Increase of weight bearing activity

The SOP requirements here are:

Reasonable hypothesis:

• Increasing the frequency, duration, or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs, for at least two hours per day, for at least the seven days before the clinical onset/clinical worsening of chondromalacia patella.

Balance of probabilities:

• Increasing the frequency, duration, or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs, for at least four hours per day, for at least the seven days before the clinical onset/clinical worsening of chondromalacia patella.

RMA definition

A "MET" means a unit of measurement of the level of physical exertion. 1 MET=3.5ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate.

The RMA does not define 'weight bearing exercise', but it means exercise when weight is being borne through the joint.

Further information

The exercise must involve weight bearing on the leg affected by chondromalacia patella – working out on a rowing machine at the gym would not satisfy this factor. Weight bearing exercise at a intensity of 5 METS can be described as being of a 'vigorous or heavy nature' - intense enough to represent a moderate challenge to an individual and refers to a level of effort in which a person should experience:

• medium increase in breathing or heart rate (conversation causes discomfort) and
• the effort a healthy individual might expend while walking (6.5km/hr), doing heavy gardening (digging or shovelling) carpentry (sawing or planing), swimming laps (non-competitive), walking steadily up a flight of stairs, standing or walking with more than 20 kg for example.

MET ratings for common activities

Note: The person also needs to demonstrate that they were performing exercise at least at a similar level to that as the amount of exercise in the factor, and in the seven days before the clinical onset or clinical worsening of the chondromalacia patella, doubled (increased by 100 percent) that level of exercise and undertook the extra exercise which meets the SOP requirement additional to the level they had been performing. The reason for the increase would then need to be considered to establish if there was a requirement from service duties to undertake the increased level of exercise.

Last reviewed for CCPS 16 June 2014.

Investigative Documents

Preliminary questions [42042]

42043 there is some evidence that an increase in weight bearing activity may be a factor in the development of the condition under consideration.

42044 the veteran increased the frequency or duration or intensity of weight bearing activity as specified in the Statements of Principles requirements at some time.

42045  the veteran has established the causal connection between an increase of weight bearing activity and VEA service for chondromalacia patella.

42046   the veteran has established the causal connection an increase of weight bearing activity and VEA service for the clinical onset of chondromalacia patella.

42048  the veteran has established the causal connection between an increase of weight bearing activity and operational service for the clinical onset of chondromalacia patella.

or

42049  the veteran has established the causal connection an increase of weight bearing activity and eligible service for the clinical onset of chondromalacia patella.

or

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

42047   the veteran has established the causal connection between an increase of weight bearing activity and VEA service for the clinical worsening of chondromalacia patella.

42050  the veteran has established the causal connection between an increase of weight bearing activity and operational service for the clinical worsening of chondromalacia patellae.

or

42051  the veteran has established the causal connection between an increase of weight bearing activity and eligible service for the clinical worsening of chondromalacia patella.

Clinical onset and operational service [42048]

42052 operational service made a material contribution to the veteran increasing the frequency or duration, or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least two hours per day.

42053 operational service made a material contribution to the veteran increasing the frequency or duration or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least the seven days before the clinical onset of the condition under consideration.

Clinical onset and eligible service [42049]

42054 eligible service made a material contribution to the veteran increasing the frequency or duration or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least four hours per day.

42055 eligible service made a material contribution to the veteran increasing the frequency or duration or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least the seven days before the clinical onset of the condition under consideration.

Clinical worsening and operational service [42050]

42052 operational service made a material contribution to the veteran increasing the frequency or duration, or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least two hours per day.

42056 operational service made a material contribution to the veteran increasing the frequency or duration, or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for chondromalacia patella, for at least the seven days before the clinical worsening of the condition under consideration.

42057 the increase in weight bearing exercise activity as specified in the Statement of Principle for chondromalacia patella, for at least two hours per day, for at least seven days before the clinical worsening of the chondromalacia patella to side and site of the body, commenced after the onset of the condition under consideration.

Clinical worsening and eligible service [42051]

42054 eligible service made a material contribution to the veteran increasing the frequency or duration or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least four hours per day.

42058 eligible service made a material contribution to the veteran increasing the frequency or duration, or intensity of weight bearing activity to the level as described in the Statements of Principles, for chondromalacia patella to side and site of the body, for at least the seven days before the clinical worsening of the condition under consideration.

42059 the increase in weight bearing exercise activity as specified in the Statement of Principle for chondromalacia patella, for at least four hours per day, for at least seven days before the clinical worsening of the chondromalacia patella to side and site of the body commenced after the onset of the condition under consideration.