I have a senior client with extreme rheumatoid arthritis in both knees and to a lesser extent both hands. She is interested in achieving weight loss but finds walking and most resistance training challenging because of the discomfort in her knees and hands at all times. Unfortunately, swimming is not an option for her at this time, so we are limited to the gym setting. Any suggestions on how to approach her training program would be very helpful. Thank you for your time!
Thank you for your question. I have similar experiences and would like to share the process we follow at Kinetic Conditioning to enhance function. First, understand function of any client is based on the individual and the assessment process is always a “you versus you” approach. In other words, we assess the client’s ability levels to move and never compare to arbitrary norms written in textbooks. The movements we select to assess are based on their everyday function examples and include (please apply to your client's needs):
- Pulling (i.e., a door)
- Shifting (shifting weight to get out of a car)
- Hygiene activities
- Dressing activities
- Household duties
- Recreational activities
After analyzing a client’s everyday life function (by asking questions), we select from the above mentioned list what we need to assess (physically). Once determined, we videotape their ability to execute the selected movements. For example, someone with RA may have difficulty getting in and out of a chair yet still performs this everyday maneuver (albeit not the way we would like). Our recommendation is to videotape their current ability whatever that ability level is (even if they drop into the chair). Your job is to strategize to improve upon the current status. In this example, you may find improving dorsiflexion and subtalar eversion allows a better loading of the lower extremity, which will then transfer into a smoother unloading, thus not only reducing stress to the knee but also creating a stronger lower extremity. Remember, the knee is “stuck in the middle with no place to hide.” Therefore, you must make the ankles and hips as successful as possible to protect the knees.
In addition to the mechanical points, please consider the following with regards to RA:
- Gradual progression is recommended.
- Observe for red, swollen, hot and painful complaints (tends to affect the body symmetrically).
- If there is a flare up, do not use foam roller exercises. Anything that increases circulation also increases the chance that the disease may spread to other joints in the body.
- Avoid high repetition and high resistance training (use body weight and apply functional movements that the body is accustomed to).
- Research shows exercise does not stop the disease BUT also shows it doesn’t progress the disease. Therefore, if the program is designed and progressed properly, you will improve many other areas that pertain to life quality.