movement

Joint Replacement- What Can I Do?

Joint replacement surgery is becoming more and more common. With an ageing population and 1.8 million Australians suffering from osteoarthritis in 2013, it’s fair to say that the number of people getting joint replacement surgery is likely continuing to rise. 

Physiotherapy assists people suffering with osteoarthritis with prehabilitation. Prehabilitation is just rehabilitation, pre-surgery! Prehab is a general term that describes three months of moderately intense exercise immediately prior to joint-replacement surgery with the aim of improving outcomes after the surgery. 

After surgery, there are a few options for rehabilitation. One is to stay in the hospital and do your rehabilitation in a specialised rehab wing. Alternatively, if you’re deemed safe enough (i.e. steady enough on your feet) to go home with family or friends, you can complete the rehabilitation as an out-patient with a physiotherapist in the community. Completing a course of prehabilitation has been shown to decrease the number of people needing in-patient rehabilitation post-operatively, and to decrease the amount of rehabilitation input needed.

The prehabilitation or rehabilitation comes in various forms. Common types of exercises used are strength training, aerobic/cardiovascular training and hydrotherapy (exercise in the pool). Recently, exercises with slow deliberate movements, like yoga and Tai Chi, have also been shown to be effective in treating osteoarthritis. Exercise has been shown to improve pain levels, improve muscular strength of the hips, knees and back, improve the efficiency of the walking pattern & other functional tasks and improve quality of life for people who suffer from osteoarthritis3.

Chari teaching some balance exercises in one of our training groups.

Chari teaching some balance exercises in one of our training groups.

For years, surgeons have had rules about who they are willing to operate on. Usually, you’ll hear terms thrown around like ‘medically stable’ and ‘low risk’ (hopefully this is you!). This means consistently taking medications effectively to control other conditions like high blood pressure or diabetes. Surgeons are increasingly incorporating weight limits on their patients prior to surgery as well, as increased body weight has been shown to be a causative factor in osteoarthritis, particularly of the knee3. To do this, surgeons are suggesting that their patients try a course of prehabilitation to decrease their weight, improve their pain and function before considering surgical treatment options. 

1. www.aihw.gov.au/media-release-detail/?id=60129543357

2. www.arthritis.org/living-with-arthritis/treatments/joint-surgery/preparing/prehab-surgery.php

3. www.ncbi.nlm.nih.gov/pmc/articles/PMC3612336/

The Movement Team now has knee-specific and shoulder-specific prehabilitation training groups operating in addition to our general training groups. Essentially, we see a lot of the same injuries and conditions so we have created some small groups of (4-6) people who need guidance on similar injuries or conditions. 

You don’t need to have a surgery lined up to join in! 

Prehabiliation is a classic example of asking the question “What can I do?” when injured. So ask yourself- despite any limitations- what can you do today?

Isabelle.

Issy utilising cutting edge hear technology to keep warm (AKA a cup of tea). 

Issy utilising cutting edge hear technology to keep warm (AKA a cup of tea). 

Isabelle is currently the 1st Team Physio for Samford Rangers. Isabelle has worked in private practice around Brisbane before finding her way to Samford and The Movement Team. Isabelle is a qualified pilates instructor and also has a huge passion for dance and all things movement.

Why is Exercise Good for Type 2 Diabetes Mellitus?

We all know that exercise is good for us, we hear it time and time again in the media, but never has it been more important than now. Especially as the rates of obesity are on the rise, and with it other associated lifestyle diseases. One lifestyle related disease, the focus of this blog, is type 2 diabetes mellitus. But what is type 2 diabetes? Why is exercise good? How much, and is there anything I need to consider?

Jackie Chan wondering confused by what to do

Jackie Chan wondering confused by what to do

Well…. I’m glad you asked!

What is Type 2 diabetes?

T2DM is a progressive disease where by the body over time develops a resistance to insulin. 

Insulin is the major cellular mechanism for transport of glucose into skeletal muscle where it is stored as glycogen, or used to produce energy. As the body becomes resistant, more insulin is produced over time to facilitate this process until eventually the cells in the pancreas, responsible for insulin production, become exhausted. Not good! What is required at this point in time is an exogenous (external) source for this process to continue.

Diagram of diabetes

Diagram of diabetes

So my pancreas is exhausted. Now what do I do?

This is where exercise can assist. Muscle contraction also draws glucose into the muscle cell without the reliance on insulin. Using separate signalling pathways, these two processes eventually both lead to the same transporter protein, which transports the glucose into the muscle cell. 

So think of it like this, the more you use your muscles, whether it be walking, riding, jumping, skipping, weights etc. the more you are pumping glucose into the muscle without working the pancreas into overtime. This assists in blood glucose/glycaemic control. A bout of exercise often has a carryover effect on blood sugars of 24hours. 

How exercise is beneficial for those with diabetes

How exercise is beneficial for those with diabetes

How much exercise should I do?

Exercise and Sports Science Australia have released the following position statement when it comes to exercise recommendations for T2DM.

“Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2–4 sets of 8–10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.”

One of the greatest moments in life is realising that 2 weeks ago, your body couldn't do what it just did

One of the greatest moments in life is realising that 2 weeks ago, your body couldn't do what it just did

Things to consider.

When exercising with diabetes, it is important that you check your blood sugars pre and post exercise, as well as monitor signs and symptoms of hypoglycaemia (a dropping of blood sugars below safe levels presenting in dizziness, confusion, slurred speech and nausea which can lead to a coma or death if unattended). A normal range is 4-8mmol. However, personally I prefer that a diabetic exercising in the movement room, has a post blood sugar reading higher than 6. This accommodates the consideration that the body is still working at a higher metabolic rate for a short time post exercise, and acts as a buffer from dangerously low levels until the body returns to its resting state.

Doctor pun about blood sugar

Doctor pun about blood sugar

Other comorbidities to which the ESSA guidelines refer are heart disease and hypertension to name a few. These also require close monitoring until a safe exercise capacity can be established without risk of causing a serious event. Complications associated with diabetes are things such as peripheral neuropathies, where an individual can experience altered sensation, more commonly in the lower limbs. This can affect balance and sensitivity. So it is important to consult your GP, as well as an exercise physiologist to establish a safe exercise program that will improve your quality of life. 

MIKE

 

Michael Pegg

Exercise Physiologist

B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM

Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease.