EDNF 2011 Conference
Kathleen Zonarich, PT
Initial Considerations:
 Get approval from your doctor or physical therapist
before starting any exercise program.
 This presentation is meant for those with Classic or
Hypermobility EDS (HEDS). If there are any
cardiac/vascular issues, please discuss appropriate
exercise levels with your doctor, specific to you.
 This presentation is only meant to serve as a general
template for an Individual Exercise Program. The
specific exercises mentioned are not intended to be
used by everyone. (consult your PT/doctor)
Benefits of Exercise for the General
Population:
 Combats chronic diseases such as:
 Osteoporosis
 Diabetes
 Hypertension
 High cholesterol
 Maintains weight
 Increases energy levels
Benefits of Exercise for
the General Population (cont.):
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Improves mood
Better sleep
Fun
Decreases stress
Boosts immune system
Enhances physical relationships
 Benefits of Exercise for the General Population
also apply to the EDS Population!
Recommendations for the General
Population:
 Aerobic Exercise:
 2 hours and 30 minutes per week of moderate intensity
aerobic exercise ; or
 1 hour and 15 minutes per week of vigorous aerobic
exercise
AND
 Muscle Toning/Strengthening:
 2 or more days a week
(Landr0, 2010)
Exercise Guidelines for the
Disabled Population:
 Research (Lee, 2003) indicates that individuals with
disabilities may have benefits from as little as 30
minutes of slow exercise per day/ 5 days a week
 Start out slowly, build your program at your own pace
 Over time your body will adapt to your exercise
routine, therefore you need to change your program to
continue to challenge yourself
(Lee, 2003)
Overall Exercise Goals for the EDS
Population:
 Increase Function
 Limit Disability
 Use Appropriate Pacing /Sequencing
 Follow “Success before progress” model
(Kerr, 2004)
Specific Goals for Exercising in the
EDS Population:
 Maintain/Regain normal range of motion
 Correct and prevent movement dysfunction by re-
training of:
 Postural control
 Postural alignment
 Proprioception
 Balance
(Kerr, 2004)
Specific Goals of Exercising in the
EDS Population (cont):
 Achieving joint stability:
 Neutral joint position is most stable
 Core stability needs to be developed first
 Proximal to distal stability should follow
 Create and Follow an Individualized Exercise Program
(Kerr, 2004)
Basic forms of muscle action:
 Isometric
 Istonic
 Isokinetic
Types of Exercise:
 Aerobic
 Anerobic
 Resistive
 Against gravity
 Free weights
 Therabands
 Body weight
Components of a Balanced Exercise
Program for the EDS Population:
 Warm up
 Strengthening
 ROM/Flexibility
 Cardio
 Balance
 Proprioception
 Coordination
 Cool Down
Types of exercise that work well for
the EDS population:
 Aquatic- warm water better (90 degrees)
 Tai Chi
 Low- impact Cardio (aerobic)
 Pilates
 Yoga
 Wii
Exercise guidelines related to EDS:
 Get approval from your doctor/therapist to start a
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“normal exercise program”
Normal ROM- perform exercise in normal range of
motion. AVOID: hyperextension
Resistive exercises- can make joint instability more
severe
Isometric ex- if too much force is applied, it can be bad
for hypermobile joints
High impact- not recommended
Proper form/body mechanics are essential
(Levy, 2010)
Tips for successful exercising:
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Do the exercises in front of a mirror
Progress when you have success with current level
“No pain, no gain” – NOT for EDS
Okay to have muscle soreness up to two days after
exercise, but you should not feel new pain or an
increase in pain
 Slow and steady wins the race
 Have control throughout movement; if something
doesn’t feel right, stop
Exercise Program Sample 1 (HEDS –
12 year old girl)
 12 year old girl
 No Physical Education in school
 Frequent joint dislocations, especially at knees
 Weak core muscles
 Severe pronation of feet
 Varying joint pain throughout body on daily basis
Exercise Program 1: Guidelines
 Begin with no resistance due to joint instability and
frequent dislocations
 Core exercise to be the main focus, then develop
exercise for extremities
 Low reps to begin, progress to higher reps then drop
reps down and increase resistance slightly, build back
up to higher reps
 Focus to be in this order:
 Stabilization
 Proximal
 Distal
(Tinkle,2010)
Exercise Program 1: Core
(start with 5 reps each)
 Pelvic tilt
 Abdominal crunches with arms crossed over chest
 Rotational abdominal crunches with arms crossed over
chest
 Prone leg lifts
 Prone opposite leg/arm lifts
 Prone superman
 Prone plank - 10 seconds
 Side plank - 10 seconds
Exercise Program 1: Legs
(start with 5 reps each)
 Short arc quads
 Wall squats
 Straight leg raise (supine)
 Standing exercises (hold on to kitchen sink as needed)
 Hip flexion
 Hip abduction
 Hip extension
 Ham curls
 Heel raises
Exercise Program 1: Arms
(Start with 5 reps each)
Standing Position
 Arm circles
 Wall push ups
 Ball exercises: (small light weight playground ball)
 Rowing
 Circles (clockwise and counter clockwise)
 Push ball up over head
 Push ball out in front
 Full arc in front overhead and down to hips
 Bicep curls
 Shoulder height abduction/adduction
Exercise Program 1: Balance
(stand at kitchen sink/hold on as needed)
 Start with 30 second holds if able
 Stand on one leg
 Stand on one leg with eyes closed
 Standing tree pose
 Star fish against the wall
 Warrior
 Raise up on toes
Exercise Program 1: Frequency
 How Often:
 Cardio 2-3 days per week
 Exercises 3 times per week with one day rest between
each specific exercise type
 General Considerations:
 Exercises do not have to be done in one block of time
 If you are at a lower level, break up the exercises
throughout the day or alternate arms and legs on
different days, etc.
