their clients three critical questions. to ascertain readiness to participate in an exercise program. 1 Do you have any medical condition that could affect your participation in. an exercise program, It is important to confirm that the client has OA and not inflammatory arthritis.
such as rheumatoid arthritis RA If the individual complains of pain and or. swelling in three or more joints involvement of the small joints of hands or. feet and prolonged morning stiffness greater than 30 minutes Emery et al. 2002 he she should consult with the family physician before starting an. exercise program, Participants also need to know which joints are affected so that the fitness. Training Clients with Osteoarthritis Accompaniment to the online course developed by the American Council on Exercise in partnership with the Association of Rheumatology Health Professionals and the Arthritis Foundation INTRODUCTION Inflammation injury and pain of the joints muscles connective tissue and or soft tissues surrounding the bones and joints characterize over 100 rheumatologic

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