Exercise & ambulation

• Body Mechanics


  Coordinated efforts of the musculoskeletal and nervous systems to maintain balance, body alignment & posture during lifting, bending, moving, and performing activities of daily living (ADLs)
• Importance of Proper body mechanics

  • Helps to reduce injury
  • Facilitates ease of body movement
  • Allows for more efficient use of energy
  • Prevents illnesses
  • Promotes health
• Balance


  Maintaining balance requires a wide base of support and the centre of gravity close to the base of support
• Alignment/Posture


  Positioning of the joints, tendons, ligaments and muscles while standing, sitting and lying. Correct body alignment reduces strain, aids in maintaining adequate muscle tone, contributes to balance, and conserves energy.
• Strain


  An overstretched, torn, or twisted tendon or muscle. Can be prevented by spreading the feet apart and flexing the knees and hips to decrease musculoskeletal strain.
• Regulation of Movement


  • Involves the integrated functioning of the skeletal system, muscular system, and nervous system
• Developmental considerations affecting alignment & movement

  • Infants
  • Toddlers
  • Children
  • Adolescents
  • Adults
  • Older adults
• Pathological influences on alignment & movement

  • Postural abnormalities
  • Impaired muscle/bone development
  • Problems affecting joint mobility
  • Direct trauma to the musculoskeletal system
  • Damage to the central nervous system
• Types of Exercise

  • Isotonic exercise
  • Isometric exercise
  • Isokinetic exercise
  • Aerobic exercise
  • Anaerobic exercise
• Isotonic Exercise


  Dynamic exercises where the muscles shorten to produce muscle contraction and active movement
• Isometric Exercise


  Static exercise involving muscle contraction without movement in the angle of joint
• Isokinetic Exercise


  Resistive exercise involving muscle contraction or tension against resistance at a constant rate
• Aerobic Exercise


  Activity where the amount of oxygen taken in the body is greater than that used to perform the activity, improving cardiovascular conditioning and physical fitness
• Anaerobic Exercise


  Activity where the muscles cannot draw out enough oxygen from the bloodstream, using anaerobic pathways to provide additional energy for a short time
• Effects of Exercise

  • Cardiovascular system
  • Respiratory system
  • Musculoskeletal system
  • Metabolic processes
  • Gastrointestinal system
  • Urinary system
  • Skin/Dermatological system
  • Psychosocial outlook
• Risks related to Exercise

  • Precipitation of a cardiac event
  • Orthopaedic discomfort and disability
  • Heat stroke, exercise-induced asthma, chest pain
• Effects of Immobility
• Skin/Dermatological system


  • Exercise increases circulation to the skin
  • Improves overall skin condition
• Psychosocial outlook benefits of exercise

  • Increase energy
  • Improve sleep
  • Improve body image
  • Improve self-concept
  • Improve positive health behaviour
• Risks related to exercise

  • Precipitation of a cardiac event
  • Orthopaedic discomfort and disability
  • Heat stroke, exercise-induced asthma, chest pain
• Orthopaedic discomfort and disability


  Common injuries include: irritation to bones, tendons, ligaments & muscles
• When an injury occurs

  1. Consult a doctor

  2. Apply RICE (Rest, Ice, Compression & Elevation)
• Effects of immobility


  • Immobility can affect many major body systems, and predispose to many chronic health problems
  • The severity of effects based on the patient's age and overall health status
• Cardiovascular system effects of immobility

  • Predispose to thrombi formation because of venous stasis
  • Immobile people are more prone to have orthostatic hypotension
• Respiratory system effects of immobility

  • Decreased ventilatory effort (decrease rate and depth of respiration, may develop atelectasis)
  • Increased respiratory secretions (cause pooling of secretion and respiratory congestion, predispose a person to respiratory tract infection)
• Musculoskeletal system effects of immobility

  • Immobility leads to bone demineralisation, decreased muscle size (atrophy), tone, and strength; decrease joint mobility and flexibility (cause contractures, bone demineralisation)
  • With immobility, the bone formation will be slower (bones become spongy and brittle, which may lead to fracture)
• Metabolic process effects of immobility

  • Immobility requires less energy, cellular demand for oxygen decrease, decrease metabolic rate
• Gastrointestinal system effects of immobility

  • Decrease in appetite and food intake, altered protein metabolism and poor digestion
  • Slow GI tract movement (constipation)
• Urinary system effects of immobility


  • Urinary stasis cause urinary tract infection
  • Predispose patients to have renal calculi (renal stones)
• Skin/Dermatological system effects of immobility

  • Immobility may cause pressure over the bony prominence (may result in skin breakdown, and leads to pressure injuries)
• Psychosocial outlook effects of immobility

  • Decrease self-image (need constant assistance from others for ADL)
  • Decrease self-concept (inability to meet role expectations, feeling of worthlessness)
  • Decrease social interaction
  • Disrupt normal sleep-wake pattern
  • Produce an exaggerated emotional response
• Joints

  • The functional units of the musculoskeletal system
  • Most of the skeletal muscles attach to the bones at the joint
  • Muscles include flexors, extensors and internal rotators
  • Usually, the flexor is stronger than the extensor muscles. Thus the joints are pulled into a flexed (bent) position when the person is inactive
  • The muscles will be permanently shortened if this tendency is not counteracted with exercise
• Range of Motion (ROM)


  • The maximum movement that is possible for a joint
  • Varies from individual to individual, determined by genetic makeup, developmental patterns, the presence or absence of diseases
• Types of Range of Motion Exercises


  • Active exercise (patient can move the joints independently through their full range of motion)
  • Active-assistive exercise (nurse provides minimal support)
  • Passive exercise (nurse moves each joint through its range of motion)
• Benefits of Range of Motion Exercises

  • Improves joint mobility
  • Increase circulation to the affected part
• Active exercise increases muscle tone, mass, and strength; and improves cardiac and respiratory functioning
• Exercise should be as active as the patient's condition permits
• Nursing responsibilities for Range of Motion Exercises

  • Assess patient's ROM as baseline measure
  • Assess the patient's ability and amount of assistance needed
  • Avoid overexertion, start gradually and slowly
  • Move each joint until there is resistance, but no pain
  • Return the joint to a neutral position when finishing each exercise
  • Perform range of motion exercise regularly
  • Use support measures to prevent muscle strain or injury
• Physical conditioning exercises for patients confined to bed

  • Quadriceps drills (tighten and hold the front thigh muscles)
  • Gluteal setting drills (squeeze the buttock muscles)
  • Bridge push ups (to strengthen the muscles in the arms and shoulders)
  • Dangling (patient sits on the edge of the bed with legs and feet over the side)
• Nursing assessment for ambulation

  • Assess the patient's muscle strength and ability to ambulate for a short distance
  • Assess needs for assistance (one nurse, two nurses, ambulatory devices)
  • Assess the clearance of the path for ambulation to prevent falls