Exercise program from Roos & Dahlberg, Arthritis & Rheum

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Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005 1 Exercise intervention in the BROMS study EM Roos, L Dahlberg: Positive effects of moderate exercise on knee cartilage glycosaminoglycan

The objectives of the intervention were to improve neuromuscular control, muscle strength and aerobic capacity.

It was expected that each patient should attend three days a week.

1 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise intervention in the BROMS study EM Roos, L Dahlberg: Positive effects of moderate exercise on knee cartilage glycosaminoglycan content. A four-month randomized controlled trial in patients at risk of osteoarthritis. Arthritis Rheum 2005, 52: The objectives of the intervention were to improve neuromuscular control, muscle strength and aerobic capacity. The patients were offered exercise classes on every weekday for four months in a group-fashion led by one of five experienced and especially trained physical therapists. It was expected that each patient should attend three days a week. To tailor the program to each individual, all subjects in the exercise group underwent clinical examination and functional assessment by one physical therapist prior to the study start. This physical therapist was also responsible for instructing the five physical therapists leading the exercise groups. Each class lasted for one hour. Neuromuscular control during the exercises was repeatedly emphasized. Most commonly four to six subjects attended each exercise session allowing the physical therapist to closely monitor each individual. Acknowledgement: The authors are indebted to Inge Dahlberg PT BSc for his clinical expertise and construction of the exercise program. Exercise program The exercise program consisted of four parts, warming up, flexibility and coordination exercises, stretching exercises and then a circuit program emphasizing neuromuscular strength and neuromuscular aspects. Part 1. Warming up The warming up consisted of ergometer cycling, rope skipping and jogging on a trampoline.

2 Exercise program from Roos & Dahlberg, Arthritis & Rheum Part 2. Flexibility and coordination Flexibility and coordination exercises including trunk rotations while high kneeling; lying prone and flexing one leg whilst extending the other, alternate; standing bilateral semi-squats to full body extension with arm rotation and arm extension alternatively; standing hip flexion. Examples are given below.

3 Exercise program from Roos & Dahlberg, Arthritis & Rheum Part 3. Stretching Stretching exercises: Hip rotators, Hip abductors, Hip flexors, Hip adductors, Knee extensors

Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005 4 Part 4.

with 20 sec rest in between. All exercises should be carried out on both sides (right and left).

Level 1 Exercise circle 1. A. Crook lying, legs slightly bent.

Lying on the floor, balancing a ball under the heel. C. Jogging on a trampoline Exercise circle 2.

4 Exercise program from Roos & Dahlberg, Arthritis & Rheum Part 4. Circuit program Usually three (A,B,C), and sometimes two, exercises were carried out alternately for 40 sec with 20 sec rest in between. All exercises should be carried out on both sides (right and left). To allow for increasing challenge over time, three levels of difficulty are given for most exercises. Level 1 Exercise circle 1. A. Crook lying, legs slightly bent. Balancing a ball under the right/left heel alternatively. If possible, arms moving in opposite direction B. Lying on the floor, balancing a ball under the heel. C. Jogging on a trampoline Exercise circle 2. Pulley or rubber band A. Standing, back towards the pulley. Pulling the leg forward and up to approx. 90 degrees hip and knee flex. B. Facing the pulley. Extending the hip and flex the knee. C. Sideways. Abducting the leg.

Standing, weight bearing on the right leg (flexed knee).

Let one leg slide backwards into full hip extension.

Rope skipping. Exercise circle 4. Thick mattress A.

with weight bar in front of the shoulders and close to the

5 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise circle 3. Slide board A. Standing, weight bearing on the right leg (flexed knee). Left leg extended knee, pull in (adduct) the left leg. Alternate legs. B. Standing, facing the short end of the board. Let one leg slide backwards into full hip extension. Turn around. Let the leg slide forward into hip flexion. C. Rope skipping. Exercise circle 4. Thick mattress A. From standing to sitting onto a chair and back to standing with weight bar in front of the shoulders and close to the body. B. Step down forward from a step board onto a thick mattress. C. Balancing on one leg on a thick mattress. Other leg approx. 90 degrees of knee flexion.

Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005

Possibly a wedge under the heel. Level 2 Exercise circle 1. A.

Balancing a ball under the right/left heel alternatively.

