Osteoarthritis Disease Management Program

Osteoarthritis; degenerative. Management People with. While some evidence supports certain physical therapies, evidence for a combined program is limited. The Arthritis Self-Management Program, also known as the Arthritis Self-Help Course, was our first patient education program, and the prototype for all our other. Management of osteoarthritis in the. The goals of an exercise program are to.

Role of Exercise in Arthritis Managementby Susan Bartlett, Ph. D. Benefits of Physical Activity for Individuals with Arthritis. Physiological Benefits. The physiological benefits of exercise are well documented and include reduced risks of: (ref 1)coronary artery diseaseserum lipid abnormalitieshypertensiondiabetesosteoporosisobesitycolon cancer. Physical activity is essential to optimizing both physical and mental health and can play a vital role in the management of arthritis. Regular physical activity can keep the muscles around affected joints strong, decrease bone loss and may help control joint swelling and pain.

Regular activity replenishes lubrication to the cartilage of the joint and reduces stiffness and pain. Exercise also helps to enhance energy and stamina by decreasing fatigue and improving sleep.(ref 2) Exercise can enhance weight loss and promote long- term weight management in those with arthritis who are overweight. Exercise may offer additional benefits to improving or modifying arthritis.

Steven Blair, Exercise Epidemiologist and Director of Epidemiology at the Cooper Institute for Aerobics Research in Dallas TX notes “Skeletal muscle is the largest organ in the body and is intricately tied with protein turnover and synthesis and many other metabolic and biochemical functions. Activating skeletal muscle has many important health benefits we are only beginning to understand.”Psychological Benefits.

The psychological benefits of exercise are equally compelling.(ref 1)In the short- term (i. A growing body of empirical research also suggests that exercise has long- term effects on well being as well. Improvements in mood and well being have been reported by regular exercisers in both clinical and non- clinical populations and with most types of exercise.

Baseline levels of anxiety are lower in individuals who exercise regularly as compared with sedentary adults. Thus, exercise appears to be a potent stress reducer as well. In at least one major clinical trial sponsored by the National Institutes of Health, exercise and group counseling is being tested by clinicians (who are qualified to assess and monitor the disorder) as a primary treatment for mild depression. Because depression is a concern for individuals with arthritis, physical activity is an important psychological adjunct to treatment. Though more research is warranted to confirm these findings, preliminary studies suggest that moderate- intensity lifestyle exercise, such as walking, is as effective as traditional vigorous aerobic exercise in improving mood. Physical Activity Recommendations. The goals of an exercise program for individuals with arthritis are to: 1) preserve or restore range of motion and flexibility around affected joints, 2) increase muscle strength and endurance, and 3) increase aerobic conditioning to improve mood and decrease health risks associated with a sedentary lifestyle.(ref 3) The exercise program can be organized around the Exercise Pyramid for Patients with Arthritis, as pictured below.

• Osteoarthritis; Gout; Lyme Disease. It may be helpful to discuss whether a structured weight management program in your community that offers education and.
• The Disease Management is an online medical reference, designed to provide nationally established treatment guidelines for the most commonly seen diseases and conditions.
• Osteoarthritis is a chronic (long-term) disease. There is no cure, but treatments are available to manage symptoms. Long-term management of the disease will include.
• Osteoarthritis Treatment & Management. After an 8-week exercise program. Obesity and osteoarthritis: disease genesis and nonpharmacologic.
• The exercise program consisted of muscle strengthening. There are other surgical approaches to osteoarthritis treatment. The management of osteoarthritis.
• Osteoarthritis (OA) is the most. Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis. URAC's accreditation program is an independent audit.

Reprinted with permission from the American Council on Exercise. Based on: Hoffman, DF Arthritis and Exercise Primary Care. The Physician. Preventive Services Task Force recommends that physicians advise patients to engage in a program of regular physical activity tailored to their individual health status and lifestyle.(ref 5) The Surgeon General.

We must continue to stress the importance of physical activity to every patient we see and help to motivate them to choose the road to good health and long life.”(ref 7)This message of the therapeutic importance of physical activity to manage arthritis more effectively is new to many patients with arthritis. Brief doctor- patient discussions about exercise do translate into behavior change among patients. In a major multi- site trial in primary care settings with diverse patient populations, the PACE (Physician- Based Assessment and Counseling for Exercise) Project found that 3- 5 minute counseling sessions increased physical activity among patients. Eighty percent of the physicians reported that their patients were “receptive” or “very receptive” to physical activity counseling and more than 5. In another randomized trial, patients were asked their response to the statement “If my doctor advised me to exercise, I would follow his/her advice.” Thirty- five percent strongly agreed, 5.

