Chapter 5 ResistanceTraining Strategies for Individuals with Osteoarthritis

Osteoarthritis Overview • Chronic, degenerative joint disease • Primarily affects lower extremity weightbearing joints

Osteoarthritis Overview • Causes pain during weight-bearing activities • Results in disuse/atrophy of regional

Prevalence of Osteoarthritis • Nearly 40 million Americans have arthritis – By 2020, number

Prevalence of Osteoarthritis • • Most people ages 45 to 65 Affects all ethnic/demographic

Prevalence of Osteoarthritis • Leading cause of work-related disability – Particularly over age 65

Economic Impact of Osteoarthritis • Total annual cost in US estimated at $15. 5

Etiology of Osteoarthritis • Primarily affects lower extremity, weightbearing joints of hips, knees, and

Etiology of Osteoarthritis • Breakdown of joint cartilage puts bones in contact with each

Etiology of Osteoarthritis • • Progression varies among individuals Joint damage irreversible Symptoms may

Contributing Risk Factors • Age • Obesity • Joint injuries due to sports or

Benefits of Resistance Training • Reduces pain/disability by improving muscle strength, stability, ROM of

Research Supports Resistance Training • Numerous studies show improvements in strength, gait speed, and

Individuals’ Behavioral Challenges to Resistance Training • • Sedentary lifestyle Anxiety or depression Unrealistic

Strategies to Overcoming Barriers • Educate on specific, customized benefits of training • Be

Well-Developed Training Goals • • • Significant Measurable Attainable Specific to the individual Time-limited

Program Design Considerations • “Optimal” exercise regimen still undetermined • Both resistance training and

Program Design Considerations • Must include strategies to maintain program • Evidence does not

Exercise Testing Considerations • Perform preprogram evaluation • Perform physician-supervised stress test for individuals

Exercise Testing Considerations • Alternately, prescreen for contraindications and require comprehensive physical and physician’s

Exercise Training Considerations • Consider individual variation in manifestation of joint pain, restricted ROM,

Exercise Training Considerations • Remain flexible to accommodate individual needs, health, and exercise status

Types of Muscle Action • CON – Shortening of muscle – Produce lowest maximal

Types of Muscle Action • Isometric – No change in muscle length Copyright ©

Program Components • Use combination of open- and closed-chain exercises within pain-free ROM •

Program Components • Include isometric exercises to: – Maximize muscle activation – Minimize joint

Exercise Selection • Multiple sets of 8 to 12 RM are ideal – May

Exercise Selection • Multi-joint exercises more demanding on nervous system and more effective at

Exercise Sequence • Maximize training stimulus while minimizing fatigue • Begin with multi-joint movements

Training Frequency • Time between sessions must allow for muscular adaptation and recuperation while

Training Frequency • Three days per week for untrained individuals with osteoarthritis • See

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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.

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 • • 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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 • • Progression varies among individuals Joint damage irreversible Symptoms may be intermittent Disability more common when disease affects spine, knees, or hips Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Contributing Risk Factors • Age • Obesity • Joint injuries due to sports or work-related activity • Nerve injury • Lack of physical activity • Genetics Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Individuals’ Behavioral Challenges to Resistance Training • • Sedentary lifestyle Anxiety or depression Unrealistic goals Harboring perceived barriers to exercise that psychologically prevents from training Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Exercise Testing Considerations • Perform preprogram evaluation • Perform physician-supervised stress test for individuals over age 50 – If individual able Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Exercise Testing Considerations • Alternately, prescreen for contraindications and require comprehensive physical and physician’s clearance • Assess capacity using 1 RM strength assessment Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Types of Muscle Action • CON – Shortening of muscle – Produce lowest maximal torques • ECC – Lengthening of muscle – Produce greatest maximal torques Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.