Activity and Exercise

Shurouq Qadose
4/3/2008
An activity –exercise pattern refers to a person's
routine of exercise, activity, leisure, and
recreation. It includes:
• Activities of daily living (ADL) that require
energy expenditure such as hygiene, cooking ,
shopping, eating , working.
• Type, quality, and quantity of exercises,
including sports.
• Ligaments; tough fibrous bands that bind
joints together & connect bones & cartilages.
• Tendon; strong, flexible, inelastic fibrous band
that attach muscle to bone.
Cartilage; nonvascular connective tissue found
in the joint s as well as in the nose, ear,
thorax, trachea and larynx
 Physiology of Movement
The following physiology of movement is:
 Skeletal system; the bones and cartilage that protect
our organ and allow us to move are called skeletal
system. The function of this system include:
– Maintain body posture by supporting the soft
tissue
– Protect the delicate structures of the body such as
brain, heart and spinal cord
– Furnishes surface for attachments of muscles
tendons and ligaments
– Storage areas of minerals salts and fats.
– Produce blood cells
 
Muscular system; provide functions for the body
through
• contraction
• Motion
• Maintenance of posture
• Heat production
The 3 types of muscles are 1) Skeletal 2) Cardiac 3)
Smooth or visceral muscles.
Muscles have two different points of attachments:
The attachment of a muscle to the more stationary
bone is called the Point of Origin.
The attachment to the more movable bone is the
Point of Insertion
 
Nervous System; the nerve impulses stimulate
muscles to contract.
Body Mechanics; is the efficient use of the body
as a machine and as a mean of locomotion,
correct body mechanics lead to health
promotion and illness prevention so the
responsibility of the nurse to apply the body
mechanics and to teach others .
 
 Types of Joint Movement
Flexion: decreases the angle of the joint" bending the
elbow"
Extension: Increasing the angle of the joint "
straightening the arm at the elbow"
Hyperextension: further extension or straightening of a
joint " bending the head backward"
Abduction: movement of the bone away from the
midline of the body
Adduction: movement of the bone toward the midline of
the body
Rotation: movement of the bone around its central axis
Circumduction: movement of the distal part of the bone
in a circle while the proximal end remains fixed.
Eversion: Turning the sole of the foot outward by
moving the ankle joint
Inversion: Turning the sole of the foot inward by
moving the ankle joint.
Pronation: moving the bones of the forearm so that the
palm of the hand faces downward when held in front
of the body.
Supination: moving the bones of the forearm so that the
palm of the hand faces upward when held in front of
the body.
Exercise
Is a type of physical activity defined as a
planned, structured, and repetitive bodily
movement performed to improve or maintain
one or more components of physical fitness.
Types of exercise:
Exercise can be classified according to the type of
muscle contraction to:-
 Isotonic exercise; in which the muscle shortens to
produce muscle contraction and active movement.
Example; running, swimming, walking. This increase
muscle mass, tone and strength, increase cardiac and
respiratory and circulatory functions.
Isometric exercise; in which there is muscle contraction
without moving the joint shortening. An example
includes squeezing a towel or pillow between the
knees. These exercises are useful for strengthening
abdominal, quadriceps and gluteal muscles so the
nurse encourage both isotonic and isometric exercises
for the hospitalized client’s.
Isokinetic exercises; involve muscle contraction with
resistance example include rehabilitation exercises
for the knee and elbow injuries.
OR exercise can be classified according to the
source of energy to:-
Aerobic exercise is activity during which the
amount of oxygen taken in the body is greater
than that used to perform the activity. An
example walking, running.
 
Anaerobic exercise involves activity in which
the muscles cannot draw out enough oxygen
from the bloodstream, and anaerobic pathways
are used to provide additional energy for a
short time. An example weight lifting.
 Factors affecting body alignment and activity
• Growth and development; according to person age
the nurse should be familiar with the differences of
the neuromuscular development of the client in order
to facilitate coping.
• Physical health; because any problems in the
musculoskeletal or nervous system can have negative
influence on the body alignments and movement.
• Mental health; bodily processes tend to slow down in
depression
• Lifestyle variables; such as exercise, food, smoking,
occupation, culture.
• Attitude and values; such as swim, fitness, many
individual values also influence the exercise options
people make.
• Fatigue and stress; chronic stress may deplete
body energy to the point that fatigue makes
even the thought of exercise overwhelming
• External factors; environment which influence,
humidity, support people, lack of free time,
unsafe environment.
• Nutrition; both undernutritioin and
overnutrition can influence body alignment
and mobility.
 
