Transcript 投影片 1 - Hong Kong Medical Association

Exercise Prescription for Arthritis and
Rheumatological Problems
You & Your patient are supported
Common Conditions
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Degenerative Knees
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Degenerative Hips
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Shoulder Stiffness
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Painful back conditions
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Painful neck conditions
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Polyarthritis- seropositive / seronegative
Associate Problems
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Lower limb
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Wasting of the thigh and leg
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Stiffness
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Obesity
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Home bound and dependent
Upper limb
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Stiffness
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Impaired self care and dependent
Spine
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Stiffness
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Impaired sitting and standing tolerance
Disease related
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Neuropathy
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medications
Worry of exercise in Osteoarthritis
Increased physical activity exaggerate joint symptoms ?
Rejected by studies
Benefit of exercise in osteoathritic conditions
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Alleviate pain, improve physical fitness, improves quality
of life
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Better ambulatory status
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Less dependent
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Self confidence
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Social integration
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Avoid unnecessary medications
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Defer surgical need
Classic teaching - recommended activities
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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
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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
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2001 June Consensus practice recommendations
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Initial Evaluation & Assess
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Pain severity
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Physical impairments
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Physical disabilities
Check
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Medically stable
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Without joint laxity
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Willing to exercise
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Exercise prescription
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Re-evaluate at 4 wks
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Monitor at 4-6 months, Encourage increasing physical activities
Exercise dose - Start
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Golden rules
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Assess
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Effectiveness
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motivation
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Accessibility
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Family & Community
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Safety
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PAR-Q/med-X
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Individualised
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Problem orientated
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Enjoyment
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Enjoyment
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Regular evaluation
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Achievements &
reinforcement
Components
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Warm-up
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Gentle flexibility
Conditioning
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Aerobic activity
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Strength-training
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Static muscle stretching
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Cool-down
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Progression
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Initial, improvement, maintenance
Exercise prescription plan
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Flexibility
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Initial
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Ultimate 3-5 stretches, hold 20-30 sec
Aerobic exercise
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hold 5-15 seconds
20-30 minutes/day, 3-4 /wk
Strength-training exercise
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Isometric
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hold <6 sec, 20sec rest period, daily
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Useful in acute phase
Isotonic
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6-15 repetitions, 2-3 / wk
Programme For Osteoarthritis
Programme For Osteoarthritis
Safe Play
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Low back conditions
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Avoid or minimise exercise that precipitates or exasperates
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forced extreme flexion, extension, and violent twisting,
correct posture, proper back exercise
Osteoporosis
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Avoid exercise with high risks for fracture
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Push-ups, curls-ups, vertical jump and trunk forward
flexion,
Engage in low-impact weight-bearing activities and
resistance training
Safe Play
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Arthritis – acute ( infective, rheumatoid, gout)
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Arthritis – subacute
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Treatment, plus judicious blend of rest, splinting and gentle
movement
Progressive increase of active exercise therapy
Arthritis – chronic ( osteoarthritis )
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Maintenance of mobility and strength, non-weight bearing
exercises to minimise joint trauma ( e.g. cycling, aquatic
activity etc.)
My practice
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Find out the obstacles
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Support
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Companion
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Family
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Skills
Set the goal (phase approach)
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Enjoyment
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Achievable
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The rose garden
Caution about the fluctuations
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Occasional attack of inflammations
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Ways to deal with it
Upper limbs
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Stress
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Shoulder Range of Motion
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Active
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Active assisted
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passive
Balance muscle training
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Multiple directions
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Static
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dynamic
Knees
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Stress
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Full Range of motion, especially full extension
Mild pain
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Active ROM, 10 rep
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Flexibility and static exercise, 10 rep x 6 sec
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Dynamic exercise, Quads & Hamstring 10 rep
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Low-impact activities 20 min, 3x/wk
Backs
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Stretching
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Pectorals, back extensors, hamstrings, psoas
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Active ROM ex 10 x /day
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Dynamic ex
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Trunk & hip muscle 5-8 rep
Aerobic ex
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20 min 3 x /wk
Issues of different exercise
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Brisk walk, Jogging
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Swimming
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Aerobic dance
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TaiChi
Brisk walk, jogging, hiking
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Preparation
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Park, podium, gym
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Surface, terrain
Shoe wear, clothing
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Warm up
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Pacing
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Warm-down
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Issues of knee brace
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Advise on control of flare up
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Caution about the yellow flag
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Increase swelling, morning stiffness
Swimming
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Swimmer vs. Non-swimmer
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Community resources
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Hydro exercise vs. lap-swimming
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Style
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Breast stroke – Knee ROM required
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Free style – Shoulder Rom required
Taichi
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Proved to be good in aerobic ability, muscle strength &
Balance
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Community resource
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Demanding on
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Knees
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Co-ordination
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Stress on the need of warm up
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Stress enjoyment
Osteoarthritis
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Individualized treatment
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Comorbid conditions
Patient's needs and
expectations
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Types of treatment
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Non-pharmacological
 Patient education
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Exercise Therapy
Assistive devices
PT & OT
Weight management
Supplements
Pharmacological
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Simple analgesics
NSAID
COX-2 inhibitor
Local analgesics
Intra-articular corticosteroid
Intra-articular hyaluronic acidlike
product
Surgery
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Arthroscopic debridement or joint
lavage
Osteotomy for mal-alignment of the
knee or hip
Arthroplasty
Important charts
“Supplementary Information on
Writing an Exercise Prescription”