Lab 4Lab 4Older Adults and Older Adults and

OsteoarthritisOsteoarthritis

Mike LombardoMike Lombardo

Josh McDonaldJosh McDonald

KerryAnn SuteuKerryAnn Suteu

Osteoarthritis Osteoarthritis Defined asDefined as a degenerative joint condition characterized by deterioration of

the cartilaginous weight-bearing surfaces of articular joints, sclerotic changes in subchondral bone, and proliferation of new bone at the margins of joints. Osteoarthritis (OA) affects 1 in 10 Canadian adults and affects men and women at roughly the same rate. OA has been around for along time: dinosaur bones and Egyptian mummies show evidence of OA. (NSCA)

Factors that increase prevalence of Osteo Arthritis: Heredity - Joints do not always fit together properly or cushioning between bones is

not normal which are factors passed to you from your parents -Excess Weight - Too much weight puts a lot of added stress on your hips, knees,

and feet -Joint Injury - Joints which haven’t healed completely are at risk for OA -Complications of Another Type of Arthritis - OA can be caused from other types

of joint disease -Wear and Tear? - recent research shows that normal wear and tear on joints does

not directly cause OA, normal exercise is beneficial in preventing OA

Osteoarthritis continuedOsteoarthritis continued Medications that can help with Osteoarthritis: Analgesics - Acetaminophen (Tylenol®) is a pain reliever that can help with mild to

moderate along with prescription medications Creams and Gels - Topical creams such as Bengay Arthritis®, or Extra-Strength

Deep Heating® use heat and cold to distract the individual from pain Codeine - A narcotic which can reduce sensitivity to pain if acetaminophen is not

working enough. (Tylenol 3®) Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)- Reduce pain, stiffness and

swelling of the joints but do not prevent further joint damage. An example is acetylsalicylic acid (Aspirin®) and ibuprofen (Advil®).

Corticosteroids - Injections can be used when the arthritis progresses to the point that it is difficult to ambulate.

Osteoarthritis continuedOsteoarthritis continued

Absolute Contraindications:

Uncontrolled arrhythmia

Third degree heart block

Recent Electrocardiographic changes

Acute Myocardial Infarcation

Acute congestive heart failure

Relative Contraindications:

Cardiomyopathy Valvular heart disease

Poorly controlled blood pressure

Uncontrolled metabolic disease

Physical Activity Considerations for Physical Activity Considerations for Older Adults 55-65Older Adults 55-65

Physical Characteristics - A lot of problems are usually from disuse, and exercising can only make them better - Strength decreasing, therefore resistance training is critical - Flexibility is decreased, especially in little used joints. Causes include degeneration

of musculoskeletal and soft tissue as well as diseases like osteoarthritis and osteoporosis

- Balance is declined. Adults over 60 tend to sway more. Balance is declining because of vision changes, decrease of fast twitch muscle fibers, loss of strength and arthritic conditions in joints

Motivational Considerations - Some older adults suffer from depression, resistance training is beneficial for

enhancing self confidence. - Provide positive reinforcement for correct technique and provide specific feedback

and suggestions

PA Considerations continuedPA Considerations continued

Conditions common to older adults Propensity for injuries: - Should train only in uncluttered facilities - Should use controlled movement speeds - Emphasize proper posture

Reduced Flexibility: - Warm up well - Avoid extreme movement ranges such as lungs - Incorporate flexibility exercises

