Fundamental Fundamental NursingNursing

Chapter 24Chapter 24

Therapeutic Therapeutic ExerciseExercise

2

ExerciseExercise (purposeful physical activity) is (purposeful physical activity) is beneficial to people of all age groups (Box 24-beneficial to people of all age groups (Box 24-1), and the health risks of a sedentary lifestyle 1), and the health risks of a sedentary lifestyle are well documented. are well documented.

3

Box 24-1 • Benefits of Physical ExerciseBox 24-1 • Benefits of Physical Exercise

Improved cardiopulmonary functionImproved cardiopulmonary function Reduced blood pressureReduced blood pressure Increased muscle tone and strengthIncreased muscle tone and strength Greater physical enduranceGreater physical endurance Increased lean mass and weight lossIncreased lean mass and weight loss Reduced blood glucose levelReduced blood glucose level Decreased low-density blood lipidsDecreased low-density blood lipids Improved physical appearanceImproved physical appearance Increased bone densityIncreased bone density Regularity of bowel eliminationRegularity of bowel elimination Promotion of sleepPromotion of sleep Reduced tension and depressionReduced tension and depression

4

Fitness AssessmentFitness Assessment

FitnessFitness means capacity to exercise. Factors means capacity to exercise. Factors such as a sedentary lifestyle, health problems, such as a sedentary lifestyle, health problems, compromised muscle and skeletal function, compromised muscle and skeletal function, obesity, advanced age, smoking, and high obesity, advanced age, smoking, and high blood pressure can impair a client's fitness and blood pressure can impair a client's fitness and stamina.stamina.

5

Body CompositionBody Composition

Body compositionBody composition is the amount of body is the amount of body tissue that is lean versus the amount that is fat. tissue that is lean versus the amount that is fat. Determining factors include anthropometric Determining factors include anthropometric measurements such as height, weight, body-measurements such as height, weight, body-mass index, skinfold thickness, and midarm mass index, skinfold thickness, and midarm muscle circumference.muscle circumference.

Inactivity without reduced food intake tends Inactivity without reduced food intake tends to promote obesity. to promote obesity.

6

Vital SignsVital Signs

Vital signs—temperature, pulse rate, Vital signs—temperature, pulse rate, respiratory rate, and blood pressure—reflect a respiratory rate, and blood pressure—reflect a person's physical status.person's physical status.

7

Fitness TestsFitness Tests

Fitness tests provide an objective measure of a person's Fitness tests provide an objective measure of a person's current fitness level and potential for safe exercise. current fitness level and potential for safe exercise.

Two methods of fitness testing are a stress Two methods of fitness testing are a stress electrocardiogram and an ambulatory electrocardiogram. electrocardiogram and an ambulatory electrocardiogram. Another is a Another is a submaximal fitness testsubmaximal fitness test, which is an , which is an exercise test that does not stress a person to exhaustion. exercise test that does not stress a person to exhaustion. Examples of submaximal fitness tests include a walk-a-Examples of submaximal fitness tests include a walk-a-mile test. mile test.

8

Stress ElectrocardiogramStress Electrocardiogram

A A stress electrocardiogramstress electrocardiogram tests electrical tests electrical conduction through the heart during maximal conduction through the heart during maximal activity and is performed in an acute care activity and is performed in an acute care facility or outpatient clinic (Fig. 24-1)facility or outpatient clinic (Fig. 24-1)

9

Figure 24-1 • Stress electrocardiogram.

10

An An ambulatory electrocardiogramambulatory electrocardiogram is a is a continuous recording of heart rate and rhythm continuous recording of heart rate and rhythm during normal activity. It requires the client to during normal activity. It requires the client to wear a device called a Holter monitor for 24 wear a device called a Holter monitor for 24 hours. hours.

11

Figure 24-2 • Ambulatory electrocardiography.

12

Walk-a-Mile TestWalk-a-Mile Test

The The walk-a-mile testwalk-a-mile test, measures the time it , measures the time it takes a person to walk 1 mile. The person is takes a person to walk 1 mile. The person is instructed to walk 1 mile on a flat surface as instructed to walk 1 mile on a flat surface as fast as possible. The examiner calculates the fast as possible. The examiner calculates the time from start to finish and interprets results time from start to finish and interprets results using the guidelines in Table 24-2. using the guidelines in Table 24-2.

13

14

Exercise PrescriptionsExercise Prescriptions

The prescription for an exercise program The prescription for an exercise program involves determining the person's target heart involves determining the person's target heart rate rate

15

Target Heart RateTarget Heart Rate

Target heart rateTarget heart rate means the goal for heart means the goal for heart rate during exercise. It is determined by first rate during exercise. It is determined by first calculating the person's calculating the person's maximum heart ratemaximum heart rate (highest limit for heart rate during exercise). (highest limit for heart rate during exercise). Maximum heart rate is calculated by Maximum heart rate is calculated by subtracting a person's age from 220. subtracting a person's age from 220.

The target heart rate is 60% to 90% of the The target heart rate is 60% to 90% of the maximum heart rate.maximum heart rate.

