1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 5 Resistance-Training Strategies for Individuals with Osteoarthritis

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Osteoarthritis Overview Chronic, degenerative joint disease Primarily affects lower extremity weight- bearing joints –E.g., hips, knees, spine Involves progressive breakdown of joint cartilage and decreased synovial fluid Review sample 24-Week Program

3. 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

4. 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

5. 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

6. 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

7. 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

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Osteoarthritis Primarily affects lower extremity, weight- bearing joints of hips, knees, and spine –May also affect hands, feet, elbows, and shoulders “Firm” joint swelling due to bone/cartilage overgrowth

9. 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

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Well-Developed Training Goals Significant Measurable Attainable Specific to the individual Time-limited

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Muscle Action Isometric –No change in muscle length

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Training Frequency Three days per week for untrained individuals with osteoarthritis See sample 24-Week Program