Arthritis Foundation/YMCA Aquatic Program Arthritis Foundation Exercise Program Leader/ Instructor Pre-Training © 2009 by the Arthritis Foundation and the YMCA of the USA. All rights reserved, including rights of translation in a foreign language. Except for use in a review, the reproduction or utilization of this work in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including xerography, photocopying, and recording, and in any information storage and retrieval system, is forbidden without the written permission of the publisher. Table of Contents How to Use This Workbook.............................................................................................. 5 Purpose........................................................................................................................ 5 What you will need....................................................................................................... 5 Activities....................................................................................................................... 5 How to Use This Workbook (continued)....................................................................... 6 Suggested Timing......................................................................................................... 6 Timing Breakdown........................................................................................................ 6 What to Bring to Class.................................................................................................. 6 Pre-Training Overview..................................................................................................... 7 Course Purpose............................................................................................................ 7 Objectives..................................................................................................................... 7 What you as an instructor need to know about your participants ................................. 7 Introduction: Defining Arthritis.......................................................................................... 8 Exercise #1................................................................................................................... 8 Introduction: Defining Arthritis (continued).................................................................... 9 Joint Structure................................................................................................................ 10 Structure of a Healthy Joint........................................................................................ 10 Structure of a Healthy Joint (Continued)..................................................................... 11 Types of Arthritis............................................................................................................ 12 Four Common Types of Arthritis and Related Conditions........................................... 12 Exercise #2: Recognize the Arthritis Umbrella ........................................................... 17 Living with Arthritis......................................................................................................... 18 Signs and Symptoms of Arthritis.................................................................................... 19 Signs and Symptoms (continued)............................................................................... 20 Psychosocial Aspect................................................................................................... 20 Chronic Illness Symptom Cycle.................................................................................. 21 Special Sensitivities....................................................................................................... 23 Exercise #3................................................................................................................. 23 Special Sensitivities (continued)................................................................................. 24 Special Sensitivities (continued)................................................................................. 25 Treatments for Arthritis................................................................................................... 26 Treatment for Arthritis (continued).............................................................................. 27 Treatment for Arthritis (continued).............................................................................. 28 Common Types of Arthritis and Treatments................................................................... 29 Exercise #4................................................................................................................. 29 Exercise # 4 (continued)............................................................................................. 30 Three Types of Exercise for Arthritis.............................................................................. 31 Three Types of Arthritis (continued)........................................................................... 32 Additional Questions................................................................................................... 33 Conclusion.................................................................................................................. 34 KNOWLEDGE CHECK.................................................................................................. 35 Appendix A..................................................................................................................... 38 Exercise #4 - Answers................................................................................................ 38 Appendix B..................................................................................................................... 40 3 Knowledge Check Answers........................................................................................ 40 Appendix C .................................................................................................................... 42 Glossary of Exercise Terms........................................................................................ 