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Consultation 1 – strengthening exercises

Watch a physiotherapists prescribe a strengthening exercise program through telehealth using the PEAK program for knee osteoarthritis
4.4
SPEAKER 1: All right, and now can you get your blue booklet?
7.9
SPEAKER 2: Blue book.
8.9
SPEAKER 1: Blue book.
9.8
SPEAKER 2: Yeah, we have blue book.
11.5
SPEAKER 1: Beautiful. Blue book has all the exercises we can give you, and it also has all the information you need to know about exercise.
19.9
SPEAKER 2: Fantastic. I didn’t even look at the blue boo– I’ve been away, but I didn’t even look at the blue book. Mm.
24.9
SPEAKER 1: Yeah. So if you open the blue book to page four–
30.6
SPEAKER 2: Yes.
31.3
SPEAKER 1: –there’s some important things. So first important thing to highlight is that it tells you about the elastic bands–
39.9
SPEAKER 2: Yes.
40.8
SPEAKER 1: –and that they have different resistance levels.
43.3
SPEAKER 2: Yes.
43.8
SPEAKER 1: Red’s the hardest. Black’s the hardest. Yeah? So you can refer back to that–
47.5
SPEAKER 2: I worked out black was the hardest. I was just trying to work out the order of the other three.
51.2
SPEAKER 1: Good work. So you can refer back to that. If you need to make an exercise– if you ever need to make it harder or easier, you can refer back to that.
59.6
SPEAKER 2: Great.
60.5
SPEAKER 1: The other thing on page five that’s super, super important is that when we give you your resistance exercises, we need to give it at a sufficient intensity, OK.
74.4
SPEAKER 2: Mm-hmm.
75.2
SPEAKER 1: So that we need to actually be working either hard to very hard whilst exercising, particularly–
80.8
SPEAKER 2: Got it.
81.1
SPEAKER 1: –with the resistance exercises. Yeah.
83.4
SPEAKER 2: Yep, OK.
84.2
SPEAKER 1: So it’s going to be hard work, and we’re going to be saying, how hard are you working? And if you say–
89.9
SPEAKER 2: OK.
90.3
SPEAKER 1: –mm, yeah, sort of hard, I’ll be all right, OK, we need to make this harder.
94.9
SPEAKER 2: OK.
95.6
SPEAKER 1: But you don’t do these exercises every day.
98.9
SPEAKER 2: Oh, really?
99.8
SPEAKER 1: No.
100.6
SPEAKER 2: Oh.
101.2
SPEAKER 1: We only do them three times a week.
103.8
SPEAKER 2: Oh. OK.
104.9
SPEAKER 1: So we’ll be doing some cardio and physical activity every day, but these resistance exercises, they’re not an everyday thing.
110.6
SPEAKER 2: Oh, OK. I think I’m better at kind of every day. But that’s OK. We can try this.
115.5
SPEAKER 1: Yeah. Yeah, it can be hard.
117.1
SPEAKER 2: I think it’s easier to ditch things when it’s not every day. You go, ah, yeah, I’ll do it tomorrow.
122.2
SPEAKER 1: Yeah, the routine is a bit more difficult. But the way I think about the positive side of it is not as much time is needed. We need to work hard–
132.2
SPEAKER 2: Yep, OK.
132.6
SPEAKER 1: –less frequently. Yeah?
134.2
SPEAKER 2: Rightio.
134.6
SPEAKER 1: So it’s really important that we’re rating the exercises. And we’re rating it from 0, being at rest, to 10, being maximal effort. And we want to be working in the vicinity of 5 to 7 out of 10, or what we’d describe as hard to somewhat hard. That’s our–
149.1
SPEAKER 2: So I’m going to be using this scale in filling in my exercise diary.
152.8
SPEAKER 1: Yes.
153.7
SPEAKER 2: Got it. OK.
155.9
SPEAKER 1: All right.
156.8
SPEAKER 2: All right.
157.7
SPEAKER 1: Almost there, and then we’re going to actually get back into the exercises.
161.4
SPEAKER 2: OK.
162.8
SPEAKER 1: Page six and page seven. Some really important things.
165.9
SPEAKER 2: Yep.
167.3
SPEAKER 1: So first important thing is that there’s a title there, Exercising with Knee Pain.
173
SPEAKER 2: Mm-hmm.
