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

2. 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.

3. 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

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

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

6. 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

7. 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

8. 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

9. 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

10. Exercise for Osteoporosis

11. Any questions?

12. 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

13. 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

14. 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)

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

16. 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

17. 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

18. 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.

19. 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.

20. Any questions?