Workouts that Work

J.L. WEBB

Workouts that Work

Arthritic and Osteopenic Patients Need a Special Exercise Regimen

Jane Fonda was 44 when she popularized the phrase “No pain, no gain” in her first fitness video in 1982.

Chances are she wasn’t thinking about how that phrase could take on a different meaning for people like her who now are in their 70s and painfully aware of their bodies’ limitations.

Exercising is even more challenging for seniors who are arthritic or osteopenic. Aching joints and brittle bones must be handled with care, but physicians and trainers understand it is especially important to prescribe an exercise program for those patients.

“In arthritic conditions, we have found that exercise is very, very helpful and a critical part of treatment,” said David Schulak, MD, a surgeon at Tampa Orthopedic Clinic and on staff at University Community Hospital. “In milder cases, we give people home exercise programs. In the more severe cases, or for patients who want to be treated more aggressively, we send them to physical therapists,” Schulak said.

Schulak said about 40 percent of his patients have either arthritis or osteoporosis. The first thing he does before prescribing an exercise program for those patients is to acquire a detailed clinical history and assess their co-morbidities and medications.

The program director for the Geriatrics Fellowship at Florida Hospital Orlando, Ariel Cole, MD, echoed that approach. “Definitely get a clinical history first,” Cole said. “Patients need to be honest with their physicians about what their level of exercise is currently. We go over their medical problems (to determine) whether there is heart or lung disease in addition to the arthritis or osteoporosis. Then you can comprehensively tailor an exercise program to them. It really needs to be individualized.”

Cole estimated 75 percent of her patients have some level of arthritis. Not all of them have been diagnosed, she said, “but most people have some aches and pains in joints that are related to osteoarthritis, the common wear-and-tear arthritis.” After obtaining the clinical history, she often prescribes exercise to those patients.

But the type of exercise will depend on a number of factors, including what type of exercise is accessible and practical, Cole said.

“Walking is accessible to everyone and it’s a good, safe exercise. But because knees and hips are often affected (and pain is present), people tend to limit movement. Pool exercise is a great option, but not available to everyone,” she said.

Once they have enough information about the patients to proceed, Cole, 34, and Schulak, 66, are ready to prescribe exercises that are specific to the condition. Schulak instructs patients with arthritis to engage in strengthening and range-of-motion exercises.

Strengthening exercises build up muscles so that they can protect arthritic joints. Light, repetitive weight training is an appropriate strengthening exercise. Range-of-motion exercises mirror everyday activities, such as raising your arms over your head, or bending over to pick up objects.

“What I have found is if you have injuries or painful arthritis to the knee, all the muscles in the leg will tend to get weaker because you don’t want to use the whole leg,” Schulak said. “So, often people are not conscious of the fact that in addition to building up the quadriceps and hamstrings, it’s very important to build up the gluteals. It is a critical part of treating people with knee arthritis.”

Cole agreed. “Certainly, strengthening the muscles around the knee joint is important. As for calves, thighs and gluteals, they are important for overall health for endurance, your core strength, your back and stomach, for stability,” she said.

But there is a different protocol for osteopenic patients. Schulak said. “We encourage exercises for them that are going to prevent, particularly in the spine, some of the sequel osteoporosis,” he said. For example, people who are bent over when they walk often have had multiple compression fractures, he said. “We try to put them on a program (of exercise) to strengthen their extensor musculature, to try to straighten their spines,” Schulak said.

Cole said patients with osteoporosis should be placed on weight-bearing exercises. “While swimming is good exercise for your joints, it is not as helpful for people with osteoporosis. For them, walking and using hand weights is more important to help both conditions,” Cole said. “So, you try to pick something that is going to kill two birds with one stone,” she said.

Noting that osteopenic patients have skeletons that are weaker than average, Schulak said they are more prone to fragility fractures from minor falls. “Our treatments are aimed at reducing fractures,” he said.

Alexis Saire, MEd, MA, a health educator and personal trainer at Florida Hospital Celebration Health Fitness Center, said roughly two-thirds of her clients are seniors. She teaches classes for people with arthritis and orthopedic problems.

The major barrier to motivating older people who have these problems “is pain, poor health and physical limitations, said Saire, 53. “But that’s also the reason they need to exercise. It makes it kind of difficult. You have to be aware of a wide variety of modalities so you can find something that is going to fit the individual,” she said.

Lifestyle habits and attitudes also have to be overcome, Saire said. “Many people with arthritis, osteoporosis, etc., fear falling, injury and adding to their pain with the slight soreness that may come with exercise,” she said. “They have lived through a time when formal exercise wasn’t valued,” Saire said, so they must be convinced of its benefit.

But once they are persuaded, the results are tangible. “The first thing they notice is a feeling of energy and improved ability to cope better with everyday activities,” Saire said, “and they sleep better.”

For those patients, it appears working out is working out.