Osteoarthritis Exercise Prescription

Exercises For Arthritis

 

Osteoarthritis, also known as a degenerative joint disease, is the most common form of arthritis in adults, and because of this prevalence it is important to understand what the condition is (2).  Along with knowing how it is developed and managed through the implementation of exercise programs, specialist inputs, and pharmacotherapies.   This condition is divided into two categories, primary osteoarthritis and secondary osteoarthritis (2).  Primary osteoarthritis is developed through the overuse and aging of the synovial tissue of the joints.  While secondary osteoarthritis is caused by heredity, obesity, and injury of the joint.  The main tissue damaged from osteoarthritis is the articulating cartilage of the various joints, and if worn down severely can lead to a change in subchondral bone density, along with development of bone spurs otherwise known as osteophytes.  These changes are due to the activity of the hyper activity of the chondrocytes within the cartilage.  This activates the production of both matrix proteins and matrix-degrading enzymes that leads to an irreversible destruction of the collagen network within the affected joints (6).  Osteoarthritis is not yet a curable disease, but symptoms can be well managed with proper treatment.  The goal of therapy is to reduce clinical signs, with the therapeutic spectrum ranging from physiotherapy and orthopedic aids to pharmacotherapy and surgery. There are many limitations and precautions to consider when designing and training individuals with osteoarthritis. One of the biggest issues of osteoarthritis is its ability to affect all of the joints of the body causing them to become painful, inflamed, and stiff (6).   Generally, the pain develops gradually over time, although sudden onset is also possible. The joint may also become stiff and swollen, making it difficult to perform flexion and extension, with symptoms being worse in the morning so exercise should be performed later in the day (3).  When determining if a client with osteoarthritis is safe to exercise it is always a good idea to have them consult their personal care physician on whether or not they should pursue this as a treatment option (3).  Due to the bone spurs and subchondral bone change these changes can reduce the client’s range of motion in the affected join from pain and inflammation (2).  Clients with osteoarthritis should also be provided with an extended warmup and cooldown period to allow the joints and muscles time to warm up which will increase the muscle’s elasticity with the main goal of preventing injury and reducing pain (3).  This can also be done through the use of heat wraps or pads.  Exercise should be directed on a symptom limited basis relying on the individual’s rating of perceived exertion to determine their level of exertion (3).  Prior to exercise it would be a good idea to ask about their current pain level and if they would prefer to avoid certain exercises.  When considering the impact of weight-bearing activity on the joint tissues there is a dominant focus on cartilage as this pertains to osteoarthritis.  Exercise has been a central component of any effort to conservatively manage osteoarthritis, with exercise being prescribed to facilitate weight loss, preserve joint range of motion, improve strength and functional performance, and improve overall cardiorespiratory fitness (2).  An exercise program for the treatment of a patient with Osteoarthritis would be composed of three major components.  These three components include aerobic training, resistance training, and flexibility training. Here is an in depth look into an example of a typical aerobic exercise program for osteoarthritis patients.  For aerobic training, the individual’s should be recommended to exercise at least 150 minutes per week between 3 and 5 days per week at an intensity of 40%-60% HRR, or at an RPE of 8-13 (1).  There are many options for these patients in terms of exercise, but they should do their best to limit it to low-impact exercises only.  Such exercises would include walking, cycling, swimming, and rowing.  Swimming is especially helpful for patients with Osteoarthritis due to the buoyancy it provides.  This takes a huge percentage of pressure off of the joints, providing a fantastic means for joint pain relief.  For this, specialists and clients must have access to a facility with a pool that is preferably heated to better facilitate joint movement (2).   Cycling machines can similarly unload the lower joints of the body and keep them stable while exercising through a large range of motion. The reasoning behind the promotion of low-impact exercise is that it will encourage the benefits of exercise whilst avoiding the potentially damaging influences of high-impact activities (1, 2, 3).  For this component of exercise training, the exercise physiologists will need access to a facility with an open space such a gym, or equipment to simulate that space such as a treadmill to allow the clients a way to perform their designated exercises. Resistance training is also necessary, due to the fact that the improved muscle strength will improve joint stability which will also reduce joint pain.  A typical resistance training program for these individuals normally should be performed 2 to 3 days per week, at an intensity of 40% to 60% 1 repetition maximum for 2 to 4 sets of 10 to 15 repetitions (1, 2, 3).  Patients should also attempt to perform isometric exercises on a daily basis at 40% to 60% maximum voluntary contraction for 1 to 6 seconds for all of the major muscle groups (1 & 3).  Proper resistance training will require proper equipment.  This equipment could include barbells, dumbbells, resistance bands, and benches.  The facility does not need to be large, but is helpful to create an environment suitable for multiple clients and specialist. The last, but certainly not least important component is flexibility.  Making sure the patient maintains or improves joint range of motion is vital for boosting their ability to perform activities of daily living efficiently and as pain free as possible (3).  Patients should attempt to do flexibility training daily if possible due to the many great benefits it provides (1).  Flexibility exercises should be performed after a warm-up involving dynamic movements such as walking.  Patients will be directed on how to stretch along with being guided on what sensations they should feel within the areas being stretched.  They should stretch until they feel stiffness or slight discomfort, and hold that position for 30 to 60 seconds, with the goal of being able to stretch each major muscle-tendon unit for 60 seconds each (1).  Together these components provide a means for being the best non-drug treatment of osteoarthritis.

