Oefeningen bij polymyalgia rheumatica (PMR) — zachte ochtendmobiliteit, botbelasting, GCA-waakzaamheid

2012 ACR/EULAR classification + 2015 EULAR/ACR PMR management framework. Polymyalgia rheumatica is bilateral shoulder + hip girdle stiffness lasting more than 45 minutes in the morning, in patients age ≥50, with elevated ESR/CRP, and a dramatic prednisone response (15-20 mg orally produces near-immediate improvement — sometimes used confirmatorily). GCA comorbidity is 15-20% — any temporal headache, jaw claudication, scalp tenderness, or visual symptom in a PMR patient requires urgent GCA workup (same-day if visual). Methotrexate is steroid-sparing during the prolonged taper. The exercise paradox: pain limits activity but movement EASES the stiffness — gentle morning ROM is medicinal, even when patients feel they 'can't move'. Graded loading as steroid takes effect (within days). The steroid-induced osteoporosis risk is VERY HIGH: chronic 5-10 mg prednisone over a 1-2 year taper in an elderly population that already has age-related bone loss compounds rapidly. Bone-loading exercise + calcium 1000-1200 + vitamin D 1000-2000 IU + bisphosphonate per ACR steroid guidelines + DEXA at diagnosis and during taper are non-optional.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain + hip-girdle bone-loading, wall-push-up for scaled upper-body strength + shoulder-girdle ROM, scapular-retraction for posture (chronic stiffness drives forward-head + rounded shoulders), cat-cow for spinal mobility + parasympathetic, supine-knee-to-chest for low-back release + hip-girdle ROM, supine-hip-abduction for hip-girdle specifically (PMR hip pain), diaphragmatic-breathing for parasympathetic + chest-wall mobility, standing-march for managed cardio + bone-loading after morning stiffness eases, sit-to-stand for functional + critical bone-loading (steroid osteoporosis from 1-2 year taper). The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Macfarlane 2018 reduces inflammatory markers), steroid-induced osteoporosis VERY HIGH risk calcium 1000-1200 + vitamin D 1000-2000 IU + weight-bearing + bisphosphonate per rheum, protein 1.2-1.4 g/kg/day + leucine 2.5-3 g per meal to overcome elderly anabolic resistance, blood glucose monitoring (steroid-induced diabetes), vitamin D often low ≥80% elderly PMR patients deficient at diagnosis, iron + B12 + folate check (chronic disease + elderly absorption + PPI overlap), salt control + BP for steroid edema, methotrexate folic acid 1-5 mg/day per rheum. CRITICAL: Vasculitis Foundation + ACR + rheumatology + primary care for steroid management + ophthalmology if any GCA symptoms + endocrinology if steroid diabetes. This is NEVER a replacement for rheumatology care.