Week 9 - Metabolic

What are the social and cultural determinants of health with Autoimmune conditions

• Socioeconomic status

• Education

• Cultural beliefs

• Access to healthcare

• Social support networks

What is the impact of the social and cultural determinants

• disease management

• access to treatment

• overall well-being

What are the two types of autoimmune disease

Localised autoimmune disease
Systemic autoimmune disease

What are the localised autoimmune disease 

primarily targets antigens found exclusively in a specific organ or tissue

What are the Systemic autoimmune diseases

involvement is broad, and it does not focus on a particular cell type but rather targets antigens that are widely distributed throughout the body

What are some example of localised autoimmune conditions

Addison disease
Autoimmune hepatitis
Coeliac disease
Crohn’s disease
Diabetes

What are some example of systemic autoimmune conditions

Scleroderma
Polymyositis 
Rheumatoid Arthritis 

What is RA

inflammation of the synovial lining of joints, leading to joint pain, swelling, stiffness and evental joint damage

What is commonly affected in RA

small joints of the hands and feet

Who is RA common in

individuals who smoke or have a family history

Benefits of exercise for RA

Increases muscle strength to better support joints
Enhances balance and posture
helps maintain joint flexibility and muscle strength
improve functional capacity without exacerbating joint damag

What are lifestyle modifications for RA

weight management, smoking cessation, and dietary changes
Help reduce inflammation

What is involved in the pharmaceutical management

Disease-Modifying Antirheumatic Drugs (DMARDs) - slow the progression
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - reduce pain and inflammation.
Corticosteroids - short-term relief of inflammation and pain

What is included in surgical interventions

Synovectomy - removal of inflamed synovial tissue

Joint replacement (arthroplasty) Used in advanced RA

Tendon repair - due to inflammation.

Joint fusion (arthrodesis)- where joint replacement isnt feasible providing stability and pain relief.

What is MS

Immune system mistakenly targets and damages the myelin, exposes and scars the nerves, disrupting their ability to transmit signals 

Whats involved in the medical management of MS

Disease-Modifying Therapies (DMTs): - reduce the frequency and severity of MS relapses and slow disease progression.
Corticosteroids: - Often used during acute relapses, reduce inflammation in the central nervous system. 
Symptomatic Treatments

What does exercise for Individuals with a general level of fitness and experience: MS

• Aerobic Exercise: Moderate intensity, 2-3 times per week; include upper body exercises, lower body exercises, and combined body exercises (e.g., elliptical trainer).

• Strength Training: Moderate intensity, 2-3 times per week; weight machines, free weights, and cable pulleys.

What does exercise For individuals with an advanced level of fitness and experience: MS

• Aerobic Exercise: Moderate to vigorous intensity, 5 times per week; examples include running or road cycling.

• Strength Training: Moderate to vigorous intensity, 2-3 times per week; may include weight machines, free weights, and cable pulleys

What does exercise look like For individuals with more severe disability 

Exercises: Breathing exercises, flexibility exercises, and arm and leg exercises for up to 20 minutes a day, 3-7 times per week.

What stretching and balance exercise should be completed

Balance exercises should reduce upper limb support and base of support
Stretching can use gravity or resistance bands

What are the beneftis of stretching and balance exercise

relief from muscle spasms and cramps, improved relaxation, sleep, posture, flexibility, and reduced fatigue

What are the barriers to exercise for those with MS

Fatigue: 

Heat Sensitivity: MS symptoms may worsen with slight temperature increases 

What is ankylosing Spondylitis 

Inflammatory arthritis that primarily affects the spine

What joint are involved in AS

 sacroiliac joints hips and shoulders

When do symptoms usually emerge

between the ages of 15 and 45

What does the spinal inflammation do

 trigger the formation of new bone around the joints in the spine =  permanent stiffness

Whats involved in the medical management of AS

Analgesics: - temporary pain relief in patients

NSAIDs - managing inflammation and offering temporary pain relief

Corticosteroids - rapid anti-inflammatory effects 

DMARDs (Disease-Modifying Anti-Rheumatic Drugs): - helping slow disease progression.

What is involved in the self management of AS

Engagement in activities: - Support patients in maintaining their involvement in daily, work, 

Nutritional guidance: 

Emotional support:Facilitate access to mental health resources

Patient education: 

Stress management: Highlight the impact of stress on symptom exacerbation

Movement encouragement: 

What are some contraindicated activities for those with AS

High-impact activities,
Exercises with high velocity or strong resistance
Activities challenging balance or postural stability

What are the Risks associated with AS

more severe AS are at higher risk for adverse events like spinal fractures or injuries

What involved in safe and effective assessment

Key assessments include measuring axial mobility and chest expansion to inform exercise planning.

Regular Monitoring

Comprehensive Evaluation: Both musculoskeletal and psychosocial factors should be considered

What are the recommendations for prescription in relation to spinal mobility

Exercises aimed at improving or maintaining spinal mobility (stretching, strengthening, and functional exercise)

What should be considered in relation to the multimodal approach

A balanced exercise program should incorporate stretching strengthening, cardiopulmonary, and functional fitness exercises

What are the recommendations in relation to patient adherence

Support through patient education, group settings, and regular monitoring

What is important to consider in relation to patient setting

patient preference and local availability should guide
Supervised group therapy and warm water exercise may offer additional benefits