12 WEEK OSTEOARTHRITIS EXERCISE PROGRAM (1 & 3):

Exercise Prescription: Aerobic training Week 1 & 2 Week 3 & 4 Week 5 & 6 Week 7 & 8 Week 9 & 10 Week 11 & 12
Frequency: 3 days per week 3 days per week 4 days per week 4 days per week 5 days per week 5 days per week
Intensity: 40% HRR

RPE:8-9

45% HRR

RPE:9-10

50% HRR

RPE:10-11

55% HRR

RPE:11-12

60% HRR

RPE:12-13

60% HRR

RPE:12-13

Time: 3×10 min sessions 3×15 min sessions 3×10 min sessions 3×15 min sessions 3×10 min sessions 2×15 min sessions
Type: Low-impact: Walking/

cycling/ rowing/ swimming

Low-impact: Walking/

cycling/ rowing/ swimming

Low-impact: Walking/

cycling/ rowing/ swimming

Low-impact: Walking/

cycling/ rowing/ swimming

Low-impact: Walking/

cycling/ rowing/ swimming

Low-impact: Walking/

cycling/ rowing/ swimming

Exercise Prescription: Resistance training Week 1 & 2 Week 3 & 4 Week 5 & 6 Week 7 & 8 Week 9 & 10 Week 11 & 12
Frequency: 2 days per week 2 days per week 2 days per week 3 days per week 3 days per week 3 days per week
Intensity: 40% 1RM 40% 1RM 50% 1RM 50% 1RM 60% 1RM 60% 1RM
Time: 2 sets  

12 reps

2 sets

15 reps

2 sets

12 reps

3 sets

10 reps

3 sets

10 reps

3 sets

12-15 reps

Type: 8 different exercises to work all major muscle groups 8 different exercises to work all major muscle groups 9 different exercises to work all major muscle groups 9 different exercises to work all major muscle groups 10 different exercises to work all major muscle groups 10 different exercises to work all major muscle groups
Exercise Prescription: Flexibility training Week 1 & 2 Week 3 & 4 Week 5 & 6 Week 7 & 8 Week 9 & 10 Week 11 & 12
Frequency: 5 days/week 5 days/week 6 days/week 6 days/week 7 days/week 7 days/week
Intensity: Stretch until stiff or slight discomfort Stretch until stiff or slight discomfort Stretch until stiff or slight discomfort Stretch until stiff or slight discomfort Stretch until stiff or slight discomfort Stretch until stiff or slight discomfort
Time: 3 sets

20 seconds

3 sets

20 seconds

2 sets

30 seconds

2 sets

30 seconds

1 sets

60 seconds

1 sets

60 seconds

Type: All major muscle-tendon units All major muscle-tendon units All major muscle-tendon units All major muscle-tendon units All major muscle-tendon units All major muscle-tendon units

 

Many different specialists play key roles in the development and outcomes of a good osteoarthritis exercise prescription.   In order to accurately design an exercise treatment program for these individuals, various tests must be performed to obtain a baseline for where they are at currently, and to know what needs to be improved (3).  Exercise physiologists play a huge role in this process by testing the individual’s cardiorespiratory fitness (3).  Some of the tools used to obtain this information include treadmills, cycle ergometers, Goniometers, electrocardiograms, and gait analysis to determine how efficiently a patient’s body is operating (1 & 3).  Other specialists involved with the treatment of individuals with osteoarthritis would include Shoe specialists, Physical Therapists, and Occupational Therapists (1).  Shoe specialists will provide patients with suggested inserts, or new shoes that will provide proper shock absorption during impact exercises (1).  Physical therapists also assist in the treatment of osteoarthritis by teaching patients about proper posture, and how to use tools such as canes and walkers.  Along with, suggesting environmental changes that may promote a safer and more functional home (5).  Another specialist involved in the treatment of osteoarthritis would be the occupational therapist.  They work with the patient to determine what that individual enjoys doing, and if they cannot do that activity due to the arthritis, the occupational therapist determines the strengths and weaknesses in their patient, and uses that knowledge to create a plan to correct the weaknesses if possible or using their strengths to overcome their weaknesses.  They will do this by providing the patient with suggestions on environmental changes that would be more beneficial such as furniture location, office accessories, along with teaching them how to recognize situations that would lead to further harm (4).  All of these specialists play major roles in the treatment of the patient with osteoarthritis. 