Listed below are several key points that have been shown to enhance exercise counseling interventions. Patients with arthritis need clear messages about the benefits of exercise for people with arthritis. It is important to stress that physical activity of the type and amount recommended for health has not been shown to cause or worsen arthritis.(ref 7) While rest is important, especially during flare- ups, lack of physical activity is associated with increased muscle weakness, joint stiffness, reduced range of motion, fatigue and general deconditioning. Hence, current recommendations now emphasize abalance of physical activity and rest. Also, exercise needs to be directed at the entire body, and not just the joints that are affected with arthritis. A simple but highly effective way of helping patients to determine the right balance is by asking them to keep records of their physical activity and arthritis symptoms between office visits. Patterns often become clear within a couple of weeks.

Regular discussions about physical activityat each office visit convey sincerity and interest in the importance of exercise. Among patients, the relationship between physical activity and arthritis is confusing. When joints hurt, a natural response to pain is to reduce physical activity. Also, health care providers often advise patients to rest and avoid exercise during acute flares. Thus, it is easy to understand why some individuals with arthritis mistakenly perceive that all physical activity is undesirable, will only aggravate or worsen their arthritis and should be minimized. It is important to explore with patients their beliefs about exercise, as well as to help them identify barriers and misinformation. Physical activity counseling is most effective when it is tailored to the individual.

Important considerations in tailoring the advice are: 1) level of readiness to be more active; 2) confidence to begin exercising; 3) expectations about the benefits the person will receive by being more active; 4) previous experience with physical activity; and 5) current lifestyle. Discussions should focus first on encouraging physical activity and allaying fears, as well as helping patients to identify opportunities to become more physically active. Sedentary patients may benefit from receiving simple written directions that reflect a basic exercise prescription to enhance safety, boost confidence and guide them in gradually increasing their levels of physical activity.

Assessing Readiness to Exercise. Psychological readiness to begin exercising is also an important consideration. Theories of behavior change suggest that people vary widely in their readiness to adopt new behaviors. Up to 4. 0% of individuals may be in the “precontemplative stage” where they remain essentially unaware of the problem and have not yet thought about change. For these individuals, realistic goals for exercise counseling are to increase awareness of the importance of physical activity and to personalize information about the benefits that can be anticipated. For those who express a willingness to be more active, a medical history and physical exam is advised. Specifically, the evaluation should assess the severity and extent of joint involvement, overall level of cardiovascular conditioning and presence of other comorbid conditions.

In the book titled ACSM. Participants in the aerobic exercise group exercised for 4. The investigators concluded that both types of exercise were associated with similar significant improvements in symptoms of physical disability, improved physical performance and reduced pain. Water Aerobics. Aquatic aerobic training programs that are offered in therapeutic pools have many advantages related to the warmth and buoyancy of the water.(ref 1.

Pools that are designed for persons with arthritis are often kept at much warmer temperatures (e. Range of Motion/Flexibility Programs. Individuals with arthritis often have a limited range of motion, especially in lower extremity joints. Decreased range of motion associated with knee and hip OA is associated with pain, loss of function, physical limitations and an increased risk of injury and falls. In addition, to receive adequate nutrition, cartilage requires regular compression and decompression to stimulate remodeling and repair.(ref 1) Minor notes that the optimal daily exercise plan to maintain cartilage health should include range of motion exercises.

She also recommends that physicians provide specific recommendations; simply advising patients “to stretch every day” is not advisable since affected joints that are lax are easily overstretched and more vulnerable to injury. Recreational or Lifestyle Exercise. Key Messages from the Surgeon General. Older adults can obtain significant health benefits with moderate amounts of physical activity, preferably daily. A moderate amount of activity can be obtained in longer sessions of moderately intense activities (such as walking) or in accumulating shorter sessions of more vigorous activities (such as fast walking or stair walking). By the early 1. 99. These findings were reinforced by recent investigations that demonstrated that health benefits of physical activity are obtained even with small amounts of moderate- intensity activity.

Thus, while improvements in fitness require strenuous and continuous activity on a regular basis, health benefits (i. Additional evidence of the value of moderate intensity exercise comes from recent investigations that have shown that activity need not be undertaken in a single bout to be beneficial. For instance, the benefits from three 1.