L9b: Exercise Prescription for Osteoarthritis

Question 1

~8% of Australians reported to have _____ in 2007

Answer 1

OA

Question 2

Knees, followed by hips, are the most commonly affected _______ joints

Answer 2

OA

Question 3

____ is the dominant symptom for OA

Answer 3

Pain

Question 4

______ does not adversely affect joint pain in most older people with OA

Answer 4

Exercise

Question 5

What are 6 clinical observations for OA?

Answer 5

1. Focal destruction of articular cartilage
2. Changes in subchondral bone structure
3. Formation of osteophytes (bony spurts)
4. Joint space narrowing
5. Micro-fractures
6. Joint swelling

Question 6

Severity of _____ does not correlate strongly with the structural changes observed in x rays for OA.

Answer 6

pain

Question 7

______ should not be viewed as a contraindication for exercise participation

Answer 7

Pain

Question 8

What are 5 symptoms of OA?

Answer 8

1. Pain
2. Joint stiffness
3. Instability
4. Swelling
5. Muscle weakness

Question 9

What are 4 disabilities of OA?

Answer 9

Physical and psychological disabilities and impaired quality of life

1. Physical
2. Psychological
3. ↓ QoL
4. Difficulty performing ADLs

Question 10

What are 4 co-existing morbidities?

Answer 10

1. Obesity
2. Heart disease
3. Hypertension
4. Diabetes

Question 11

What is the result of OA?

Answer 11

Majority of older people with OA do not achieve recommended levels of physical activity

Question 12

_______ considered the cornerstone of conservative management for OA

Answer 12

Exercise therapy

Question 13

Both ________ and _______ exercise can reduce pain and improve function and health status in OA.

Answer 13

strengthening; aerobic

Question 14

______ should be individualised and patient-centred taking into account factors in OA.

Answer 14

Exercise therapy

Question 15

To be effective, _______ should include advice and education to promote a positive lifestyle change with an increase in physical activity in OA.

Answer 15

exercise program

Question 16

In OA, _______ and _____ are equally effective and patient preference should be considered

Answer 16

group exercise; home exercise

Question 17

In OA, _____, ______, ______, _____ and ______ muscles are important for function and should be particularly targeted. In fact, Muscle weakness can contribute to joint ______ which can exacerbat OA signs, symptoms & functional disability

Answer 17

Quadriceps; hip abductors, hip extensors; hamstringsand calf; instability

Question 18

What intensity are isometric contractions?

Answer 18

Low to moderate intensity

Question 19

What intensity are isotonic contractions?

Answer 19

Low to high intensity (as tolerated)

Question 20

What is an example of an exercise to target hamstrings?

Answer 20

Question 21

What are 2 examples of an exercise to target quads?

Answer 21

Question 22

What is important to remember in OA exercise for strengthening?

Answer 22

Avoid substantial joint loading (avoid high impact loading)

Question 23

What are the 2 characteristics of a single-leg standing in terms of OA (hip abductor strength)?

Answer 23

1. High acetabular pressures
2. ↑ pressure → further cartilage damage (Sometimes can affect the bone)

Question 24

What are the 2 characteristics of a single-leg standing in terms of OA (hip abductor strength)?

Answer 24

High acetabular pressures

↑ pressure → further cartilage damage

Question 25

Fo knee OA, which exercises should be prescribed to strength knee extensors?

Answer 25

* Open versus closed kinetic chain * Gravity assisted or resisted * High-or low-intensity training (resistance/load) * High intensity: greater strength gains, ↓ time to complete exercises * Low intensity: less likely to overload joints and exacerbate symptoms

Question 26

\_\_\_\_\_(Clear/No clear) evidence showing that WB exercises are more harmful than non-WB exercise in OA

Answer 26

No clear

Question 27

What are 3 factors that determine the choice of which exercises are prescribed?

Answer 27

1. Patient comfort 2. Pain tolerance 3. Irritability of symptoms

Question 28

What are 5 features as a rule of thumb for OA exercise prescription?

Answer 28

As a rule of thumb, consider: 1. Use of gravity minimised 2. Respective joint loading 3. Patient position (lying, seated, standing) 4. Resistance (theraband, free weights) 5. Comfort always comes 1st (has an effect on exercise and long term outcomes)

Question 29

Reduced _____ associated with pain & loss of function in OA

Answer 29

range of joint motion (ROM)

Question 30

Compression & decompression of cartilage needed to stimulate _____ and repair

Answer 30

remodelling

Question 31

What are the 2 guidelines for static stretching for painful OA?

Answer 31

1. Initially, static stretch to subjective sensation of resistance Progress static stretch to full range of motion 2. Initially, static stretch to subjective sensation of resistance

Question 32

What are the guidelines for static stretching for pain from the American geriatric Society? What is the progression?

Answer 32

• 1 stretch per muscle group • 5-15 secs per stretch • Once daily Progression • Full ROM • 3-5 per muscle group • 20-30 secs per stretch 3-5 times a week

Question 33

What are 2 examples of aerobic exercises?

Answer 33

1. Weight loss 2. Walking, cycling, seated stepper

Question 34

What is an example of balance re-training?

Answer 34

Tai Chi

Question 35

What is an example of sensory training?

Answer 35

Joint proprioception (joint receptors)

Question 36

What are 3 important things to remember for exercise prescription for obesity?

Answer 36

1. Aquatic exercise (hydrotherapy) to minimise joint loading 2. Seated, strength training better tolerated than weight-bearing aerobic exercise? 3. Strength training to ↓loss of lean muscle mass during dietary-induced weight loss

Question 37

Why is walking not a suitable exercise for slow walkers with OA?

Answer 37

increase acetabular pressure

Question 38

MSK ____ and ____ are falls risk factors.

Answer 38

pain; weakness

Question 39

What are 5 precautions to exercise for OA patients?

Answer 39

1. Avoid strenuous exercise during acute flare-ups and periods of inflammation 2. Avoid exercises/positions which excessively load the joints 3. Adequate warm-up and cool down periods for minimising pain after exercise 4. Some mild pain/discomfort to be expected after exercise –patient must understand this is normal 5. Patient education –lifestyle (e.g. physical activity, diet), disease, benefits of exercise

Question 40

What are the training parameters for exercise prescription for older patients with OA pain?

Answer 40