As stated previously, medicine does not cure osteoarthritis or slow down the time in which cartilage breaks down. The goal of taking medicine is to reduce the pain and inflammation as best as possible. These medications come in a wide variety of types including steroid injections, ointments, and most commonly the pill.  NSAIDs and analgesics relieve pain and inflammation, and are the first type of medications recommended for patients with osteoarthritis (3).  Some of these medications include ibuprofen, naproxen, and aspirin (2). Capsaicin, which is a pepper extract that helps relieve joint and nerve pain. It is applied around the affected area, and is sold over the counter just like the previously mentioned medications.  Another type of drug that helps deal with pain caused by osteoarthritis is tramadol.  It is a narcotic which relieves pain by dulling the senses. These drugs require a prescription from a doctor because narcotics can be addictive.  These medications are useful tools in the management of osteoarthritis pain.

Osteoarthritis is one of the diseases with the highest rates of comorbidity, which means that patients with osteoarthritis are likely to have other conditions that are either caused by osteoarthritis or influenced by its development.  Some of these diseases include hypertension, cardiovascular disease, respiratory diseases, and diabetes.  One of the main reasons for other diseases to develop is due to the pain caused by osteoarthritis.  This pain can lead to a more sedentary lifestyle due to the negative feedback loop of pain from moving reduces physical activity, with this (2 & 3). Individuals who are overweight or obese have a higher risk of developing osteoarthritis from the stress and pressure this creates within the joints.  The pain from the joints can lead to stress, another factor that boosts the risk of developing hypertension (3). Due to the potential for an increase in sedentary lifestyle due to pain, people may search for food as a comfort leading to increased blood glucose levels to then cause the development of type 2 diabetes.  Osteoarthritis is a painful, yet manageable disease that can cause many other debilitating conditions. Exercise is a great tool for the management of osteoarthritis and should be the first step to any osteoarthritic treatment plan due to the numerous health benefits provided by it.  Even though the risk for osteoarthritis development increases as people age, there are still many things that can be done through the management of physical activity and diet that can extend the amount of time before someone develops the condition. 

 

Works Cited

  1. Pescatello, Linda S., Ross Arena, Deborah Riebe, and Paul D. Thompson, editors. ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed., Baltimore, MD, Lippincott Williams & Wilkins, 2014, pp. 260-63.
  2. Durstine, J L., Geoffrey E. Moore, Patricia L. Painter, and Scott O. Roberts, editors. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. 3rd ed., Champaign, IL, Human Kinetics, 2009, pp. 259-64.
  3. O’Grady, Michael. “Exercise Prescription For Older Adults With Osteoarthritis Pain: Consensus Practice Recommendations.” American Geriatrics Society Panel on Exercise and Osteoarthritis, vol. 49, no. 6, June 2001, pp. 808-23, agingblueprint.org/wers/2014/12/oae_guidelines.pdf. Accessed 8 Apr. 2017.
  4. “The Role of the Occupational Therapist in the Management of Rheumatic Disease.” American College of Rheumatology, American College of Rheumatology, 2015, www.rheumatology.org/I-Am-A/Patient-Caregiver/Health-Care-Team/Occupational-Therapist. Accessed 10 Apr. 2017.
  5. Fransen, M, J Crosbie, and J Edmonds. “Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.” The Journal of Rheumatology, vol. 28, no. 1, 1 Jan. 2001, pp. 156-64, www.jrheum.org/content/28/1/156. Accessed 10 Apr. 2017.
  6. Loeser, Richard F., Steven R. Goldring, Carla R. Scanzello, and Mary B. Goldring. “Osteoarthritis: A disease of the joint as an organ.” Arthritis & Rheumatism, vol. 64, no. 6, June 2012, pp. 1697-2054, doi:10.1002/art.34453, onlinelibrary.wiley.com/doi/10.1002/art.34453/full#footer-citing. Accessed 14 Apr. 2017.

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