Exercise Program Sample 2
(HEDS – 40 year old female)
 40 year old female
 Chronic dislocations of hips
 Bilateral knee pain
 Pronation of both feet
 Upper extremity weakness
 Sub-luxing right shoulder
 Desk job
 Unsuccessful attempts to exercise in the past with
increased pain
Exercise Program 2: Guidelines
 Begin with no resistance due to joint instability and
frequent dislocations
 Core exercise to be the main focus, then develop
exercise for extremities
 Low reps to begin, progress to higher reps, then drop
reps down and increase resistance slightly, build back
up to higher reps. Begin with 5 reps.
 Focus to in this order:
 Stabilize
 Proximal
 Distal
(Tinkle, 2010)
Exercise Program 2: Core
 Supine
 Pelvic tilt
 Bridging
 Knee roll
 Arm reach between knees
 Arm reach to opposite knee
Exercise Program 2: Legs
 Supine
 Quad sets
 Ham sets
 Glut sets
 Heel slides
 Hooklying hip abduction/adduction
 Hip abduction
 Prone
 Knee flexion
 Sidelying
 Hip extension
Exercise Program 2: Arms
 Supine
 Shoulder Flexion
 Shoulder abduction
 Bicep curls
 Internal/external rotation
 Horizontal shoulder abduct/adduction
 Sitting
 Same as above will make it more challenging
 Ball catch (closer to center of body is easier)
 Prone
 Elbow extension with arm hanging off bed
Exercise Program 2: Balance
 Sitting balance unsupported
 Balloon toss
 Ball toss (more challenging)
 Standing balance (holding on to sink as needed)
 Static stand
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Eyes open/closed
 Unilateral stand
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Eyes open/closed
 Low level yoga pose

Standing tree with toe on floor rather than at knee
Exercise Program 2: Frequency
 How Often:
 Cardio: 2-3 days per week
 Exercises: 3 day per week with 1 day of rest between each
specific exercise type
 General Considerations:
 Exercising does not have to be done in one block of time
 If you are at a lower level, break up the exercises
throughout the day or alternate arms and legs on
different days, etc.
General Exercise Progression
Guidelines: (in order of easiest to hardest)
 Abdominals
 Sitting on ball or chair reclined
 On floor against gravity
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Arms crossed over chest
Arms at side of head
Arms over head extended
Medicine ball at chest
Medicine ball with extended arms
General Exercise Progression
Guidelines: (in order of easiest to hardest)
 Arms/Legs
 Supported by surface (gravity eliminated)
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Partial range of motion
Full range of motion
 Against gravity range of motion
 Use of body weight for resistance
 Light weight resistance
 Heavier weight resistance
 Machines
General Exercise Progression
Guidelines: (in order of easiest to hardest)
 Balance
 Sitting
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Sitting balance supported
Sitting balance unsupported
Dynamic sitting balance
 Standing
 Static
 Supported
 Unsupported
 Hard surface to soft surface
 Dynamic
 Hard surface to soft surface
 Bilateral to unilateral
Resources on the Internet
 Exerciseismedicine.org
 Provides exercise videos and self assessment tool for
individuals with diseases
 Health.gov/paguidelines
 2008 Physical Activity Guidelines for Americans
 www.myrafitkit.com
 Provides personalized exercise program with
demonstration (For the EDS population- flexibility
should be only within normal range)
Questions???
now or
later…..
kathleenzonarich@gmail.com
Works Cited:

Kerr, PT, Rosemary. "Management of the Joint Hypermobility Syndrome: the Therapist's
Contribution." Jointandbone.org. Joint and Bone: Musculoskeletal Disease Online, 30 Sept. 2004.
Web. 3 July 2011. <http://www.reumatologia-drbravo.cl/para%20medicos/HIPERLAXITUD/www_jointandbone_org_RODGRAH.htm>.
 Landro, Laura. "The Hidden Benefits of Exercise - WSJ.com." Business News & Financial News - The
Wall Street Journal - Wsj.com. Wall Street Jounal, 5 Jan. 2010. Web. 03 July 2011.
<http://online.wsj.com/article/SB10001424052748704350304574638331243027174.html>.
 Lee, Thomas, and P. Skerrett. "ViewNewsletter." Harvard Heart Letter. Harvard Health Publication
Newsletter, 15 Aug. 2003. Web. 03 July 2011.
<http://harvardhealth.staywell.com/viewNewsletter.aspx?NLID=2>.
 Levy, MD, Howard. "Ehlers-Danlos Syndrome, Hypermobility Type - GeneReviews - NCBI Bookshelf."
Ncbi.nlm.nih.gov. National Center Biotechnology Institute: National Institute of Health, 14 Dec. 2010.
Web. 03 July 2011. <http://www.ncbi.nlm.nih.gov/books/NBK1279/>.
 Tinkle, Brad T. Joint Hypermobility Handbook: a Guide for the Issues & Management of Ehlers-Danlos
Syndrome Hypermobility Type and the Hypermobility Syndrome. Greens Fork, IN: Left Paw, 2010. 94+.
Print.
 Images: http://office.microsoft.com/enus/images/??Origin=EC790014051033&CTT=6&ver=12&app=powerpnt.exe