Effects of exercise on major body system
– Musculoskeletal system
» Increased muscle efficiency' strength
and flexibility
» Increased coordination, stability, gait
and posture
» Increased efficiency of nerve impulses
transmission
» Improve range of motion
» Maintained bone density and strength
– Cardiovascular system;
» Meet the demands for oxygen
» Increase blood flow
» Increase efficiency of the heart
» Decreased blood pressure
» Increased blood flow to all body parts
» Improved heart rate, improved
circulation, and self – reported stress
reduction
» Decreased cholesterol level
–Respiratory system; work together with the
cardiovascular system
»Increase oxygen available to the muscle
»Increase depth, rate of gas exchange,
rate of CO2 excretion
»Improved pulmonary functioning
»Decreasing breathing effort and risk of
infection.
–GI system; exercises lead to
»Increased intestinal tone, facilitating
peristalsis
»Improve digestion and elimination
»Improve the appetite
–Metabolic system; exercise elevates
the metabolic rate, thus increasing the
production of body heat and waste
products and calorie use.
»Increased efficiency of metabolic
system
»Increased efficiency of body
temperature regulation
»Reduce level of serum triglycerides
and cholesterol.
 –Urinary system; regular exercise
increase blood circulation including
improved blood flow to the kidneys
which allows the kidneys to maintain
the body's fluid balance and acid-base
balance more efficiently and to excrete
body waste.
 
 –Skin; regular exercise increase
circulation which lead to promote good
health

–Psychosocial outlook; regular exercise

have psychological effects such as
increase energy, improve sleep, body
image, improve self-concepts and
increase positive health behaviors,
improve general well being.
 
