Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 5 Resistance-Training...
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Transcript of Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 5 Resistance-Training...
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chapter 5
Resistance-Training Strategies for Individuals with Osteoarthritis
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
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
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, weight-bearing 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.
Well-Developed Training Goals
• Significant
• Measurable
• Attainable
• Specific to the individual
• Time-limited
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.
Types of Muscle Action
• Isometric– No change in muscle length
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