173.8
SPEAKER 1: And obviously, you and I both know that when we exercise, it’s not always the most comfortable feeling.
180
SPEAKER 2: Yup.
180.8
SPEAKER 1: And in fact. Often to get the best bang for buck with exercise, it needs to be uncomfortable.
185.8
SPEAKER 2: Yes.
186.4
SPEAKER 1: And it’s the same when you have chronic joint pain.
189.4
SPEAKER 2: Yep, no pain, no gain.
190.9
SPEAKER 1: Yeah. Feeling some pain with exercise may help. And the blue box helps explain that a bit further. So doing painful exercises may change the way your brain processes pain and the way you think about pain, helping you to restart movements that you might be previously a little bit apprehensive of. So–
207
SPEAKER 2: Yeah.
207.4
SPEAKER 1: –if I said, oh, we’re going to go start walking up a big hill, you might be a bit apprehensive about that at the moment.
212
SPEAKER 2: Mm.
212.6
SPEAKER 1: But if we gradually challenge you, you might get less apprehensive about that.
217
SPEAKER 2: OK.
217.9
SPEAKER 1: The other thing, exercise triggers the brain to release chemicals, i.e. endorphins, that have an analgesic, that is, pain relieving, effect.
226.1
SPEAKER 2: Mm-hmm.
226.9
SPEAKER 1: Exercising at intensities that cause some pain may release more endorphins than pain-free exercises.
232.5
SPEAKER 2: Mm-hmm.
233.5
SPEAKER 1: So you said it, no pain, no gain.
236.4
SPEAKER 2: Yep.
237.8
SPEAKER 1: To a point. So we’re going to make it– a little bit of pain is OK whilst exercising, but we don’t want to be worse 24 hours later.
247.1
SPEAKER 2: No.
247.7
SPEAKER 1: So this is the next step, managing flareups, OK?
251.8
SPEAKER 2: OK. Mm-hmm.
252.9
SPEAKER 1: So the flareup basically would be that you have unacceptable levels of knee discomfort for more than 24 hours.
261
SPEAKER 2: Yep.
261.6
SPEAKER 1: Remember what you talked about previously, when you’d lie in bed, really need those strong [INAUDIBLE]?? That’s a flareup.
267.9
SPEAKER 2: Yep.
268.9
SPEAKER 1: What do we do when that happens? Well, we want to reduce the dosage. So we might decrease the number of repetitions in the exercise we do.
276.3
SPEAKER 2: OK.
276.8
SPEAKER 1: Might reduce the resistance, so we choose a different colour band.
280
SPEAKER 2: Yep.
280.7
SPEAKER 1: We might try an easier version of the exercise. This is so I can [INAUDIBLE] there as we work through this. And we might even just have to stop the exercise that really flares it up and go onto an easier or an alternate exercise, OK?
295
SPEAKER 2: Okey doke.
296.4
SPEAKER 1: All righty. So they’re the main things.
300
SPEAKER 2: OK.
300.9
SPEAKER 1: So now we’re going to give you some exercises.
303.5
SPEAKER 2: Yep.
307.9
SPEAKER 1: And what you’ll need is you’ll need your blue book handy, and you’ll need your red book handy.
313.2
SPEAKER 2: Blue book, red book.
314.8
SPEAKER 1: Yeah.
315.5
SPEAKER 2: OK.
316.1
SPEAKER 1: OK, so in your red book, if you open to page four– and have you got a pen handy?
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SPEAKER 2: Pen. I can find one. Just give me a tick.
325.2
SPEAKER 1: Go and do that.
331.9
SPEAKER 2: Oh, yeah.
339.2
SPEAKER 1: Cool.
341.2
SPEAKER 2: Yep.
342.7
SPEAKER 1: Rightio.
344.9
SPEAKER 2: Page five, yeah?
348.7
Four? Five?
349.8
SPEAKER 1: Four, four. Four.
351.7
SPEAKER 2: Right. Gotcha.
353.5
SPEAKER 1: So this is your knee plan. This is what you’re going to do for the week.
357.1
SPEAKER 2: OK.
357.8
SPEAKER 1: Strengthening exercises. We’re going to pick the strengthening exercise right now.
362.1
SPEAKER 2: OK.
362.4
SPEAKER 1: So if you watch the tablet for a second, I’m going to share screen.
366.3
SPEAKER 2: OK.