 Effects of immobility on major body system
Musculoskeletal system
• Disuse osteoporosis; demineralization process,
known as osteoporosis, the bones become
spongy and may gradually deform and fracture
easily.
• Disuse atrophy; atrophy in muscles losing
most of their strength and normal function.
• Contractures; when the muscle fibers are not
able to shorten and lengthen (permanent
shortening of the muscle) forms limiting joint
mobility. This process eventually involves the
tendons, ligaments, and joint capsules.
Cardiovascular system
• Diminished cardiac reserve
• Orthostatic hypotension; is a common result
of immobilization. The blood pools in the
lower extremities, and central blood pressure
drops. Cerebral perfusion is seriously
compromised, and the person feels dizzy or
light headed and may even faint.
• Venous vasodilation and stasis; the skeletal
muscles do not contract sufficiently, and the
muscles atrophy, so the skeletal muscles can
no longer assist in pumping blood back to the
heart against gravity. Blood pools in the leg
veins, causing vasodilation and engorgement.
• Dependent edema; when the venous pressure
is sufficiently great, some of serous part of the
blood is forced out of the blood vessel into the
interstitial spaces surrounding the blood
vessel, causing edema.
• Thrombus formation
3. Respiratory system
• Decreased respiratory movement; in immobile
client, ventilation of the lungs is passively
altered. The body presses against the rigid bed
and curtails chest movement. The abdominal
organs push against the diaphragm, restricting
lung movement and making it difficult to
expand the lungs fully.
• Pooling of respiratory secretions; secretions of
the respiratory tract are normally expelled by
changing positions or posture and by
coughing. Inactivity allows secretions to pool
by gravity, interfering with the normal
diffusion of oxygen and carbon dioxide in the
alveoli.
• Atelectasis; is the collapse of a lobe or of an
entire lung, when ventilation is decreased,
pooled secretions may accumulate in a
dependent area of a bronchiole and effectively
block it. Immobile elderly, postoperative
clients are at greatest risk of Atelectasis.
• Pneumonia; pooled secretions provide
excellent media for bacterial growth. Under
these conditions, a minor upper respiratory
infection can evolve rapidly into severe
infection of the lower respiratory tract.
 Metabolic system
• Decreased metabolic rate; in immobile clients,
the basal metabolic rate and gastrointestinal
motility and secretions of various digestive
glands decrease as the energy requirements of
the body decrease.
• Negative nitrogen balance
• Anorexia; loss of appetite occurs because of
the decreased metabolic rate and the increased
catabolism that accompany immobility.
• Negative calcium balance
5. Urinary system
• Urinary stasis; in a mobile person, gravity plays an
important role in the emptying of the kidneys and the
bladder. When the person remains in abed, gravity
impedes the emptying of urine from the kidneys and
the urinary bladder, so emptying is not as complete
and urinary stasis occurs after few days of bed rest.
• Urinary retention, which is accumulation of
urine in the bladder, bladder distention, and
occasionally urinary incontinence (involuntary
urination). The decreased muscle tone of the
urinary bladder inhibits its ability to empty
completely.
• Urinary infection, static urine provides an
excellent medium for bacterial growth
6.Gastrointestinal system
• Constipation is a frequent problem for
immobilized people because of decreased
peristalsis and colon motility.
7. Integumentary system
• Reduced skin turgor. Skin turgor is an abnormality in
the skin's ability to change shape and return to normal
(elasticity).
The skin can atrophy as a result of prolonged immobility.
• Skin breakdown. Normal blood circulation relies on
muscle activity. Immobility impedes circulation and
diminishes the supply of nutrients to specific areas. As a
result skin breakdown and formation of pressure ulcers
can occur.
8. Psychoneurologic system
• Lower the person’s self –esteem
• Increased risk of depression
• Decreased social interaction
Nursing management
Assessing
Nursing History
Physical examination
• Body Alignment
• Appearance and movement of joints
• Capabilities and limitation for movement
• Muscle mass and strength
• Activity tolerance
• Problems related to immobility
Nursing Diagnosis
Nursing diagnoses related to mobility focus
primarily on activity and mobility levels, and
the psychosocial impact that alterations in
mobility can have on a client and the
client’s family. Common NANDA nursing
diagnoses related to the physical adaptations or
risks resulting from altered mobility include:
• Activity Intolerance related to bed rest and
immobility, generalized weakness, sedentary
lifestyle, and imbalance between oxygen supply
and demand.
• Impaired Physical Mobility related to intolerance
to activity or decreased strength and endurance,
pain, perceptual or cognitive impairment,
neuromuscular impairment, musculoskeletal
impairment, and depression or severe anxiety.
• Self-Care Deficits related to inability to wash
body or body parts, inability to obtain or get to
water source, activity intolerance, decreased
strength and endurance, pain, and impaired
transfer ability
• Ineffective Health Maintenance related to lack
of or significant alteration in communication
skills (written, nonverbal)
• Risk for Falls related to impaired mobility.
Alterations in family and social processes may
also result from immobility and inactivity.
Disruption in activity and mobility leads to
impairment of the ability to perform one’s
usual social, vocational, educational, and
family roles.
There are often changes in the client’s perception of role. Disturbed
Body Image and Situational Low Self-Esteem can result from:
1. Changes in physical abilities
2. Changes in family responsibilities
3. Lack of knowledge regarding rehabilitation
•  Fear (of falling)
• Ineffective coping
• Low self esteem
• Powerlessness
•  
• Planning
• Implementing
Nursing strategies to maintain or promote body
alignment and mobility involve positioning
clients appropriately, moving and turning clients
in bed, transferring clients, providing ROM
exercises, ambulating clients with or without
mechanical aids.
•  
Techniques to prevent back stress:
• Develop a habit of erect posture correct alignment
• Use the longest and strongest muscle of the arms
and the legs to help provide the power needed in
strenuous activities
• Use the internal girdle and a long midriff to
stabilize the pelvis and to protect the abdominal
viscera when stopping, reaching , lifting or pulling
• Use the weight of the body as a force for pulling
or pushing by rocking on the feet or leaning
forward or backward
• Work as closely as possible to an object that is to
be lifted or moved.
• Flex the knees, put on the internal girdle and
come down to an object that is to be lifted.
• Spread the feet apart to provide a wider base of
support when increased stability of body