# Exercise as it relates to Disease/Elastic/Theraband use with the Osteoarthritic and Aging Client

This fact sheet is designed to encourage exercise professionals to consider using elastic resistance bands with an elderly OA client.

## Background Information

Osteoarthritis (OA) is a degenerative condition of the joints caused by a progressive and irreversible loss of articular cartilage which acts as a protective cushion between bones, particularly in weight-bearing joints. Risk factors for osteoarthritis are obesity, physical inactivity, joint trauma and injury and misalignment of joints. Pain results from deformation of the bones and fluid accumulation in the joints. The most common site for OA is hands, feet, spine, hips and knees.

## Presentation

Elderly clients with OA often present with the following symptoms
* Decreased range of motion.
* Joint deformities.
* Abnormal gait.
* Pain with weight bearing.
* Crepitus.
* Impaired proprioception.

### Co-Morbidities

Arthritis Australia reports patients with OA often have other chronic conditions including hypertension, are overweight /obese, have diabetes, suffer renal impairment and have other cardiovascular disease. This often means traditional methods of exercise are not suitable for this client.

## How Can Elastic Resistance Training Assist the Osteoarthritic Client?

Elastic resistance bands are an easy to use latex elastic band that has been shown to:
* Facilitate an increase in range of motion in mildly effected joints.
* Improve flexibility.
* Increase muscle strength and endurance.
* Provide both concentric and eccentric resistance on the muscles.
* Improve proprioception and balance.
* Increase the ability to participate in the activities of daily living (sit to stands, ascend/descend stairs) and maintain independence.
* Be used on patients with low aerobic capacity.
Bearing in mind all the constraints and co-morbidities of OA, this product design and versatility allows elderly OA sufferers to exercise to their physical limits through a range of specifically targeted exercises. It is easier than conventional resistance training as the inertia of elastic resistance is negligible while with weight such as dumbbells there is an increased moment of force during accelerative movements. Minimum weight on standard universal weight training machines often exceed the OA clients' initial strength capacity.

### Resistance Equivalent

While there are many resistance elastic band brands on the market resistance equivalents have been documented for Theraband, which is graded by colour. Stretching the Theraband results in the following Kilogram (Kg) resistance equivalents at these given % elongations
| Colour | 25% | 50% | 75% | 100% | 125% | 150% | 175% | 200% |
| Yellow | 0.5 | 0.8 | 1.1 | 1.3 | 1.5 | 1.8 | 2.0 | 2.2 |
| Red | 0.7 | 1.2 | 1.5 | 1.8 | 2.0 | 2.2 | 2.5 | 2.7 |
| Green | 0.9 | 1.5 | 1.9 | 2.3 | 2.6 | 3.0 | 3.3 | 3.6 |
| Blue | 1.3 | 2.1 | 2.7 | 3.2 | 3.7 | 4.1 | 4.6 | 5.0 |

### Resistance Exercise Options

Resistance elastic training offers a range of exercises to suit the elderly OA client. Examples with illustrations can be found at http://www.thera-band.com/UserFiles/File/Resistance_Band-Tubing_Instruction_Manual.pdf
| Hip Joint | Knee Joint | Ankle Joint | Shoulder Joint | Arms |
| Hip Flexion (seated or standing), Hip Extension, Hip Abduction, Hip Adduction, Hip Internal/External Rotation | Knee Extension (seated or prone), Knee Flexion (seated or prone), | Dorsiflexion, Plantarflexion, Inversion, Eversion | Flexion, Extension, Abduction, Adduction, Internal/External Rotation | Elbow Flexion, Elbow Extension, Wrist Flexion, Wrist extension, Supination, Pronation |

### Recommendations

| Frequency | Duration | Intensity | Goal |
| Minimum 3 days/week | 8-16 week program as a minimum | 20 repetitions per exercise starting with RPE intensity at 11-13 progressing to 15-17 on the BORG scale. Increase resistance/change band colour when RPE is low while completing the set | The goal of using elastic resistance bands with elderly OA clients is to increase pain free completion of daily routines and improve functional capacity achieving outcomes as listed above. |

### Advantages of Elastic Resistance Bands

* No technical knowledge is required for use.
* No pain associated with its use as elongation/resistance is controlled by OA client.
* Low Cost.
* Can be used in water as part of hydrotherapy program.
* Handled options available with tubing to increase comfort with arthritic hands.
* Can be used prone, supine, seated or in a standing position.
* Use is independent of weather, time of day, location.

