Activity and Exercise
Dr. Abdul-Monim Batiha
Assistant Professor
Critical Care Nursing
Philadelphia university
Describe four basic elements of
normal movement.

Four Basic Elements of Normal Movement
Body alignment (posture)
 Joint mobility
 Balance
 Coordinated movement


Body Alignment/Posture


Brings body parts into position that promotes
optimal balance and body function
Person maintains balance as long as line of
gravity passes through center of gravity and
base of support
Figure 44-1
The center of gravity and the line of gravity influence standing alignment.
Joint Mobility






ROM is maximum movement
possible for joint
ROM varies and determined by:
Genetic makeup
Developmental patterns
Presence or absence of disease
Physical activity
Coordinated Movement

The mechanisms involved in maintaining
balance and posture are complex and
involve informational inputs from the
labyrinth (inner ear), from vision (vestibuloocular input), and from stretch receptors of
muscles and tendons (vestibulospinal input).
Mechanisms of equilibrium respond,
frequently without awareness.
Proprioception

Awareness of posture, movement,
changes in equilibrium and awarness of
Knowledge of position, weight, resistance
of objects in relation to body
Balance





Smooth, purposeful movement
Result of proper functioning of
cerebral cortex, cerebellum, basal
ganglia
Cerebral cortex initiates voluntary movement
Cerebellum coordinates motor activity
Basal ganglia maintains posture
Differentiate isotonic, isometric,
isokinetic, aerobic, and
anaerobic exercise.

Isotonic (Dynamic) Exercise
Muscle shortens to produce muscle
contraction and active movement
 Increase muscle tone, mass, and strength
 Maintain joint flexibility and circulation
 Heart rate and cardiac output increase
 Most physical conditioning exercises (e.g.,
running and walking) are isotonic ADLs and
active ROMs.


Isometric (Static or Setting) Exercise
Muscle contraction without moving the joint
(muscle length does not change)
 Involve exerting pressure against a solid
object
 Produce a mild increase in heart rate and
cardiac output
 No apparent increase in blood flow to other
parts of the body

Figure 44-31
Example of an isometric exercise for the knees and legs. The client sits or lies on a flat surface with the
legs straight out. Using a rolled towel between the knees, the person pushes the knees together and tightens the
muscles in the front of the thighs by forcing the knees downward and holding for 10 seconds.

Example of isometric would be extending
leg in supine position, tensing the thigh
muscle, and pressing the knee against the
bed, holding it for several seconds.

Isokinetic (Resistive) Exercise
Muscle contraction or tension against
resistance
 Can either be isotonic or isometric
 Person moves (isotonic) or tenses (isometric)
against resistance
 An increase in blood pressure and blood flow
to muscles occurs
 e.g. chest muscles may be increased in sized
and strength by lifting weights


Aerobic Exercise
Amount of oxygen taken in the body is greater
than that used to perform the activity
 Improve cardiovascular conditioning and
physical fitness

 Anaerobic
 Muscles
cannot draw enough oxygen
from the bloodstream
 Anaerobic pathways are used to provide
additional energy for a short time
 Used in endurance (toleration) training
for athletes
Compare the effects of exercise
and immobility on body systems.
Effect on the Musculoskeletal
System
Exercise
Maintain size, shape, tone, and strength of
muscles (including the heart muscle)
 Nourish joints
 Increase joint flexibility, stability, and ROM
 Maintain bone density and strength

Immobility
Disuse osteoporosis
 Disuse atrophy
 Contractures
 Stiffness and pain in the joints

Effect on the Cardiovascular
System

Exercise
Increases heart rate, strength of
contraction, and blood supply to the heart
and muscles
 Mediates the harmful effects of stress

Immobility
Diminished cardiac reserve
 Increased use of the Valsalva maneuver
 Orthostatic (postural) hypotension
 Venous vasodilation and stasis
 Dependent edema
 Thrombus formation

Effect on the Respiratory System
Exercise
 Increase ventilation and oxygen intake
improving gas exchange
 Prevents pooling of secretions in the
bronchi and bronchioles
Immobility
Decreased respiratory movement
 Pooling of respiratory secretions
 Atelectasis
 Hypostatic pneumonia

Effect on the Metabolic/Endocrine
System
Exercise



Elevates the metabolic rate, thus increasing the
production of body heat and waste products and
calorie use
Decrease serum triglycerides and cholesterol
Stabilize blood sugar and make cells more
responsive to insulin
Immobility
Decreased metabolic rate
 Negative nitrogen balance
 Anorexia
 Negative calcium balance

Effect on the Gastrointestinal
System
Exercise
 Improves the appetite
 Increases gastrointestinal tract tone
 Facilitates peristalsis
Immobility

