Download Timby: Fundamental Nursing Skills and Concepts

Chapter 24
Therapeutic Exercise
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Exercise
• Beneficial to all age groups
• Sedentary lifestyle is a health risk
• Individualized
• Nurses assess fitness level before initiating
exercise program
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Fitness Assessment
• Fitness: capacity to exercise
• Factors interfering with fitness:
sedentary lifestyle, health problems,
impaired musculoskeletal function,
obesity, advanced age, smoking, and
high blood pressure
• Assessment of fitness level necessary
• Assessment techniques: measuring body
composition, evaluating trends in vital
signs, performing fitness tests
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Fitness Assessment (cont’d)
• Body composition: lean body tissue versus
fat
– Determined by height, weight, body-mass
index, skinfold thickness, and midarm
muscle circumference
– Inactivity without reduced food intake
leads to obesity
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Fitness Assessment (cont’d)
• Vital signs: temperature, pulse rate,
respiratory rate, and blood pressure
– Reflect a person’s physical status
– Elevated vital signs while resting may
indicate life-threatening cardiovascular
symptoms during exercise
– Modified exercise: vital signs may
decrease
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Fitness Assessment (cont’d)
• Fitness tests objectively measure current
fitness level and potential for safe exercise
– Methods
o Stress electrocardiogram
o Ambulatory electrocardiogram
o Submaximal fitness test
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Fitness Assessment (cont’d)
• Stress electrocardiogram
– Tests electrical conduction through the
heart during maximal activity
– Pulse oximeter measures peripheral
oxygenation
o Test stopped if abnormal heart rhythm,
cardiac ischemia, elevated blood
pressure, or exhaustion occur
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Stress Electrocardiogram
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Fitness Assessment (cont’d)
• Ambulatory electrocardiogram
– Continuous recording of heart rate and
rhythm during normal activity
– Used when a client has had prior cardiacrelated symptoms or when a stress
electrocardiogram is contraindicated
– Assessment: heart’s response to normal
activity, cardiac rehabilitation, and
medical therapy
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Fitness Assessment (cont’d)
• Ambulatory electrocardiogram
– Client keeps a diary of the time and type
of activities performed
– Physician compares the client’s diary with
the electrocardiogram
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Fitness Assessment (cont’d)
• Step test
– Submaximal fitness test: timed stepping
activity
– Variations: Harvard Step Test; Queens
College Step Test; Chester Step Test
– Uses a metronome or stopwatch to keep
track of the rate and the time
– Recovery index: guide for determining a
person’s fitness level
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Fitness Assessment (cont’d)
• Walk-a-mile test
– Measures the time it takes a person to
walk 1 mile
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Question
• Which of the following tests assesses
electrical conduction through the heart
during maximal activity?
a. Ambulatory electrocardiogram
b. Stress electrocardiogram
c. Step test
d. Walk-a-mile test
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Answer
b. Stress electrocardiogram
A stress electrocardiogram tests electrical
conduction through the heart during maximal
activity. An ambulatory electrocardiogram is a
continuous recording of heart rate and rhythm
during normal activity. A step test is a
submaximal fitness test involving timed
stepping activity. The walk-a-mile test
measures the time it takes a person to walk 1
mile.
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Exercise Prescriptions
• Target heart rate
– Goal for heart rate during exercise
– Maximum heart rate: highest limit for
heart rate during exercise; subtract
client’s age from 220
– Target heart rate is 60% to 90% of
maximum heart rate during exercise
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Question
• Is the following statement true or false?
Exercising at the maximum heart rate for
15 minutes three or more times per week
strengthens the heart muscle and promotes
the use of fat reserves for energy.
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Answer
False.
Exercising at the target heart rate for 15
minutes three or more times per week
strengthens the heart muscle and promotes
the use of fat reserves for energy. Exercising
beyond the target heart rate reduces
endurance by increasing fatigue.
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Fitness Assessment (cont’d)
• Metabolic energy equivalent
– Fitness levels vary: exercise prescribed by
metabolic energy equivalent
o Measure of energy and oxygen
consumption during exercise
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Types of Exercise
• Fitness exercise: develops and maintains
cardiorespiratory function, muscular
strength, endurance
– 2 categories
o Isotonic
o Isometric
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Types of Exercise (cont’d)
• Isotonic exercise
– Involves movement and work
– Increases cardiorespiratory function
o Aerobic exercise
o Jogging
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Types of Exercise (cont’d)
• Isometric exercise
– Stationary exercise, usually against
resistance
– Increases circulation but does NOT
promote cardiorespiratory function
o Weight lifting
o Body building
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Question
• Is the following statement true or false?
Isotonic exercise consists of stationary
exercises generally performed against a
resistive force.
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Answer
False.
Isotonic exercise is activity that involves
movement and work. Isometric exercise
consists of stationary exercises generally
performed against a resistive force.
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Types of Exercise (cont’d)
• Therapeutic exercise: activity performed by
people with health risks that prevents
complications and restores lost function
– Isotonic or isometric
o Active exercise: performed
independently by client after instruction
o Passive exercise: performed by client
with assistance when client is unable to
move body parts
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Types of Exercise (cont’d)
• Range-of-motion exercises
– Therapeutic activities to move joints
– Performed to assess joint flexibility;
maintain joint mobility and flexibility in
inactive clients; prevent ankylosis;
stretch joints for strenuous activities;
and evaluate response to therapeutic
exercise program
– Performed for care of inactive client
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Types of Exercise (cont’d)
• Continuous passive motion machine
– Electrical device that supplements or
substitutes for manual ROM; for clients
with burn injuries or knee and hip
replacement surgery
– Produces 0° to 110° motion, 2 to 10
times a minute; initial setting is very low
and is increased each day
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Range of Motion of the Knee With a
Continuous Passive Motion Machine
(Refer to Skill 24-2 in the textbook.)
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Nursing Implications
• Nursing diagnoses to be treated with activity
or exercise regimen
– Impaired physical mobility
– Disuse syndrome
– Unilateral neglect
– Delayed surgical recovery
– Activity intolerance
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General Gerontologic Considerations
• Balance physical activity with rest
• Shortness of breath, increased heart rate
indicates activity level beyond tolerance
• Eliminate intake of caffeinated or alcoholic
beverages before or during physical activity
• Water preferred for fluid replacement
• Encourage to join organizations, social clubs
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General Gerontologic Considerations
(cont’d)
• Families, caregivers of cognitively impaired
– Encourage physical activities
– Daily active ROM exercises in short
sessions
– If client is inactive, daily passive ROM
exercises prevents muscle atrophy and
disuse syndrome
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General Gerontologic Considerations
(cont’d)
• Swimming or exercising in water is less
stressful on joints, beneficial for older adults
• Many physically challenging sports offer
categories for older adults
• Safe shoes with nonskid soles can prevent
falls
• Falls add to morbidity and mortality rates
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