16

Beginners should not exceed 60%, intermediates can Beginners should not exceed 60%, intermediates can exercise at 70% to 75%, and competitive athletes can exercise at 70% to 75%, and competitive athletes can tolerate 80% to 90% of their maximum heart rate.tolerate 80% to 90% of their maximum heart rate.

Exercising at the target rate for 15 minutes (excluding Exercising at the target rate for 15 minutes (excluding the warm-up and cool-down periods) three or more the warm-up and cool-down periods) three or more times per week strengthens the heart muscle and times per week strengthens the heart muscle and promotes the use of fat reserves for energy. promotes the use of fat reserves for energy. Exercising beyond the target heart rate reduces Exercising beyond the target heart rate reduces endurance by increasing fatigue.endurance by increasing fatigue.

17

Types of ExerciseTypes of Exercise

The two major types of exercise are:The two major types of exercise are:

fitness exercise fitness exercise therapeutic exercise. therapeutic exercise.

18

1. Fitness Exercise1. Fitness Exercise

Fitness exerciseFitness exercise means physical activity means physical activity performed by healthy adults. Fitness exercise performed by healthy adults. Fitness exercise develops and maintains cardiorespiratory develops and maintains cardiorespiratory function, muscular strength, and endurance function, muscular strength, and endurance (Fig. 24-3). The two categories of fitness (Fig. 24-3). The two categories of fitness exercise are isotonic and isometric.exercise are isotonic and isometric.

19

Figure 24-3 • Stationary cycling.

20

Isotonic exerciseIsotonic exercise is activity that involves is activity that involves movement and work. The example is movement and work. The example is aerobic aerobic exerciseexercise, which involves rhythmically moving , which involves rhythmically moving all parts of the body at a moderate to slow all parts of the body at a moderate to slow speed without hindering the ability to breathe. speed without hindering the ability to breathe. In other words, the person can talk In other words, the person can talk comfortably if the exercise is within his or her comfortably if the exercise is within his or her level of fitness. level of fitness.

21

Isometric exerciseIsometric exercise consists of stationary consists of stationary exercises generally performed against a resistive exercises generally performed against a resistive force. force.

Examples include body building, weight lifting, Examples include body building, weight lifting, and less intense activities such as simply and less intense activities such as simply contracting and relaxing muscle groups while contracting and relaxing muscle groups while sitting or standingsitting or standing. .

22

2. Therapeutic Exercise2. Therapeutic Exercise

Therapeutic exerciseTherapeutic exercise is activity performed by is activity performed by people with health risks or being treated for an people with health risks or being treated for an existing health problem. Clients perform existing health problem. Clients perform therapeutic exercise to prevent health-related therapeutic exercise to prevent health-related complications or to restore lost functionscomplications or to restore lost functions

23

Active ExerciseActive Exercise

Active exerciseActive exercise is therapeutic activity that the is therapeutic activity that the client performs independently after proper client performs independently after proper instruction. instruction.

For example, clients who have undergone a For example, clients who have undergone a mastectomy learn to exercise the arm on the mastectomy learn to exercise the arm on the surgical sidesurgical side

24

Passive ExercisePassive Exercise

Passive exercisePassive exercise is therapeutic activity that the is therapeutic activity that the client performs with assistance and is provided client performs with assistance and is provided when a client cannot move one or more parts when a client cannot move one or more parts of the body. of the body.

For example, for clients who are comatose or For example, for clients who are comatose or paralyzed from a stroke or spinal injury.paralyzed from a stroke or spinal injury.

25

Range-of-Motion ExercisesRange-of-Motion ExercisesRange-of-motionRange-of-motion (ROM) (ROM) exercisesexercises are therapeutic activities that are therapeutic activities that

move the joints. They are performed for the following reasons:move the joints. They are performed for the following reasons:

To assess joint flexibility before initiating an exercise programTo assess joint flexibility before initiating an exercise program To maintain joint mobility and flexibility in inactive clientsTo maintain joint mobility and flexibility in inactive clients To prevent To prevent ankylosisankylosis (permanent loss of joint movement) (permanent loss of joint movement) To stretch joints before performing more strenuous activitiesTo stretch joints before performing more strenuous activities To evaluate the client's response to a therapeutic exercise To evaluate the client's response to a therapeutic exercise

programprogram

26

During ROM exercises, the client moves or is During ROM exercises, the client moves or is assisted to move unused joints in the positions assisted to move unused joints in the positions that the joint normally permits (Table 24-4). that the joint normally permits (Table 24-4). Whenever possible, the client actively Whenever possible, the client actively exercises as many joints as possible while the exercises as many joints as possible while the nurse assists with those that are compromised. nurse assists with those that are compromised. See Nursing Guidelines 24-1.See Nursing Guidelines 24-1.

27

28

29

Nursing ImplicationsNursing Implications

Impaired Physical MobilityImpaired Physical Mobility Risk for Disuse SyndromeRisk for Disuse Syndrome Unilateral NeglectUnilateral Neglect Risk for Delayed Surgical RecoveryRisk for Delayed Surgical Recovery Activity IntoleranceActivity Intolerance