6 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise circle 5. A. Step up with one leg on a step board. Final knee extension important! Possibly a wedge under the heel. B. Lunge forward with bar bells C. Single leg standing with weight bar in front of shoulders. One leg in full hip and knee flexion. Extend the weight bearing leg and hold extended leg straight. Final knee extension important! Possibly a wedge under the heel. Level 2 Exercise circle 1. A. Crook lying on the floor, legs slightly bent. Balancing a ball under the right/left heel alternatively. If possible, arms moving in opposite direction. B. Lying on the floor, balancing a ball under the heel. C. Jogging on a trampoline. Work in pair, throw a ball to each other.

Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005 7 Exercise circle 2.

Pulling the leg forward and up to approx. 90 degrees hip and knee flex. B.

Sideways. Abducting the leg. Exercise circle 3. Slide board A.

Left leg extended knee, pull in (adduct) the left leg. Alternate legs. B.

7 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise circle 2. Pulley or rubber band A. Standing, back towards the pulley. Pulling the leg forward and up to approx. 90 degrees hip and knee flex. B. Prone on a bench with extended hip. Facing away from the pulley. Knee flexion. C. Sideways. Abducting the leg. Exercise circle 3. Slide board A. Standing, weight bearing on the right leg (flexed knee) on a step board. Left leg extended knee, pull in (adduct) the left leg. Alternate legs. B. Standing, weight bearing leg on a step board, facing away from the short end of the board. Let one leg slide backwards into full extension of hip. Alternate legs. C. Rope skipping

Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005 8 Exercise circle 4. Thick mattress A.

8 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise circle 4. Thick mattress A. Standing to sitting onto a chair and back to standing with weight bar in front of the shoulders close to the body. Jump when standing up. B. Step down from a step board onto a thick mattress, if possible then jump forward. C. Single leg standing on one leg on a thick mattress holding a ball in both hands above the head. Other leg approx. 90 degrees knee flexion. Exercise circle 5. A. Stand and face away from the step board. Step up backwards with one leg on the step board. Final knee extension important! B. Lunge forward with bar bells. C. Standing with weight bar in front of shoulders. One leg in full hip and knee flexion. Extend the weight bearing leg. Final knee extension important! Level 3 Exercise circle 1. A. Work in pair. Sit ups while throwing a ball between each other. Alternate between sitting up forward, to the right and to the left. B. Crook lying on the floor, balancing a ball under the right/left heel alternatively. C. Jogging on a trampoline. Work in pairs, throw a ball to each other. Jump on one leg while throwing.

Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005 9 Exercise circle 2. Pulley or rubber band A. Stand on a stool. Standing, back towards the pulley.

Stand with mid and forefoot on a step board, heel outside board. Other leg on a chair in front (hip and knee flexed to about 90 degrees).heel lifts. Exercise circle 3. Slide board A.

9 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise circle 2. Pulley or rubber band A. Stand on a stool. Standing, back towards the pulley. Pulling the leg forward and up to approx. 90 degrees hip and knee flex. B. Prone on a bench with extended hip. Facing away from the pulley. Knee flexion. C. Stand with mid and forefoot on a step board, heel outside board. Other leg on a chair in front (hip and knee flexed to about 90 degrees).heel lifts. Exercise circle 3. Slide board A. Standing, weight bearing on the right leg (flexed knee) on a step board. Left leg extended knee, pull in (adduct) the left leg. B. Standing, weight bearing leg on a step board, facing away from the short end of the board. Let one leg slide backwards into full extension of hip. C. Rope skipping Exercise circle 4. Thick mattress A. Standing legs wide apart with bar in front of shoulders. Deep squats. When in approximately 90 degrees of flexion (or less if maximum), lift one foot from the floor at the time by flexing the hip. Alternate legs. B. Long sitting. Use the knee extensors and press the knee down into full extension. C. Balancing on one leg on the thick mattress holding a ball in both hands above the head. Other leg approx. 90 degrees of hip and knee flexion.

Exercise program from Roos & Dahlberg, Arthritis & Rheum 2005 10 Exercise circle 5. A. Stand and face away from the step board. Step up backwards with one leg on the step board.

10 Exercise program from Roos & Dahlberg, Arthritis & Rheum Exercise circle 5. A. Stand and face away from the step board. Step up backwards with one leg on the step board. Final knee extension important! B. Lunge forward with bell bars. Front foot on low step board. C. Standing sideways with weight bar in front of shoulders or medicine ball above head. Left foot on step board. Right foot on the floor. Extend left knee. Then alternatively flex the right knee to approx 90 degrees and extend the knee and let the heel (extended knee and flexed foot) approach the floor.

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copyrighted material by PRO-ED, Inc. Contents Preparation for Functional Sitting Partial Pull to Sit.......................................................... 2 Pull to Sit................................................................ 3