PA considerations continuedPA considerations continued

Seeing and Hearing: - Demonstrate exactly how the

exercise is performed - Trainers should speak clearly

with sufficient volume - Use large print materials - Often ask if they understand - Demonstrate breathing

techniques ie. Exhaling during lifting phase and inhaling during lowering phase

Exercise PrescriptionExercise Prescription Stage 1 – Warm UpStage 1 – Warm Up Teaching Aids : Leading by example, Verbal and visual descriptionsTeaching Aids : Leading by example, Verbal and visual descriptions Activity Description: 10 minute walk around the track with variations Activity Description: 10 minute walk around the track with variations

each minuteeach minute 1) Walk with big arm swings1) Walk with big arm swings 2) Big strides and arm swings side to side2) Big strides and arm swings side to side 3) High knees touching one hand to opposite knee3) High knees touching one hand to opposite knee 4)Hamstring curls with biceps curls4)Hamstring curls with biceps curls 5) Side steps (right) with shoulder abduction5) Side steps (right) with shoulder abduction 6) Side steps (left) with shoulder abduction and high reaches6) Side steps (left) with shoulder abduction and high reaches 7) grape vine (right) with horizontal ab/adduction (alternating sides)7) grape vine (right) with horizontal ab/adduction (alternating sides) 8) grape vine (left)8) grape vine (left) 9) with horizontal ab/adduction (both sides)9) with horizontal ab/adduction (both sides) 10) normal walk with arms in Y’s T’s and I’s10) normal walk with arms in Y’s T’s and I’s

Comments for Warm UpComments for Warm Up

Use the first 2 lanes of the trackUse the first 2 lanes of the track Those in wheelchairs are encouraged to Those in wheelchairs are encouraged to

wheel with the walkers – move legs in wheel with the walkers – move legs in chair if possiblechair if possible

Those using walking aids are encouraged Those using walking aids are encouraged to walk at their own speed – arm to walk at their own speed – arm movements will probably use smaller ROMmovements will probably use smaller ROM

Stage 2 – Exercises and ActivitiesStage 2 – Exercises and Activities

Teaching Aids:Teaching Aids: leading by exampleleading by example verbal and visual cues, verbal and visual cues, offering variations so all abilities are offering variations so all abilities are

includedincluded Exercises alternate upper/lower body to Exercises alternate upper/lower body to

allow for rest periods (1 min), allow for rest periods (1 min), Exercises approximately 60% 1 RMExercises approximately 60% 1 RM

Exercises and Activities continuedExercises and Activities continued

Part 1) Part 1) Cardio component : Cardio component : - 5 minute aerobic style - 5 minute aerobic style

class class

Exercises & Activities continuedExercises & Activities continued Part 2 – Resistance Part 2 – Resistance

ComponentComponent -15 min theraband -15 min theraband

(TB), body weight (BW) (TB), body weight (BW) or Tennis Ball (T) or Tennis Ball (T) resistance (10 reps X 1 resistance (10 reps X 1 set)set)

Exercises: Exercises: Chest Press (TB) Fig. Chest Press (TB) Fig.

2.212.21 Crunches (BW) Fig. Crunches (BW) Fig.

2.222.22

Exercises continuedExercises continued

Partner Seated Row (TB) Fig. 2.23Partner Seated Row (TB) Fig. 2.23 Chair Squats (BW) Fig. 2.24Chair Squats (BW) Fig. 2.24

Exercises ContinuedExercises Continued

Biceps Curls Biceps Curls (TB) Fig. 2.25(TB) Fig. 2.25

Hip abduction Hip abduction (BW/TB) Fig. (BW/TB) Fig. 2.262.26

Exercises ContinuedExercises Continued Triceps Extensions (TB) Fig. 2.27Triceps Extensions (TB) Fig. 2.27 Hip adduction (BW/TB) Fig. 2.28Hip adduction (BW/TB) Fig. 2.28

Exercises continuedExercises continued Tennis Ball Squeezes (T) Tennis Ball Squeezes (T)

Fig. 2.29Fig. 2.29Comments for Exercises:

-Those in wheelchairs and walking aids are encouraged to move within their comfort zone – use arm movements and try to move feet if possible

-Exercises may be performed from a seated or standing position to accommodate all participants

Warm DownWarm Down

Part 1 Tai Chi – 5 minutesPart 1 Tai Chi – 5 minutes Teaching aids : leading by example, verbal and Teaching aids : leading by example, verbal and

visual cues, offering variations so all abilities are visual cues, offering variations so all abilities are includedincluded

