Patient guidelines for weight-resistance training in osteoarthritis

INTRODUCTION

The following guidelines should be followed when prescribing weight-resistance training in patients with osteoarthritis.

• Before starting any weight resistance program, consult with a rheumatologist to learn what response you might expect from exercise and discuss limitations. Some forms of arthritis do not respond well to weight resistance training and there may be some contraindications.
• Consult with a qualified physical therapist and/or personal trainer to find out which exercises are best for your particular type of arthritis. Some exercise and stretching routines are contraindicated and can aggravate a preexisting condition.
• A supervised exercise program in a gym is more desirable than an individual home based program. People tend to be more compliant and motivated if they are being supervised. A gym has a greater diversity of equipment and classes.
• Find a training partner. Training partners are great for maintaining interest and motivation. A partner can also provide constructive criticism and act as a spotter.
• Always warm-up before starting your workout routine. This promotes circulation and prepares joints for activity.
• Once you have warmed-up, do some light stretching exercises. This promotes greater flexibility and range of motion. Stretching can also provide some relief from the stiffness associated with arthritis. Do static stretches rather than ballistic stretches (static stretches are stretches that are held without bouncing for 20 to 30 seconds while ballistic stretches are stretches that are done with bouncing involved). Do not go beyond your range of motion. Over-stretching can place excessive strain on muscles and joints.
• Become familiar with your limitations. There is a tendency to become over anxious to get back into shape, especially after being sedentary for a long time. Start out with light weights. This will put less strain on your joints. You will gain greater results from using proper technique, good body alignment, full muscle contractions and a slow steady pace. Heavy weights don't always promote muscle strength and growth.
• Always maintain proper body alignment. When standing, keep your knees bent to reduce stress on the lower back, keep abdominal muscles tight, keep your head positioned forward and not off to one side, and always stay focused when you are working out with weights.
• Use the mirrors in the gym to check your form and body alignment.
• Move the weights in a smooth steady motion without any sudden or jerky movements.
• Don't "lock-out" your joints at the end phase of an exercise. Always try to keep a small amount of flexion to reduce strain on the joints.
• Make sure you are breathing; don't hold your breath while you are lifting weights or stretching. Exhale while you are in the concentric contraction phase of lifting. Breathing while you are involved in a forceful contraction will reduce intrathoracic pressure. Reducing intrathoracic pressure is particularly important to those people with hypertension.
• Try to achieve a balance in opposing muscle groups. If you can do a biceps curl with 20 pounds, you should be able to do a tricep extension with the same amount of weight. This type of balance in muscle groups provides greater stability in joints.
• If you are taking medication for arthritis, be aware of the possible side effects and the implications it could have for exercise. The benefits of some medications could give you a false sense of well-being and may allow you to push beyond your limits which could lead to injury or exacerbation of your condition. The same guidelines should be followed with over-the-counter medications. They should not be overused. If you find little or no relief from the recommended dosage, it could be a sign of a more serious condition. The use of ointments is another commonly used method of relief for the symptoms of arthritis. Ointments work by activating heat receptors in the skin. Whether or not they promote circulation is unclear. There are no scientific data that suggest how much relief is actually obtained by their use or whether or not they are effective in the treatment of arthritis.
• Orthopedic braces prescribed by a physician should be worn during exercise unless otherwise prescribed. Cloth or Neoprene braces provide inadequate support to joints and at most provide warmth and some proprioceptive stimulation. Wraps function in the same way that cloth and Neoprene braces work. Gloves are critical for providing padding to the hands and assisting in improving gripping power. Straps are excellent for relieving strain on the fingers and wrists. Taping can provide adequate support if done by a qualified trainer. Taping also provides adequate proprioceptive stimulation. Contrary to popular belief, weight belts provide inadequate support and should be used only for their proprioceptive benefits. Weightlifting belts may provide a false sense of support and may lead people to believe that they can lift excessive loads, especially during squats or dead-lifts.
• Hot packs can be applied to joints and muscles prior to exercising to reduce pain and promote circulation. Cold packs can be applied after exercising to reduce inflammation; they should be applied for 20 minutes on and 20 minutes off.
• Wear proper shoes while exercising. Try on as many pairs as possible and pick the most comfortable pair. Try out all the various types of shoes: Cross trainers, mid-tops, high-tops, tennis shoes, basketball shoes, weightlifting shoes, running shoes, walking shoes or hiking shoes. If you wear orthoses, try the shoes on with the orthoses in place.
• Pick cushioned surfaces on which to exercise such as carpet, grass, exercise mats, or sand. Cushioned surfaces reduce the shock impact off of the joints of the lower extremities.
• Stop exercising if you experience any of the following: increased pain or swelling in muscles or joints, popping, locking, giving-way, or new onset of musculoskeletal pain, abdominal pain, groin pain, chest pain, or shortness of breath.
• Alternate between weight bearing and non-weight bearing exercises.
• Exercise at times of the day when you feel most energetic and when you are not in a hurry.
• If you are overweight, incorporate a weight loss program through diet and cardiovascular exercise. This will reduce the weight bearing loads placed on the joints.
• Always end an exercise session with an active cool-down. An active cool-down will reduce the onset of delayed muscle soreness, will slowly decrease an elevated heart rate, and will prevent blood from pooling in lower extremities which can lead to dizziness. Stretching at the end of a workout session is also advisable.
• Keep yourself educated on the latest trends in exercise. Try different exercises. Try free weights as well as machines, as they have different benefits. Ask a lot of questions of personal trainers and other fitness experts; don't take anything for granted.
• Incorporate recreational activities of your choice into a fitness program such as golf, bicycling, hiking, or swimming.
• Have fun! You will not continue doing any activity if you do not enjoy it.

ACKNOWLEDGMENT

The author and editorial staff at UpToDate, Inc. would like to acknowledge Andrew L Concoff, MD, who contributed to an earlier version of this topic review.