1. Making Movement Part of your Life: Exercise and Arthritis Daniel O’Brien Lecturer, Physiotherapy Department, AUT University

2. My Background Trained as a physiotherapist (AUT University) Musculoskeletal Clinical Practice (Private Practice / Sports / Hospital / Teaching) My study (Masters and PhD)

3. My Research Clinical management of osteoarthritis (exercise adherence, treatment beliefs and best practice management) Cross-profession integration of healthcare student clinical education

4. Outline  Where does exercise and activity fit into living with arthritis  Having a balanced exercise programme  Progressing your exercise programme  Signs to look for if you are over exercising  Goal setting  Making exercise part of your life  Action and coping plans

5. Why Exercise?  Exercise can improve:  Brain function  Muscle strength  Sleep health  Joint range of motion  Pain  Body weight  Mood  Motivation…

6. Where does exercise and activity fit into the overall picture of the treatment of arthritis?

7. The Management Scale (Osteoarthritis) Lifestyle and dietary changes Exercise and manual therapy Non-opioid analgesics and NSAIDs Opioid analgesics Surgery

8. The Management Scale (Other Forms of Arthritis) Lifestyle and dietary changes Disease Modifying Drugs Exercise and manual therapy Analgesic medication Surgery

9. Self-Management

10. Management of Arthritis Should be a ‘Team Approach’ You GP Rheumatologist Surgeon Psychologist / Psychotherapist Physiotherapist Practice Nurse Counselor Occupational Therapist Fitness Instructor

11. A Balanced Exercise Programme Cardiovascular Strength Stretching (Flexibility) Balance (Control)

12. Cardiovascular Aerobic exercise Vary intensity Vary the activity Daily Exercise snacking

14. Strengthening: Adding Resistance Strengthening exercises do not always meaning making big muscles Hypertrophy / endurance / power Between 5 to 25 repetitions, repeat 2 to 5 times, 2 to 3 times per week Add upper and lower body exercises Explore options of adding resistance, not all resistance exercises work for all people

15. Stretching / Flexibility

16. Warm up first (walking / cycling etc.) Do a balance of upper and lower limb stretches Protect the joint while stretching Hold each stretch for 30 seconds (3 x 10 second stretches is almost as good if you cannot hold them) 3 to 7 times per week

17. Balance / Control Northglenn Community Fitness Programme Balance / control exercises can be stand alone or can be incorporated into other exercises (strength) Balance / control can be practiced on a regular basis (every day)

18. Balance / Control

19. Exercise: What is Too Much? Hurt not harm (change from baseline pain longer than 20 minutes post exercise) Joint swelling post exercise (can be upto 48 hours later)

20. Break

21. Goal Setting + Can you explain it to some one in one or two sentences (in 2014 I want to run a ½ marathon in under 1:40) SMART Goals  Specific (Waitakere 1/2 Marathon)  Measureable (Complete it or not in the allocated time)  Achievable (Run half marathons before / 11 months to train)  Relevant (Improve my cardiovascular health)  Timed (Under 1:40 in October, 2014)

22. Creating an Exercise / Activity Programme + Think about a goal you want to achieve Write it out the exercise programme Seek advice as needed Pace yourself (you can not do everything all at once) Ask your self the following questions regarding your exercise programme  Is it balanced?  Is it achievable?  Will you enjoy it?

23. Creating an Exercise / Activity Programme + ActivityMondayTuesdayWednesdayThursdayFridaySaturdaySunday Running25 min30 minRest day50 min Strength25 min at the gym Rest day Stretches10 min at the gym Rest day Other activities Walking the kids to daycare Rest day

24. Safe Progressions When Exercising (Challenging Yourself) Change one thing at a time  Duration (i.e. time you are walking for)  Resistance (i.e. carrying a backpack)  Activity (i.e. replacing walking with stair climbing)  Complexity (i.e. walking on rough surfaces)  Intensity (i.e. walking up hill) Think about small steps (<10% per week) Think about volume (all the activity you are doing) over a 7 day period

25. Making Exercise / Activity Part of your Life + Take the stairs not the lift Park a little further away and walk Take the coffee to go and walk for a bit rather than sitting in the cafe Have exercise snacks (i.e. 3x 10 minute periods of exercise per day) Work it into your day and plan to be active

26. Factors that Improve Adherence to Exercise (Behaviour Change) Pick something that you will enjoy Do the right exercises (seek advice) Exercise with others Keep it simple Make sure it is achievable Put supported mechanisms in place

27. Implementation Intentions: Making a Plan and Sticking to it ‘Implementations intentions are planning process which describe how, when and where the desired behaviour will occur’ (Golwitzer, 1998) Think Implementation Intention Action

28. Creating an Action Plan Action PlanRunning WhenMonday, Wednesday, Friday and Sunday WhereTo the park and back How long25 minutes (50 minutes on Sundays) Who withMy dog (Schwarzer et al., 2006; Sniehotta et al., 2005)

29. Creating a Coping Plan  What are the possible obstacles to completing my exercises?  How will I overcome these?

30. Creating a Coping Plan + Action PlanRunningCoping WhenTuesday, Thursday and Sunday On the days when the weather is too poor to run outside I will use my exercise bike for 15 minutes instead On the days when my knee is too painful to run I will ice my knee and then do my ROM exercises instead WhereTo the park and back How long25 minutes (50 minutes on Sundays) Who withMy dog (Schwarzer et al., 2006; Sniehotta et al., 2005)

31. Summary Make a plan Pick exercise and activity your enjoy (make it fun) Do it with someone (where ever possible) Be realistic and keep it simple Make it a balanced exercise programme Don’t over do it

32. Resources (Page 7) Shameless Plug: Research Participants People with OA of the hip and/or knee who have not had surgery and are happy to be interviewed regarding their experience of management of their condition dobrien@aut.ac.nz