STAYING STRONG: EXERCISE FOR BONE AND JOINT HEALTH AFTER TRANSPLANT

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4 STAYING STRONG: EXERCISE FOR BONE AND JOINT HEALTH AFTER TRANSPLANT Allison Sigrist, DPT Physical Therapist Froedtert Rehabilitation Services, Fitness Center

5 Objectives Learn about different types of exercise Understand key muscle groups to target Learn exercises that are safe to try at home Understand outpatient physical therapy and how to obtain a referral

6 About me Currently work in outpatient orthopedics Age 40-70, total joint replacement, spine, shoulder, hip, knee, balance, deconditioning Inpatient physical therapy Liver transplant prehab research project with Dr. Kim

7 Physical Therapy Inpatient goals: Medical management Get you home safely Outpatient goals: Decrease pain and disability Improve quality of life

8 Living with a transplant Immunosuppressant medications Side effects: muscle or joint pain, constipation, weight gain, weakness, stiff neck, low back pain, increased risk of cardiovascular complications Tests to monitor organ function Electrocardiograms, echocardiograms Pulmonary function tests

9 Diet and Exercise Diet Consult a dietitian if weight loss is your goal Protein is a building block of muscle Exercise Aerobic (endurance, cardio) Strength training Balance

10 Exercise Risks & Considerations Muscle soreness, overuse injury, equipment accident Osteoarthritis: exercise does not progress the disease if done in correct dose Benefits: decreased pain, improved physical function, improved quality of life, improved mental health Diabetes: **Exercise may decrease blood sugar **Check your feet!

11 2008 Physical Activity Guidelines for Americans U.S. Department of Health and Human Services Adults age minutes of moderate intensity aerobic exercise per week; at least 10 minute increments 2 times per week strength training of major muscle groups Adults age 65+ Same recommendations or as abilities allow When adults with chronic conditions do activity according to their abilities, physical activity is safe.

12 2008 Physical Activity Guidelines for Americans U.S. Department of Health and Human Services Committee analyzes best available research to determine guidelines for and benefits of exercise. Complete list of benefits available at: er2.aspx Strong evidence: prevention of weight gain, prevention of falls, prevention of developing Type 2 Diabetes, prevention of coronary heart disease, improved cardiorespiratory and muscular fitness

13 Aerobic Exercise (cardio, endurance) 150 minutes of moderate intensity per week; at least 10 minute increments Measuring moderate intensity Track heart rate: target range calculated based on age Rate of perceived exertion: BORG scale

14 Heart rate calculation Centers for Disease Control and Prevention Heart rate max= 220- age Moderate intensity= 50-70% of heart rate max Example calculation for 50 year old heart rate max= = 170 beats per minute (bpm) 50% x 170 = 85 bpm 70% x 170= 119 bpm

15 Rate of Perceived Exertion How hard do you feel your body is working? Rate from 6 to 20. This scale correlates well with heart rate. Moderate intensity rating is

16 Types of Aerobic Exercise Brisk walking Pro: no equipment necessary Con: weather dependent, safety Optional Equipment Treadmill Trekking poles

17 Types of Aerobic Exercise Elliptical Recumbent or stationary bike NuStep bike Water walking or aerobics Swimming

18 Strength Training 2008 Physical Activity Guidelines for Americans: 2 times per week strength training of major muscle groups Shoulders, legs (hips), back Why is this important after transplant? Deconditioning due to inactivity Side effects of medications

19 Strength Training Body weight/weight bearing Resistance bands Ankle weights and free weights Machines

20 Body weight/weight bearing More functional No equipment Promotes bone strengthening

21 Resistance bands $10-30 Done at home Add greater challenge to exercises Bands will wear out and change amount of resistance

22 Free weights and ankle weights $5 to $50+ Done at home or used at gym Will need to continue to purchase higher weights as strength improves

23 Machines Higher cost to purchase for at home or gym membership for use Good for targeting large muscle groups Leg press Knee extension 4 way hip

24 Stability ball $7-30 Good for balance, core, postural muscles May pose higher risk for at home injury if baseline strength and balance are poor

25 Where you can exercise Gyms: YMCA, WAC Senior Centers High school pools High school gym Community recreation department programs

26 Balance Declines with older age, deconditioning, inactivity *Feeling dizzy, light headed, or room spinning is not a normal response to activity Balance has components of vision, proprioception & sensation, and vestibular

27 Balance Testing Stand heel to toe for 30 seconds Reach forward 10 inches from base of support A few home exercises: Tandem stance Toe taps on book or stair Clock face balance Tai Chi and yoga are good group classes to try

28 Stretching Hip flexors Hamstrings Pectorals

29 When should I get a PT referral? Persistent joint or back pain Balance Vestibular/vertigo General deconditioning

30 Useful websites Office of Disease Prevention and Health Promotion 2008 Physical Activity Guidelines for Americans Center for Disease Control and Prevention Physical activity basics and measuring intensity Arthritis Foundation Exercise recommendations and videos

31 Stretching Hip flexors Hamstrings Pectorals

32 Balance

33 Upper body strength

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35 Lower body strength

36 Back strength

37 Stability ball

38 References Photos:

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40 Making Memorial Day (Food) Memories Thursday, April 27, 2017 Watch kidneywi.org for details.

41 The BIG Ask, the BIG Give Tuesday, March In-person Location: Community Conference Center 8700 Watertown Plank Rd Wauwatosa, WI Room 3 6:00 pm -7:30 pm This program will be online and in-person. Call to register.

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