Exercise for Osteoporosis and Arthritis Based on ACE CPT Textbook & NSCA CPT Textbook © 2018 NPTI Colorado  | Slide 1 | Revision 7 (6/17/18) DM

Lecture Objectives Students should be able to: Define and describe osteoporosis and arthritis. Describe the physical and functional limitations to exercise for clients with osteoporosis and arthritis. Describe how to modify program design for clients with osteoporosis and arthritis.

Osteoporosis Osteoporosis is a skeletal disorder characterized by low bone mineral density and deterioration in bone microarchitecture resulting in structural weakness. Most common fracture sites: Proximal femur (hip) Vertebrae Distal forearm (wrist) Affects more women than men

Osteoporosis Osteopenia: Having low bone mass, a less severe condition of low bone density Possible precursor to osteoporosis

Osteoporosis Bone density can be affected by: Sex and Age Genetics Menopause Genetics Physical inactivity Nutrition Vitamin D and Calcium deficiencies Smoking Alcohol consumption

Exercise for Osteoporosis Weightbearing exercises and resistance training are keys in the prevention of osteoporosis Enhances peak bone mass during growth and development Slows the rate of bone loss during aging Muscle strength and the ability to balance reduces the risk of falling

Exercise for Osteoporosis For individuals at risk for osteoporosis, exercise programming should aim to preserve bone health: Moderate-to-vigorous intensity aerobic exercise on 3-5 days/week Moderate-to-vigorous intensity resistance training on 2-3 days/week Jogging, jumping, and plyometric exercises Higher-intensity strength-training (8-RM) may be most beneficial

Exercise for Osteoporosis For individuals with osteoporosis, exercise programming should aim to prevent disease progression: Moderate intensity aerobic exercise on 3-5 days/week Moderate intensity resistance training on 2-3 days/week Jogging, walking, stair-climbing, aquatic, and other exercises as tolerated

Exercise for Osteoporosis To prevent further injury and falls, some clients may need to avoid: Spinal flexion, crunches, and rowing machines Jumping and high-impact aerobics Trampolines and step aerobics Abducting or adducting the legs against resistance Pulling on the neck with hands behind the head

Exercise for Osteoporosis

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Arthritis Osteoarthritis (most common type): Degenerative joint disease Leads to deterioration of cartilage and development of bone spurs at joint edges Results from overuse, trauma, obesity, aging

Arthritis Rheumatoid arthritis (most crippling type): A chronic and systematic inflammatory disease; classified as an autoimmune disorder Affects more women than men Characterized by joint pain, swelling, stiffness, and contractures

Arthritis The primary goals for an exercise program for clients with arthritis: Improve cardiovascular fitness and lower CVD risk Increase muscular strength and endurance Improve range of motion and flexibility around the affected joint(s)

Arthritis Additional benefits of exercise: Improved daily function and associated quality of life Improved psychosocial well-being Decreased pain and stiffness Improved neuromuscular coordination

Arthritis Exercise guidelines are consistent with that of healthy individuals but should consider the client’s: Pain Stability Functional limitations Always warm up and cool down Very-light-to-moderate intensities is an appropriate starting point Activities with low joint stress are ideal (aquatic vs. weight-bearing, walking vs. running) Flexibility training should be performed daily

Arthritis Avoid exercising during flare-ups Schedule exercise during the time of day when client experiences the least discomfort Choose shock absorbent footwear During aquatic exercise, water should be warm

Arthritis People experiencing chronic pain and inflammation shy away from physical activity, thereby causing their health to spiral downward. Significant deconditioning Diminished muscular strength and endurance Joint weakness Personal trainers should work with client’s physician and/or physical therapist.

Arthritis Condition Mode Intensity Frequency Duration Comments Non-weightbearing or non-impact activities such as elliptical training, cycling, warm- water aquatic exercise, and swimming. Include recreational activities such as golf, gardening, table tennis, or bowling. Isometric exercises may strengthen the joint structures and surrounding muscle while placing less stress on the joint itself. Low-intensity, low- impact dynamic exercise rather than high-intensity, high- impact activities. Generally, the intensity should be in the 9 to 15 RPE range (6 to 20 scale). Strength training should focus on increasing the number of repetitions rather than increasing the weight being lifted. Clients can gradually increase repetitions from two or three to 10 to 12.   Three to five times per week. Prolonged and gradual warm-up and cool-down periods (greater than 10 minutes). Clients can begin initial exercise sessions at 10 to 15 minutes and gradually progress to 30 minutes. Some individuals may require intermittent exercise with shorter durations, at least initially. Put all joints through their full range of motion at least once a day to maintain mobility. Individuals with rheumatoid arthritis should not exercise during periods of inflammation, and regular rest periods should be stressed during exercise sessions. Clients who are still experiencing pain or joint discomfort more than two hours after a workout should have the exercise intensity reduced.

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