Activity and Exercise

• Effects of exercise on body systems and its role in health promotion:

  • Exercise improves health status of clients
  • Reduces risk for cardiovascular disease
  • Strengthens bone and muscle
  • Reduces risk of some illnesses
  • Improves stability
• Different types of exercise:

  • Isotonic
  • Isometric
  • Isokinetic
  • Aerobic
  • Anaerobic
• Physical fitness benefits:

  • Improving mood and overall mental health
  • Reducing risk for cardiovascular disease
  • Strengthening bone and muscle
  • Reducing risk of some illnesses
  • Improving stability
• Research findings:

  • Exercise improves health status of clients
  • Benefits for cardiovascular disease, pulmonary dysfunction, disabilities of aging, and depression
  • Exercise can prevent and reverse chronic diseases experienced in aging
• Activity-exercise pattern:

  • Routine of exercise, activity, leisure, and recreation
  • Includes activities of daily living (ADLs)
  • Considers type, quantity, and quality of exercise
• Physical activity:

  • Bodily movement produced by skeletal muscle contraction
  • Increases energy expenditure
• Exercise:

  • Planned, structured, repetitive bodily movement
  • Performed to improve and maintain fitness
• Activity tolerance:

  • Type and amount of exercise and ADLs an individual can perform without adverse effects
• Functional strength:

  • Body's ability to perform work
• Mobility:

  • Ability to move freely, easily, rhythmically, and purposefully in the environment
• Factors affecting body alignment and activity:

  • Growth & development: Osteoporosis due to calcium depletion
  • Nutrition: Undernutrition, overnutrition, vitamin D deficiency, obesity
  • Personal values and attitude: Individualized exercise prescriptions
  • External factors: Environmental temperature, hydration, availability of facilities
• Types of muscle contraction:

  • Isotonic: Muscle shortens to produce muscle contraction and active movement
  • Isometric: Muscle contraction occurs without moving the joint
  • Isokinetic: Resistive exercises against resistance
  • Aerobic: Oxygen intake greater than used for activity
  • Anaerobic: Muscles cannot draw out enough oxygen from bloodstream
• Intensity of exercise measurement:

  • Target heart rate calculation
  • Talk test for labored breathing and conversation ability
  • Borg scale of perceived exertion
• Benefits of exercise on the musculoskeletal system:

  • Muscles hypertrophy
  • Increased efficiency of muscular contraction
  • Joints receive nourishment through activity
  • Bone density and strength maintained through weight bearing
• Cardiovascular system:

  • Helps to prevent stroke and cardiovascular disease
  • Increases heart rate and strength of heart muscle
  • Mediates harmful effects of stress
• Respiratory system:

  • Ventilation and oxygen intake increase
  • Toxins eliminated with deeper breathing
  • Problem-solving and emotional stability enhanced
  • Prevents pooling of secretions
• Gastrointestinal system:

  • Improves appetite
  • Increases GI tract tone
  • Abdominal compressive exercise improves symptoms of IBS
• Metabolic/endocrine system:

  • Elevates metabolism
  • Weight loss and exercise stabilize blood sugar
• Urinary system:

  • Promotes efficient blood flow
  • Body excretes wastes more efficiently
• Immune system:

  • Lymph fluid pumped more efficiently
  • Circulation improves
  • Benefits of moderate exercise in older adults
  • Strenuous exercise may reduce immune function
• Psychoneurological system:

  • Mental and affective disorders may affect desire to move
  • Fatigue of chronic stress discourages exercise
  • Role of exercise in elevating mood and relieving stress and anxiety
  • Increases levels of endorphins
  • Improves oxygenation
  • Releases stored stress
  • Improves quality of sleep
  • Aerobic exercise has a dramatic positive effect on insomnia in older adults
• Cognitive function:

  • Physical exertion induces cells in the brain to strengthen and build neuronal connections
  • Exercise has positive effects in individuals with Parkinson's disease and Alzheimer's disease
• Spiritual health:

  • Enhances experience of mind-body-spirit connection
  • Lowers anxiety
  • Fewer psychotic symptoms
  • Less substance abuse
• Musculoskeletal movement:

  • Disuse osteoporosis
  • Disuse atrophy
  • Contractures
  • Footdrop
  • Stiffness and pain in the joints
  • Ankylosed
• Cardiovascular system:

  • Diminished cardiac reserve
  • Increased use of Valsalva maneuver
  • Orthostatic (postural) hypotension
  • Venous vasodilation and stasis
  • Dependent edema
  • Thrombus formation
• Respiratory system:

  • Decreased respiratory movement
  • Pooling of respiratory secretions
  • Atelectasis
  • Hypostatic pneumonia
• Metabolic system:

  • Decreased metabolic rate
  • Negative nitrogen balance
  • Anorexia
  • Negative calcium balance
• Urinary system:

  • Urinary stasis
  • Urinary retention
  • Urinary infection
  • Renal calculi
• Gastrointestinal system:

  • Constipation
• Integumentary system:

  • Reduced skin turgor
  • Skin breakdown
• Psychoneurologic System:

  • Immobilized client's participation in life becomes much narrower
  • Variety of stimuli decreases
  • Perception of time intervals deteriorates
  • Problem-solving and decision-making abilities may deteriorate
• Capabilities and Limitations for Movement:

  • Muscle mass and strength
  • Activity tolerance
  • Heart rate, strength, and rhythm
  • Respiratory rate, depth, rhythm
  • Blood pressure
• Activity Intolerance:

  • Sudden facial pallor
  • Feelings of dizziness or weakness
  • Change in level of consciousness
  • Heart rate or respiratory rate that significantly exceeds baseline
  • Change in heart or respiratory rhythm
  • Weakening of the pulse
  • Dyspnea, shortness of breath, or chest pain
  • Diastolic blood pressure change of 10 mmHg or more
• Nursing Management:

  • Diagnosing activity intolerance
  • Risk for activity intolerance
  • Impaired physical mobility
  • Sedentary lifestyle
  • Risk for disuse syndrome
• Using Body Mechanics:

  • Term used to describe the efficient, coordinated, and safe use of the body to move objects and carry out ADLs
  • Lifting
  • Pulling and pushing
  • Pivoting
• Clinical Alert:

  • Back injuries caused by force, repetition, and awkward positions
  • Common injuries among healthcare workers include low back pain, herniated disks, strained muscles, pulled and/or torn ligaments, and disk degradation
  • Nurses should not lift more than 35 pounds without assistance from proper equipment and/or other individuals
• When positioning clients:

  • Ensure the mattress is firm and level yet has enough give to support natural body curvatures
  • Place support devices in specified areas according to the client's position
  • Avoid placing one body part, particularly one with bony prominences, directly on top of another body part
  • Plan a systematic 24-hour schedule for position changes
  • Obtain information from the client to determine the most comfortable and appropriate position
• Repositioning clients in bed, specifically pulling a client toward the head of the bed, is a significant cause of back injuries and back pain among caregivers in the health care industry
• When moving a client up on the bed:

  • If the client weighs less than 200 lbs, use a friction-reducing device and 2 assistants
  • If the client weighs 201-300 lbs, use a friction-reducing slide sheet and four assistants OR an air transfer system and two assistants
  • If the client weighs more than 300 lbs, use an air transfer system and two assistants OR a total transfer lift
• Active ROM Exercises:

  • Perform each exercise to the point of slight resistance, but not beyond or to discomfort
  • Perform the movements systematically, using the same sequence during each session
  • Perform each exercise three times
  • Perform each series of exercises twice daily
  • For older adults, emphasize achieving a sufficient range of motion to carry out ADLs, such as walking