Transcript Chapter 5 - Delmar Cengage Learning

Chapter 5
Resistance-Training Strategies for
Individuals with Osteoarthritis
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Osteoarthritis Overview
• Chronic, degenerative joint disease
• Primarily affects lower extremity weightbearing joints
– E.g., hips, knees, spine
• Involves progressive breakdown of joint
cartilage and decreased synovial fluid
• Review sample 24-Week Program
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Osteoarthritis Overview
• Causes pain during weight-bearing
activities
• Results in disuse/atrophy of regional
muscles
– Lax ligaments
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Prevalence of Osteoarthritis
• Nearly 40 million Americans have arthritis
– By 2020, number increases to 59.4 million
– By 2030, number increases to 67 million
• Approximately 21 million Americans have
osteoarthritis
– Most common form of arthritis
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Prevalence of Osteoarthritis
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Most people ages 45 to 65
Affects all ethnic/demographic groups
Annually, 480,000 new cases diagnosed
Younger adults may have symptomatic knee
or hip osteoarthritis
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Prevalence of Osteoarthritis
• Leading cause of work-related disability
– Particularly over age 65
• Causes more dependency in walking, stair
climbing, and lower extremity activity than
other diseases
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Economic Impact of Osteoarthritis
• Total annual cost in US estimated at $15.5
billion
• Per individual, six-month costs estimated at
$2,856
– Excludes cost of comorbid conditions
• Quality of life and social costs
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Osteoarthritis
• Primarily affects lower extremity, weightbearing joints of hips, knees, and spine
– May also affect hands, feet, elbows, and shoulders
• “Firm” joint swelling due to bone/cartilage
overgrowth
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Etiology of Osteoarthritis
• Breakdown of joint cartilage puts bones in
contact with each other
– Causing pain
• Exact etiology unclear, but may be related to:
– Excessive biomechanical loading from injury, accident,
or overuse
– Abnormal biomechanical properties of joint tissues
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Osteoarthritis
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Progression varies among individuals
Joint damage irreversible
Symptoms may be intermittent
Disability more common when disease
affects spine, knees, or hips
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Contributing Risk Factors
• Age
• Obesity
• Joint injuries due to sports or work-related
activity
• Nerve injury
• Lack of physical activity
• Genetics
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Benefits of Resistance Training
• Reduces pain/disability by improving
muscle strength, stability, ROM of joints,
and aerobic fitness
• Used regularly, can significantly reduce
pain at rest, at night, and during functional
activities (i.e., walking, stairs, bending)
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Research Supports Resistance
Training
• Numerous studies show improvements in
strength, gait speed, and stair climbing
• Setting appears unimportant
– Group and individual programs equally effective
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Individuals’ Behavioral Challenges
to Resistance Training
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Sedentary lifestyle
Anxiety or depression
Unrealistic goals
Harboring perceived barriers to exercise
that psychologically prevents from training
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Strategies to Overcoming Barriers
• Educate on specific, customized benefits of
training
• Be alert for statements that reveal perceived
barriers
• Develop realistic, attainable training goals
with individual
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Well-Developed Training Goals
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Significant
Measurable
Attainable
Specific to the individual
Time-limited
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Program Design Considerations
• “Optimal” exercise regimen still
undetermined
• Both resistance training and aerobic exercise
reduce pain and improve function in patients
with knee and/or hip osteoarthritis
• Must promote positive lifestyle changes that
include increases in overall physical activity
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Program Design Considerations
• Must include strategies to maintain program
• Evidence does not support link between
weight loss and pain reduction
• Severity of disease progression does not
seem to predict effectiveness of exercise
intervention
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Exercise Testing Considerations
• Perform preprogram evaluation
• Perform physician-supervised stress test for
individuals over age 50
– If individual able
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Exercise Testing Considerations
• Alternately, prescreen for contraindications
and require comprehensive physical and
physician’s clearance
• Assess capacity using 1 RM strength
assessment
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Exercise Training Considerations
• Consider individual variation in
manifestation of joint pain, restricted ROM,
muscle weakness, and endurance
• Avoid further injuring affected joint(s)
through compressive or shearing forces
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Exercise Training Considerations
• Remain flexible to accommodate individual
needs, health, and exercise status
• Identify present and past fitness activity
levels to determine modes of training that
lead to compliance
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Types of Muscle Action
• CON
– Shortening of muscle
– Produce lowest maximal torques
• ECC
– Lengthening of muscle
– Produce greatest maximal torques
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Types of Muscle Action
• Isometric
– No change in muscle length
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Program Components
• Use combination of open- and closed-chain
exercises within pain-free ROM
• Select exercise ROM that avoids excessive
shear or compression
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Program Components
• Include isometric exercises to:
– Maximize muscle activation
– Minimize joint compression and shearing forces
• Make goal activities consistent with muscle
actions articulated during training
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Exercise Selection
• Multiple sets of 8 to 12 RM are ideal
– May take four to eight weeks to achieve for those with
osteoarthritis
• Single-joint exercises generally safer
– But produce slower strength gains
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Exercise Selection
• Multi-joint exercises more demanding on
nervous system and more effective at
increasing overall body strength
• Individual may need to progress to multi-joint
exercises over time to achieve training goals
• No exercises currently exist for upper
extremity osteoarthritis
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Exercise Sequence
• Maximize training stimulus while
minimizing fatigue
• Begin with multi-joint movements
involving large muscle groups
• Follow with single-joint exercises involving
small muscle groups
• Three to five minutes rest between sets
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Training Frequency
• Time between sessions must allow for
muscular adaptation and recuperation while
minimizing injury due to overtraining
• Two days per week for trained individuals
with osteoarthritis
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Training Frequency
• Three days per week for untrained
individuals with osteoarthritis
• See sample 24-Week Program
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.