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


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


Osteoarthritis Overview

• Causes pain during weight-bearing activities

• Results in disuse/atrophy of regional muscles– Lax ligaments


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



• 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



• Leading cause of work-related disability– Particularly over age 65

• Causes more dependency in walking, stair climbing, and lower extremity activity than other diseases


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


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



• 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



• Progression varies among individuals

• Joint damage irreversible

• Symptoms may be intermittent

• Disability more common when disease affects spine, knees, or hips


Contributing Risk Factors

• Age

• Obesity

• Joint injuries due to sports or work-related activity

• Nerve injury

• Lack of physical activity

• Genetics


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)


Research Supports Resistance Training

• Numerous studies show improvements in strength, gait speed, and stair climbing

• Setting appears unimportant– Group and individual programs equally effective


Individuals’ Behavioral Challenges to Resistance Training• Sedentary lifestyle

• Anxiety or depression

• Unrealistic goals

• Harboring perceived barriers to exercise that psychologically prevents from training


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


Well-Developed Training Goals

• Significant

• Measurable

• Attainable

• Specific to the individual

• Time-limited


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


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


Exercise Testing Considerations

• Perform preprogram evaluation

• Perform physician-supervised stress test for individuals over age 50– If individual able


Exercise Testing Considerations

• Alternately, prescreen for contraindications and require comprehensive physical and physician’s clearance

• Assess capacity using 1 RM strength assessment


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


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


Types of Muscle Action

• CON– Shortening of muscle

– Produce lowest maximal torques

• ECC– Lengthening of muscle

– Produce greatest maximal torques


Types of Muscle Action

• Isometric– No change in muscle length


Program Components

• Use combination of open- and closed-chain exercises within pain-free ROM

• Select exercise ROM that avoids excessive shear or compression


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


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


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


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


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


Training Frequency

• Three days per week for untrained individuals with osteoarthritis

• See sample 24-Week Program

copyright © 2010 delmar, cengage learning. all rights reserved. chapter 5 resistance-training...

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hip osteoarthritis slide

week program slide

bonecartilage overgrowth

common form of arthritis

degenerative joint disease

lower extremity activity

lower extremity weight