367.4
SPEAKER 1: So you should now be able to see my screen.
369.6
SPEAKER 2: Yeah.
370.3
SPEAKER 1: And you can see Exercise Q3, sit to stand without using hands.
374.2
SPEAKER 2: Mm, yep.
375.5
SPEAKER 1: And this exercise, you just had a go at it before.
378
SPEAKER 2: Yep.
378.6
SPEAKER 1: That’s what it looks like.
380.2
SPEAKER 2: Yeah.
380.9
SPEAKER 1: Yep. All right, and we’re going to be trying that exercise with you, making sure that it’s hard enough. Now you did a little cheat before where you used your left knee a bit more than your right.
396.4
SPEAKER 2: Mm.
396.9
SPEAKER 1: So when we do this exercise, we’ve got to make sure it’s either 50-50, or we might have to do Exercise Q4, which is biassing it to use one leg more than the other–
410.1
SPEAKER 2: Mm-hmm.
411.3
SPEAKER 1: –and making sure we’re using the right knee more than the left. And we do that by putting the right leg further back and the left leg further forward.
420.8
SPEAKER 2: Ah, so this is putting– so putting the arthritis knee further back.
425.8
SPEAKER 1: Yes, correct.
427.3
SPEAKER 2: OK, closer to the chair, and the non-arthritis knee forward.
431.6
SPEAKER 1: Yes.
432.5
SPEAKER 2: I suspect that’s probably what I should be endeavouring to do from the uptake, because I just won’t– I don’t think it’s something I can easily make the other knee do it.
441.8
SPEAKER 1: Yeah. So why don’t we give that a go then.
444.8
SPEAKER 2: OK, let’s do that.
445.2
SPEAKER 1: And we’ll see if we can even make it harder. So if you push yourself–
447.4
SPEAKER 2: OK.
447.7
SPEAKER 1: –back– you don’t have to write anything just yet. We’re going to have a practise first.
451.1
SPEAKER 2: OK.
451.9
SPEAKER 1: Exercise Q4.
454.1
SPEAKER 2: Yep.
455.6
SPEAKER 1: And I want your right leg further back, your left leg further forward.
460.4
SPEAKER 2: Yep. Yep.
461.6
SPEAKER 1: Stand up.
462.6
SPEAKER 2: Yeah, that’s not fun. Oh.
464.5
SPEAKER 1: Slowly sit down.
466.2
SPEAKER 2: Don’t like that.
467.3
SPEAKER 1: Slowly down. Slow it down. So that was one.
469.7
SPEAKER 2: Yeah.
470.4
SPEAKER 1: Slower on the way down. Yeah, try not to plonk at the end. That was too–
474.5
SPEAKER 2: Is that because you’re not using the muscle–
476.5
SPEAKER 1: Correct.
476.9
SPEAKER 2: –if you plonk?
478
SPEAKER 1: That’s right. This will be three. Slower. That was good.
484
SPEAKER 2: That’s so–
485.7
SPEAKER 1: Oopsies.
487
SPEAKER 2: Yeah.
487.8
SPEAKER 1: We’ll call that four. So we might have to be at feet level. I don’t know. You tell me. Is that almost too hard to do?
495.9
SPEAKER 2: No, because if I don’t do it that– I can feel that knee. I couldn’t feel it before.
500.9
SPEAKER 1: Good, OK.
501.7
SPEAKER 2: So I think that I unconsciously compensate.
504.5
SPEAKER 1: Are you? Yeah, yeah. [INAUDIBLE]
506.5
SPEAKER 2: So I think that it’s going to be better for me to actually have a fairly clear delineation that doesn’t allow me to–
512.5
SPEAKER 1: Good.
513.1
SPEAKER 2: –because I suspect my brain is quite programmed into compensating.
516.2
SPEAKER 1: You’re just automatically compensating.
517.8
SPEAKER 2: Yeah.
518.2
SPEAKER 1: Yep, OK.
518.6
SPEAKER 2: It just does it.
519
SPEAKER 1: All right, keep going. So we’re up to– we’ll say that was four, and we’re going to do a full 10.
524.1
SPEAKER 2: Oh.
524.8
SPEAKER 1: Yeah. I’m going to make you do 10. And then you’re going to rate them for me.
528
SPEAKER 2: OK. Then that’s done for today?
