physiotherapy Management in obesity,osteoporosis,diabetes,rickets
- 1. Physiotherapy management in rickets, osteoporosis, diabetes, obesity AKASH JAINTH MPT
- 2. RICKETS • Rickets is a disease of a growing bone that is unique to children and adolescents. • Caused by failure of osteoid to calcify in a growing person. • Vitamin D deficiency rickets occur when the metabolities of vitamin D are deficient.
- 3. PREVALENCE • It is a major public health problem worldwide. • This problem is particularly high in the Middle East, especially among girls. • According to a recent National Health and Nutrition Examination Survey, overall prevalence rate of vitamin D deficiency is approximately 41% in the US adult population.
- 5. Symptoms of Rickets • Pain in spine, legs, or pelvis • Delayed growth • Muscle weakness • Bowed legs • Thickened ankles or wrists • Other skeletal deformities
- 6. Physiotherapy Management • Stretching • Strengthening exercises • Physical functioning • Balancing exercises • Falls prevention
- 7. DIABETES • Impairment of glucose metabolism in which glucose is underutilised and blood glucose level become abnormally elevated.
- 8. INCIDENCE • According to WHO, 366 million people projected to have a form diabetes by the year 2030. • Nearly 4.5 % of the world population. • Male are more affected than females. • Greatest increase in people age more than 60yrs.
- 9. Type 1 Diabetes • Usually diagnosed in childhood(under 20 years). • The body makes little or no insulin, and daily injection of insulin are required to sustain life. Without proper daily management, medical emergencies can arise. • These patients are prone to ketacidosis and disorder related to hyperglycemia. • They compromise 5-10% of all cases of diabetes mellitus.(Cade,2008;Goodman,2004).
- 10. Type 2 Diabetes • Makes up 90% or more of all cases of diabetes mellitus and historically occur in adulthood (over 40yr). • The pancreas does not make enough insulin for normal blood glucose level, often because the body does not respond well to the insulin. • Continiuum with metobolic syndrome and obesity.
- 12. Effect of exercise on diabetes • Increases GLUT-4 transporters at cell membrane -Increases transport of glucose into cell. -Does NOT require insulin during this time. -Does need some insulin in the system. • Over time, increases senstivity of cells to insulin. • Changes composition of lipids in mainstream.
- 14. Patient Education • Exercise helps improve insulin sensitivity. • Exercise counteracts several negative outcomes of the disease process. • Exercise can improve weight control efforts. • Timing of insulin or med may be the most important self controlled factor to tight glycemic control.
- 15. OBESITY • Obesity is the presence of excess fat, in the form of adipose tissue, which is stored subcutaneously and viscerally. • Clinically this is most often measured using the body mass index (BMI), where BMI = weight (Kg) / height (m2).
- 16. Prevalence • The prevalence of obesity has rocketed since the early 1980’s, leaving 312 million adults worldwide classified as clinically obese, and Western society labeled obesogenic.
- 18. Treatment • May enhance caloric burn during a comprehensive weight loss strategy- but ineffective when used alone. • Inhibits malonyl CoA at a level of myocyte (malonyl CoA inhibits fatty acid oxidation).
- 19. Exercise prescription • FIIT principle: • Type : Aerobic exercise and resistance training • Duration: 40 min • Frequency : 4-5 days • Intensity- DHR=(DI* HRR)+RHR Where • EHR= exercise heart rate in beats per minute • DI= desired exercise intensity or desired % of vo2 max expressed as decimal(eg 40%=0.40)
- 20. • HRR= heart rate range or maximal heart rate minus resting heart rate • RHR= resting heart rate. Maximum heart rate for the obese can be estimated by the formula: 200-(0.5*age). • High intensity vs low intensity
- 22. Effect of exercise on fat metabolism • 2 main source of energy: fat and carbohydrate • At rest body metabolises only about 30% of FFA(free fatty acid). • At rest body metabolises only about 25%of FFA converted back into fat. • During light exercises(30% to 50% of vo2 max) about 50 to 70% of energy will come from FFA.
- 23. To be contd • A large percentage of the FFA is used a source of energy. • Lactic acid threshold will be higher. • Resting metabolic rate increases. • Increased level of epinephrine and non epinephrine.
- 24. OSTEOPOROSIS • Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low- impact, fragility fractures. • Osteoporotic fractures lead to a significant decrease in quality of life, with increased morbidity, mortality, and disability.
- 25. Prevalence • Over 50% of postmenopausal white women will have an osteoporotic-related fracture. • Only 33% of senior women who have a hip fracture will be able to return to independence. • Black males and females have less osteoporosis than their white counterparts, but those diagnosed with osteoporosis have similar fracture risks.
- 26. Types 2 TYPES: • Primary osteoporosis a. Postmenopausal Osteoporosis b. Age- Associated Osteoporosis • Secondary osteoporosis: any inflammatory condition, bone marrow cellularity disorder.
- 28. Diagnosis
- 29. Physiotherapy management GOALS: • To educate proper posture. • Teach safe ways of moving and lifting. • To prevent a decline in bone mass and prevent fracture. • To increase the strength in bones. • To maintain or improve balance. • To improve flexibility.
- 30. To be contd • To help decreased the stress placed on the bones by tight muscles. • To improve overall mobility. • To control pain and gradually returning back to regular activities.
- 31. • If a patient has a fracture related to osteoporosis: • Ice • Heat • Ultrasound • Electric current • After that, start with more advanced exercises, involving strenghtening, balance, weight bearing and flexibility exercises.
- 32. EXERCISES • Extension exercises • Chin tucks • Scapular retractions • Thoracic extension • Hip extension • Flexion exercises are contraindicated
- 33. DO’s and DON’T • It is important not to rush into unaccustomed exercise too quickly. • Exercise must regularly be done to have benefits. • Avoid flexion and rotation of vertebrae of trunk to avoid stress on vertebrae. • Always maintain a upright posture.