The Fitness Zone
Arthritis is a leading cause of pain, illness and disability. Sheldon Caines, Australian Institute of Fitness NSW/ACT Massage Lead Coach, explains how Personal Trainers should approach a client with arthritis.
Arthritis is often referred to as a single disease, but it actually covers more than 100 medical conditions that affect the musculoskeletal system. Osteoarthritis is one of the most significant of these musculoskeletal problems. Symptoms of arthritis can include pain, stiffness, inflammation and damage to joint cartilage.
Contrary to popular belief arthritis is not a normal occurrence of ageing. However, it is strongly related to the physiologic responses to ageing.
With approximately 3.85 million Australians presenting with arthritis, it is an issue you're almost certainly going to come across as a Personal Trainer.
Weight bearing joints such as the lower back, hips, knees and ankles are typically affected, and the greatest challenge to those suffering from arthritis is overcoming the discomfort of movement. Typically the client will avoid provoking the pain and you will see marked declines in strength, endurance, range of movement and cardiovascular health. This decreased physical and functional capacity becomes problematic when the client carries out activities associated with everyday living and independence.
Where does exercise come in?
The good news is that physical and manual therapies, such as those provided by fitness professionals, contribute significantly to the improvement and maintenance of these very parameters!
As with any exercise program, the importance of pre-exercise screening cannot be underestimated. Establishing baseline measures for clients with osteoarthritis may yield inaccurate results in the event of cessation due to pain or fatigue. The fitness professional should ensure adequate recovery between testing protocols to avoid symptomatic exacerbation.
If in doubt, ask yourself, Does the risk of testing outweigh the potential benefits derived from the exercise program? If so, the test should not be performed.
Methodically planning your testing procedures is important. You may wish to assess: pain and functional limitations, physical function or performance, and muscle function and cardiovascular function.
Pain and functional limitations
No one knows you client like your own client! So let them tell you how they feel using self-report questionnaires and visual scales to identify painful areas. Specific to osteoarthritis is the Western Ontario and McMasters Universities Osteoarthritis Index.
Physical function or performance
There are numerous methods of determining physical performance. The following are specific to osteoarthritis:
- 6 minute walk test and ratings of perceived exertion.
- Sit and reach test to determine lower back flexibility.
- Climbing stairs or rising from a chair (timed).
When conducting tests for strength, power, contraction speed and endurance it is important to consider the potential neural involvement which may alter the muscle's ability to maximally perform due to joint pain and inhibition. Isometric, isotonic and isokinetic measures may be appropriate in this instance.
Generally, clients with osteoarthritis tend to be deconditioned peripherally as opposed to centrally. Most clients will be able to accomplish a graded exercise test with minimal symptoms. Treadmill walking may result in cessation due to pain in any weight bearing joints, so non weight bearing activities such as a cycle ergometer may deliver more accurate measure of cardiovascular function.
The most appropriate and beneficial exercise prescription for individuals with arthritis appears to be that of a progression from flexibility and muscle function to aerobic exercise combined with functional activities.
It is important to distinguish between exercising for an improvement in one's functional capabilities and exercising for an improved level of fitness. As fitness professionals working in an aging population, the need to understand arthritis and similar conditions is increasingly important.