531.7
SPEAKER 1: Good. No, you’ll have to do two more sets for today. But for you and me, I’ll just watch you do one. That six. Slowly down. That was good. Seven. Yep. So really make sure you get your body weight going forward. So really lean forward at the hips. That was a better one. Slowly down. Slowly down.
553.7
SPEAKER 2: I haven’t got the best positioning.
555.7
SPEAKER 1: Yeah.
556.1
SPEAKER 2: So I’ll position the chair better for next time.
558.5
SPEAKER 1: Good. Nine. One more. Slowly down, slowly down. Slowly, slowly, slowly. Yeah. OK.
565.4
SPEAKER 2: Is that still too fast?
566.6
SPEAKER 1: Well, that last one looked a little bit. So how hard were you working for that right thigh? 10 out of 10 was it’s maximal effort. 0 is at rest.
578.2
SPEAKER 2: The thigh.
579.5
SPEAKER 1: Yeah, the leg.
580
SPEAKER 2: Because I thought I was working the knee.
582.2
SPEAKER 1: Yeah, well, how hard was that working?
584.4
SPEAKER 2: Yeah, I reckon I was probably doing a good 7 or so.
587.2
SPEAKER 1: OK, perfect. All right, that’s good. That’s in the zone.
590.2
SPEAKER 2: Mm-hmm.
591
SPEAKER 1: So in your red book, can you write– in this–
595.7
SPEAKER 2: Red book.
596.6
SPEAKER 1: Red book.
597.1
SPEAKER 2: Yep, red book.
598.1
SPEAKER 1: For the first column, write Q4.
603.7
SPEAKER 2: Q4.
604.9
SPEAKER 1: Q4, the exercise Q4.
607.2
SPEAKER 2: Oh, got it, yep. Yep.
612.4
SPEAKER 1: Three sets of 10.
615
SPEAKER 2: Q4, so and that’s here, isn’t it?
617.7
SPEAKER 1: Yeah, that is odd.
619
SPEAKER 2: Q–
619.4
SPEAKER 1: I’ll tell you what happened.
620.1
SPEAKER 2: –Q1, Q2, just making sure I’ve not– oh, yeah, gotcha. Q4, three sets of 10.
625.7
SPEAKER 1: Yeah. So Q4’s on page 12.
628.7
SPEAKER 2: Three sets of 10 three times a week.
631.2
SPEAKER 1: Three times a week, yeah. And well, we might as well do it now, but what’s going to be the easiest way to get you to remember to do it? Because you said that’s your challenge when you’re not doing it daily.
641.4
SPEAKER 2: Oh, I’ll set myself a time.
643.7
SPEAKER 1: Yep, and write it down somewhere or put it on– a reminder on a phone or–
648.8
SPEAKER 2: Well, yeah. Well, I’ve got to keep this logbook, haven’t I?
651.7
SPEAKER 1: You do, yeah. You’ve got to write it down. That’s it.
654.2
SPEAKER 2: So that’s going to kind of–
655.6
SPEAKER 1: That’s going to keep you honest.
656.7
SPEAKER 2: Yeah.
657.4
SPEAKER 1: OK. Good.
658.9
SPEAKER 2: Ah, you want to know if I’m not going to cheat. I got it.
661.4
SPEAKER 1: Oh, no, no, no.
662.4
SPEAKER 2: Yeah.
663
SPEAKER 1: No, no, no, it’s more about–
664.1
SPEAKER 2: What will help me to do this? OK, I’ll say I’ll use a reminder on my phone.
669.6
SPEAKER 1: Sounds good, yeah.
670.9
SPEAKER 2: OK.
671.3
SPEAKER 1: We’ll hold you to that. No. No, this is–
674.5
SPEAKER 2: Right.
675.3
SPEAKER 1: No, this is all about helping you, so we just want to try and assist you to make time to do it–
681.5
SPEAKER 2: Yep.
682.2
SPEAKER 1: –because this is what you want to do, right? You want to get–
684.5
SPEAKER 2: Absolutely. No, look, it’s just perfect. Yep.
688.5
SPEAKER 1: Beautiful. All righty.

This short clip shows a segment of a real consultation, during the PEAK clinical trial, via videoconferencing, and recorded via Zoom. Sound and picture quality may thus be less than ideal.

What did you take away from this video? How will you need to change your exercise prescription to suit a telehealth consultation?

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Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK)

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