### Disadvantages of Elastic Resistance Bands

* The repetition maximum test where muscles are fatigued to the point of exhaustion to set a baseline and goals is not suitable for rehabilitation purposes.
* The percentage of elongation achieved by the elderly OA client is difficult to evaluate. Therefore it is difficult to measure the resistance applied.
* There is no definite formula for calculating the most suited intensity when using elastic resistance.
* Physiological measures such as heart rate can not be used to evaluate intensity.

## Further reading

http://www.thera-bandacademy.com/tba-portal/thera-band-exercise-bands

## References

* ↑ http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-arthritis-osteoarth
* 1 2 3 4 5 6 Magee DJ, Zachazewski JE, Quillen WS (2009) Pathology and Intervention in Musculoskeletal Rehabilitation. Saunders Elsevier
* 1 2 3 4 5 6 7 8 Durstine JL, Moore GE, Painter PL, Roberts SO (2009) ACSM Exercise Management for Persons With Chronic Disease and Disabilities 3rd Edition. American College of Sports Medicine.
* ↑ http://medical-dictionary.thefreedictionary.com/osteoarthritis
* 1 2 3 4 5 Ehrman JK, Gordon PM, Visich PS, Keteyian SJ (2009) Clinical Exercise Physiology 2nd Edition. Human Kinetics
* 1 2 Ebersole P, Hess P, Touhy TA, Jett K, Luggen A (2008) Towards Healthy Aging – Human Needs and Nursing Response. 7th Edition Mosby Elsevier
* ↑ Athritis Australia Publication Whose problem is it Anyway? Whose Problem Is It Anyway? The Voice Of GPs On Arthritis - Qualitative and Quantitative Marketing Research Arthritis Australia March 2012
* 1 2 3 http://www.thera-bandacademy.com/elements/clients/docs/TBInstruction-012706__013106_130451.pdf
* 1 2 3 4 Topp R, Woolley S, Hornyak J, Khuder S, Kahaleh B. The Effect of Dynamic Versus Isometric Resistance Training on Pain and Functioning Among Adults With Osteoarthritis of the Knee. Archives Physical Medicine Rehabititation 2002;83:1187-95
* 1 2 Anderson LL, Anderson CH, Mortenson OS, Poulsen OM, Birthe I, Bjournlund T, Zebis MK. Muscle Activation and Perceived Loading During Rehabilitation Exercises: Comparison of Dumbbells and Elastic Resistance. Physical Therapy 2010;90(4):538-549
* 1 2 Takeshima N, Islam M, Rogers M, Rogers L, Sengoku N, Koizumi D, Kitabayashi Y, Imai A, Naruse A. Effects Of Nordic Walking Compared To Conventional Walking And Band-Based Resistance Exercise On Fitness In Older Adults. Journal of Sports Science and Medicine 2013;12:422-30
* 1 2 Takeshima N, Rogers L, Rogers, Islam M, Koizumi D, Lee S. Functional Fitness Gain Varies in Older Adults Depending on Exercise Mode. Medicine and Science in Sports and Exercise 2007;39(11):2036-2043
* ↑ http://www.thera-bandacademy.com/faq-category.aspx?id=41&faqID=593>
* ↑ Day ML, McGuigan MR, Brice G, Foster C. Monitoring Exercise Intensity During Resistance Training Using the Session RPE Scale. Journal of Strength and Conditioning Association 2004;18(2):353-358