Physical Rehabilitation for Geriatric and Obese Patients
Kevin Jones, DVM, CCRP
Geriatric patient walking over cavalettis.
Geriatric dogs and cats are a part of every general and specialty companion animal practice across the United States. Each patient has specific requirements to maintain his/her body in optimal condition. Having a healthy Body Condition Score (BCS) and a regular exercise routine is essential for these pets for increased longevity, minimizing disease and an overall greater quality of life. This definition of quality of life for our pets includes not only physical benefits but psychological as well. A research study involving mice (van Praag, et. al) found that the subjects that were given access to exercise had increased cell proliferation and neurogenesis in an area of the brain that controls memory creation. Human studies have revealed that exercise releases endorphins in the body that act on the brain to reduce pain perception, decrease stress and promote a sense of well-being. We see this reflected in our geriatric pets that are regularly exercised by their owners, where the pets have fewer behavioral issues and better sleep cycles, as well as stronger muscles and bone density.
One of the most common conditions that we see in our geriatric companion animals is Degenerative Joint Disease (DJD)/Osteoarthritis (OA). This includes both canine and feline patients. It should be noted that DJD/OA involves not only the joints of all four limbs but the vertebral column as well. Vertebral OA in felines can result in behavioral abnormalities such as:
– Excessive grooming over a certain region or decreased general grooming
– Difficulty jumping
– Decreased activity
– Not using the litter box
– Decreased appetite
– Depression
DJD/OA is a very common finding in domestic cats. In one study (Hardie, et al), radiographic evidence of DJD was found in 90 per cent of cats over 12 years of age. Another (Lascelles, et. al), found 92 percent of cats with radiographic evidence of DJD from 0-20 years of age. Due to the nature of cats it is more challenging, but very possible, to do outpatient rehabilitation therapy and establish a Home Exercise Program that can be customized for each patient, allowing them to have a regular exercise routine.
Patient building core strength on a physioroll.
OA is much better recognized and diagnosed in our canine patients. It is widely known and accepted that exercise for patients with osteoarthritis helps to maintain their strength and mobility. In working with these patients, rehabilitation centers usually have a greater range of modality/equipment and exercise options that can be used for their sessions. Some of the lesser-known modalities and exercises that are used in rehabilitation include manual therapies, therapeutic exercises, the use of therapy balls and physiorolls, and cavalettis. These modalities/exercises focus on limb strength but also strengthening of the core muscles through the chest and abdomen, to help dogs maintain a level topline and good posture.
Aquatic therapy using an underwater treadmill and/or therapy pool is a common modality with multiple benefits including improvements in muscle strength, coordination, balance and conditioning. The cardiovascular system can also benefit from combinations of these exercises for increased endurance.
A review by Freeman in the Journal of Veterinary Internal Medicine, 2012, emphasizes the need to recognize the loss of lean body mass in geriatric dogs and differentiates Sarcopenia, defined as a loss of lean body mass due to aging and in the absence of disease, from Cachexia, a loss of lean body mass due to a disease such as congestive heart failure or renal failure. In this review, Freeman states that both of these conditions are being recognized as increasingly important in human and veterinary medicine because they are so commonly found as our aging patient population grows and has greater longevity. Many geriatric patients can fall into one or both of these categories. Reversal of these conditions is extremely important to the survival of the patient. These conditions are complex, and require approaches from multiple disciplines of medicine, including nutrition, internal medicine and rehabilitation.
Formerly obese patient swimming in therapy pool.
Obesity is a common issue for dogs and cats of all ages with almost 40% of dogs classifiable as overweight or obese. The long-term physical effects of obesity can aggravate degenerative joint disease, intervertebral disc disease and osteoarthritis. Returning patients to a healthy body condition is the ultimate goal but requires determination and compliance from owners. In addition to alterations in diet, rehabilitation, with modalities that build muscle strength through the body and burn calories, is very helpful. Aquatic therapy increases metabolism, decreases fat and assists with weight loss (Lavoie et al., Ruoti et al.) The activity of swimming alone can burn 500-700 kcal/hour.
Veterinary practices continue to see their geriatric patients living longer. With this increased longevity comes continued challenges to maintain quality of life. Our clients place the care of their family members in our hands. It is our responsibility to continue to offer these patients and their families the best options for optimum health and happiness, and to be educated on their behalf so that we make sound decisions for their benefit.
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