42 4 How to Use This Workbook Purpose The purpose of this pre-training workbook is to prepare you for the in-person Arthritis Foundation/YMCA Aquatic Program or Arthritis Foundation Exercise Program Instructor Training Workshop. This workbook covers basic aspects of arthritis and its treatment and an overview of the psychosocial aspects of arthritis. You will be able to use this workbook at your own pace as long as you complete the required assignments in the book prior to coming to the classroom portion of this training. What you will need Contained in this book are activities with questions that you will have to answer. Answers to the questions can be found in this book. Therefore, you will need a quiet place to work with limited distractions so you can stay focused. Activities In this workbook, you will have activities to complete. Some of the activities will have an answer key found in designated Appendix sections. Other activities have answers built right into them. 5 How to Use This Workbook (continued) Suggested Timing Below you’ll find suggested timing for each section. Please note that this is a guide to allow you to plan your time accordingly. Timing Breakdown Introduction: Defining Arthritis 5 Joint Structure 10 Types of Arthritis 10 Living with Arthritis 2 Signs and Symptoms 8 Special Sensitivities 5 Treatments for Arthritis 5 Common Types of Arthritis and Treatments 15 Three Types of Exercise for Arthritis 10 Knowledge Check 10 Total Time 80 One hour and 20 min What to Bring to Class • This workbook • Completed Knowledge Check (be prepared to hand in to Trainer) 6 Pre-Training Overview Course Purpose The purpose of using this Pre-Training Workbook is to provide an overview of basic medical aspects of arthritis, its treatment and psychosocial impact. Completion of this workbook is a requirement for training and certification as an Arthritis Foundation/YMCA Aquatic Program Leader or Instructor or Arthritis Foundation Exercise Program Instructor. Objectives At the conclusion of completing this Pre-Training Workbook, you can expect to be able to: • Define arthritis. • Comprehend joint function and the anatomy of a joint. • Recognize the four most common types of arthritis seen in participants. • Identify the different types of arthritis. • Aid in the understanding of what it is like to live with arthritis. • Identify key signs and symptoms of arthritis. • Describe the psychosocial impact of living with arthritis. • Adhere to special sensitivity guidelines when referring to people with arthritis. • Identify at least three arthritis treatment approaches. • Describe the three important types of exercise for people with arthritis. What you as an instructor need to know about your participants (cid:137) People of any age live with arthritis, rheumatic diseases or related musculoskeletal conditions. (cid:137) People with arthritis have varying degrees of capabilities and so the program can be geared to different levels. For instance, you can offer: o A basic level program for those currently living a sedentary lifestyle and seeking a low-intensity exercise program, and/or, o A “Plus” or more advanced or mixed class for those currently living a more active lifestyle and able to achieve and sustain moderate-intensity exercise levels and longer periods of endurance exercise. 7 Introduction: Defining Arthritis Many people have heard of arthritis but may not have a basic understanding of what it is. Some have arthritis or know someone who has arthritis and may have slightly more knowledge of what it actually means. To begin your training, it is important to have a definition of what arthritis actually is. The word arthritis is a general term that means “joint inflammation” (arth = joint; itis = inflammation). A joint is a place in the body where two bones meet. Inflammation is a natural protective response but in various types of arthritis, it can damage joints and other body parts. The term arthritis refers to more than 100 rheumatic conditions, inflammatory and non- inflammatory, affecting not only joints but also surrounding structures and other tissues. Many forms of arthritis are systemic diseases (pertaining to or affecting the body as a whole) that can cause generalized fatigue and problems with the skin, eyes, heart, lungs, kidneys and other parts of the body. Forty-six million Americans (one in five people) have been diagnosed with arthritis. There are several misconceptions about arthritis. Some of these you may have some knowledge about and some you may not have considered before. Below is a list of beliefs about arthritis. For each belief, identify whether you think the statement is True or False. Exercise #1 Beliefs True/False 1. Every day is the same for people with arthritis. 2. Only old people have arthritis. 3. Poor diet causes arthritis. 4. Arthritis is a minor physical inconvenience. 5. There is very little that can be done to help people with arthritis. 8 Introduction: Defining Arthritis (continued) If you answered False to all of the beliefs, you are correct. If you answered True to couple of them, that’s okay. Many people who don’t know about arthritis think this way. The first step in changing misconceptions is learning about the facts of arthritis: 1. Many people with arthritis have disease activity that fluctuates with flare-ups, when symptoms worsen, and remissions, times when the symptoms lessen or disappear. 2. Arthritis affects all ages and arthritis is NOT an inevitable part of aging. Nearly three out of five people with arthritis are under the age of 65 and even children get arthritis. 3. Diet can not cause or cure arthritis, although reducing weight if you are overweight can help reduce pain. 4. Arthritis is the most common cause of disability in the U.S., making it difficult for many Americans to bathe, dress, reach and do other simple activities of daily living. 5. Most forms of arthritis are chronic, meaning they last a lifetime; early, aggressive treatment can do a lot to control symptoms and reduce their impact. After completing this workbook, you will have a broader understanding of what arthritis is, the effect it has on people physically and emotionally, how to be sensitive to what they are going through on a daily basis and what treatment is available. Be prepared to answers questions in class related to the material contained in this pre-training. 9 Joint Structure To understand what happens in arthritis, rheumatic diseases and related musculoskeletal conditions, it is helpful to be familiar with the structure of a joint. Structure of a Healthy Joint Bone – A relatively hard, porous substance that provides a supporting framework for the body. It serves as a place for attachment of muscles and provides a storehouse of minerals such as calcium that the body can draw on. Bones are living tissue capable of local growth and rebuilding, as in healing a fracture. In osteoporosis, bones lose mass and become thin and brittle, leading to fractures. Cartilage – A tough material that cushions and protects the bone ends. The end of each bone is covered with cartilage. In osteoarthritis, there is a breakdown of cartilage. Synovial Membrane (synovium) – Lines and protects each joint by secreting a synovial fluid that lubricates and nourishes the joint. In rheumatoid arthritis, the synovium becomes inflamed and can damage the other joint tissues. Muscles – Contractile tissue that moves the bones by becoming shorter or longer and thus moves you. Fibromyalgia involves pain in the muscles and polymyositis is an inflammatory condition of muscles. 10