Exercises: Shoulder relaxation Fig. 3.11 (previous Exercises: Shoulder relaxation Fig. 3.11 (previous slide) slide)

Tai Chi continuedTai Chi continued Opening form squat Fig. 3.12Opening form squat Fig. 3.12 Swinging Arms Fig. 3.13Swinging Arms Fig. 3.13

Tai Chi continuedTai Chi continued Heaven & earth Fig. 3.14Heaven & earth Fig. 3.14 Parting the clouds Fig. 3.14Parting the clouds Fig. 3.14

Tai Chi & YogaTai Chi & Yoga Pushing Chi Fig. 3.16Pushing Chi Fig. 3.16 Yoga – 15 minutesYoga – 15 minutes Standing Knee squeeze Fig. 3.21Standing Knee squeeze Fig. 3.21

Yoga continuedYoga continued

Standing Balance Standing Balance Fig. 3.22Fig. 3.22

Tree Fig. 3.23 Tree Fig. 3.23

Yoga continuedYoga continued Warrior Fig. 3.24Warrior Fig. 3.24 Triangle Fig. 3.25Triangle Fig. 3.25

Yoga continuedYoga continued

Forward bent twist Fig. 3.26Forward bent twist Fig. 3.26 Boat Fig. 3.27Boat Fig. 3.27

Yoga ContinuedYoga Continued Sitting Spinal twist Fig. 3.28Sitting Spinal twist Fig. 3.28 Sitting forward bend Fig. 3.29Sitting forward bend Fig. 3.29

Yoga ContinuedYoga Continued

Downward Dog Fig. 3.210Downward Dog Fig. 3.210 Upward Dog Fig. 3.211Upward Dog Fig. 3.211

Yoga continuedYoga continued

CatCat Cow’s HeadCow’s Head

Yoga continuedYoga continued

Neck Stretches Fig. 3.213Neck Stretches Fig. 3.213 Hip loosener Fig. 3.214Hip loosener Fig. 3.214

Yoga continuedYoga continued

Savasana Fig. 3.215Savasana Fig. 3.215

Warm Down CommentsWarm Down Comments

All activities can be done standing, sitting All activities can be done standing, sitting in a chair or on the floor so all participants in a chair or on the floor so all participants are involved are involved

Tai Chi is used to relax the participants Tai Chi is used to relax the participants and move from the strength training to the and move from the strength training to the flexibility training componentflexibility training component

Flexibility exercises will be held from 10-30 Flexibility exercises will be held from 10-30 seconds eachseconds each

Challenge ActivityChallenge Activity

Relay RaceRelay Race Challenge: Challenge:

5 teams of 45 teams of 4 Preferably 2 guys and 2 girls per teamPreferably 2 guys and 2 girls per team In hangar, start on end line, one at a time run In hangar, start on end line, one at a time run

to half and then back, then next person goes to half and then back, then next person goes until everyone else is done. Losing teams do until everyone else is done. Losing teams do 10 push ups 10 push ups

ReferencesReferences Bryant, G., & James, L. (2003). Simply Tai Chi. Victoria, Australia:

Hinkler Books. Earle, Roger. Baechle, Thomas. (2004). NSCA’s Essentials of

Personal Training. Human Kinetics Getchell, N., Haywood, K.M. (2005). Life Span Motor Development

(4th Ed.). Champaign, Il. Edwards Brothers Kent, H., & Hayler, C. (2003). Beginner’s Guide to Yoga. London:

Axis Publishing. Kraemer, W., Adams, K,. Cafarelli, E., Dudley, G., Dooly, C.,

Feigenbaum, M., Fleck, S., Franklin, B., Fry, A., Hoffman, J., Newton, R., Potteiger, J., Stone, M., Ratamess, N. & Triplett-McBride, T. (2002). Progression Models in Resistance Training for Healthy Adults: Position Stand. American College of Sports Medicine, 364-380.

The Arthritis Society Canada. 2006. Living well with Arthritis