Chronic Condition Exercise Physiology Initial Assessment

Client Background

• Robert Davies, 68yo retired builder, DOB 14/05/1956 (Medicare: 2948 58201 1). Lives in a single-storey home in Subiaco, WA with his wife. Referred under CDM plan for bilateral knee OA and T2DM management. Current meds: metformin 1,000 mg PO BID, paracetamol (Panadol Osteo®) 1,330 mg PO TID PRN, perindopril 5 mg PO daily.
• Constant dull ache B knees (R > L), baseline 4/10 NPRS, spiking to 7/10 with prolonged weight-bearing.
• Struggles with stairs, prolonged standing (> 15 mins), and heavy gardening.
• Morning stiffness lasting ~20 mins; reduced R knee flexion limiting deep squatting and kneeling.
• Wife (Margaret) is healthy and supportive; assists with heavy domestic tasks and shopping.
• Socially active; meets mates at the local Men's Shed twice weekly, though currently limited to seated tasks.
• Standard Western diet; recently reduced refined carbohydrates and portion sizes following GP advice.
• Reports increased satiety since increasing protein intake at breakfast; no abnormal hunger cravings.
• Mild frustration and low mood regarding loss of physical independence; nil formal Dx of depression or anxiety.
• Sedentary; walks dog 10 mins daily (limited by knee pain), nil structured resistance or aerobic training.
• Nil recent hospitalisations; one near-fall 3 weeks ago when R knee "gave way" stepping off a kerb.
• Woodworking at the Men's Shed, watching AFL, and maintaining his backyard vegetable patch.

Client Concerns

• 5-year Hx of progressive B knee pain; diagnosed with moderate-severe medial compartment OA via X-ray in 2022. T2DM diagnosed 2019.
• Attributed to 40+ years of heavy physical labour, repetitive kneeling, and heavy lifting in the construction industry, compounded by elevated BMI (31.2 kg/m²).
• Trialled meloxicam 15 mg PO daily in 2023 (ceased due to GI upset); cortisone injection R knee (11/2023) provided ~6 weeks of moderate relief; 4 sessions of private physiotherapy in 2022 (passive modalities) provided short-term relief only.
• Symptoms worse in the mornings and late evenings. Aggravated by descending stairs, walking > 15 mins on hard surfaces, and squatting. Relieved by heat packs, rest, and paracetamol.
• Wakes 1-2 times per night when rolling over and catching the R knee; takes ~15 mins to return to sleep.
• Believes knees are "worn out bone-on-bone" and fears loading will accelerate joint damage, hoping only to delay a total knee replacement rather than expecting genuine functional improvement.

Patient-Specific Function Scale

• Navigating a flight of 10 stairs, walking the dog for 30 mins, and kneeling in the garden.
• Navigating stairs: 4/10; Walking dog 30 mins: 3/10; Kneeling in garden: 2/10.

Goals

• Reduce baseline R knee pain from 4/10 to ≤ 2/10 within 8 weeks.
• Return to gardening for 45 mins continuously and ascend/descend stairs reciprocally without handrail reliance in 12 weeks.
• Reduce HbA1c from 7.6 % to < 7.0 % and lose 4 kg over the next 6 months.
• Build capacity to walk 30 mins continuously on flat ground and complete 2x/week strength sessions independently.

Assessments

• Resting Vitals, Anthropometrics, Knee Active Range of Motion (AROM), 30-Second Sit-to-Stand (30s STS), 6-Minute Walk Test (6MWT), and Timed Up and Go (TUG).
• Resting BP: 134/82 mmHg, HR: 74 bpm; Weight: 96.5 kg, Height: 176 cm, BMI: 31.2 kg/m²; AROM: R knee flexion 0–105° (pain at end-range), L knee flexion 0–118°; 30s STS: 9 reps (utilised armrests, R knee pain 5/10); 6MWT: 340 m (RPE 13/20, stopped once at 4 mins due to R knee ache); TUG: 11.4 s.

Intervention

• Pain neuroscience education (addressing "bone-on-bone" beliefs and benefits of mechanical loading for cartilage health) alongside a progressive home-based and clinic-supervised resistance and aerobic exercise program.
• Sit-to-stand from elevated surface (45 cm) 3x10, Standing calf raises 3x12, Glute bridges 3x10, Seated knee extensions with light resistance band 3x12 (all performed 3x/week, non-consecutive days); Stationary cycling 10 mins at RPE 11-12 (3x/week).
• Break up prolonged sitting every 45 mins with 2 mins of light ambulation; apply heat pack 15 mins prior to evening wind-down to assist sleep onset; pace gardening tasks into 15-min blocks.
• Client reports fear of pain flare-ups during unsupervised home exercise and lack of a stationary bike at home (agreed to utilise the local community centre gym 2x/week and attend 1x/week supervised EP group class).