1. Exercise in rheumatic disease

10. Higher sensoromotor control & psychological factors Decreased motivation, loss of confidence, fear of pain or (re)injury. Muscle sensorimotor dysfunction Weakness, reduced voluntary activation (inhibition), increased fatigue, decreased proprioceptive acuity, decreased neuromuscular protective mechanisms, functional joint instability, postural instability. Persistent but “sub-clinical” deficits. Ageing process Weakness , articular wear and tear, slow reflexes. Decreased disability and optimisation of function. Participation in habitual exercise and functional activities, i.e. walking. Limb injury previous innocuous, unilateral injury with bilateral adverse affects. Joint damage Abnormal movement and instability causing pain, effusion and stress on articular structures, microtrauma to cartilage and sub-chondral bone sclerosis. Disability or decrease in habitual activities Atrophy of articular cartilage, subchondral osteoporosis Exercises to increase strength, improve proprioceptive acuity, balance/ and co-ordination, function Rehabilitation