Constipation
Effect on the Urinary System
Exercise
Promotes blood flow to the kidneys
causing body wastes to be excreted more
effectively
 Prevents stasis (stagnation) of urine in the
bladder

Immobility
Urinary stasis
 Renal calculi
 Urinary retention
 Urinary infection

Effect on the Immune System
Exercise



Pumps lymph fluid from tissues into lymph
capillaries and vessels throughout the body
Increases circulation through lymph nodes
where destruction of pathogens and removal of
foreign antigens can occur
Strenuous exercise may reduce immune
function, leaving a window of opportunity for
infection during recovery phase
Effect on the Psychoneurologic
System
Exercise
Elevates mood and relieving stress and
anxiety across the lifespan
 Improves quality of sleep for most
individuals

Immobility
Decline in mood elevating substances
 Perception of time intervals deteriorates
 Problem-solving and decision-making
abilities may deteriorate
 Loss of control over events can cause
anxiety

Effect on Cognitive Function
Exercise
 Positive effects on decision-making and
problem-solving processes, planning, and
paying attention
 Induces cells in the brain to strengthen
and build neuronal connections
Other Effects of Exercise and
Immobility


Evidence that certain types of exercise
increase spiritual health
Immobility causes reduced skin turgor and
skin breakdown
Identify factors influencing a
person’s body alignment and
activity.

Factors Affecting Body Alignment,
Mobility, and Daily Activity Level
Growth and development
 Nutrition, personal values, and attitudes
 External factors (such as temperature,
humidity, availability of recreational facilities
and safety of the neighborhood)

Prescribed limitations (such as
casts, braces, traction, activity
restrictions including bed rest)
 Assess
activity-exercise
pattern, alignment, mobility
capabilities and limitations,
activity tolerance, and potential
problems related to immobility.
Assessment of Activity and
Exercise
 Nursing
history
 Physical examination of the
following:







Body alignment
Gait
Appearance and movement of joints
Capabilities and limitations for movement
Muscle mass and strength
Activity tolerance
Problems related to immobility
Figure 44-40
A standing person with A, good trunk alignment; B, poor trunk alignment. The arrows indicate the
direction in which the pelvis is tilted.
Figure 44-40 (continued)
A standing person with A, good trunk alignment; B, poor trunk alignment. The arrows
indicate the direction in which the pelvis is tilted.
Develop nursing diagnoses and
outcomes related to activity,
exercise, and mobility problems.
 Mobility
problems Nursing
Diagnoses for Activity and
Exercise Problems
Activity intolerance
 Risk for activity intolerance
 Impaired physical mobility
 Sedentary lifestyle
 Risk for disuse syndrome

NANDA Diagnoses: Mobility
Problem Becomes the Etiology
Fear (of falling)
 Ineffective coping
 Low self-esteem
 Powerlessness
 Risk for falls
 Self-care deficit

Prolonged Immobility
Ineffective airway clearance
 Risk for infection
 Risk for injury
 Risk for disturbed sleep pattern
 Risk for situational low self-esteem

Examples of Desired Outcomes
(NOC labels)
 Activity
tolerance
 Body positioning
 Bowel elimination
 Fall prevention behavior
 Immobility consequences both
physiological and psycho-cognitive
 Joint movement
 Mobility
Respiratory
status
Ventilation and gas exchange
Self-care
Sleep
Stress level
Weight control
Overall Goals for Problems Related
to Mobility or Activity
 Increased
tolerance for physical activity
 Restored or improved capability to
ambulate and/or participate in ADLs
 Absence of injury from falling or
improper use of body mechanics
 Enhanced physical fitness
 Absence of any complications
associated with immobility


Improved social, emotional, and intellectual wellbeing may be appropriate as the diagnostic label
or as the etiology for other nursing diagnoses.
NANDA includes the following nursing
diagnostic labels for activity and exercise
problems: Activity Intolerance, Risk for Activity
Intolerance, Impaired Physical Mobility,
Sedentary Lifestyle, and Risk for Disuse
Syndrome .
Use safe practices when
positioning, moving, lifting, and
ambulating clients.
 Safe
Practice for Positioning, Moving,
Lifting, Ambulating Clients
Correct body mechanics required for nurse to
prevent injury
 Correct body alignment for the client also so
that undue stress is not placed on the
musculoskeletal system

General Guidelines for Moving and
Lifting:







Before moving, assess
If indicated, use pain relief modalities
Prepare any needed assistive devices
Plan around encumbrance (obstacles)
Be alert to the effects of any medications
Obtain required assistance
Explain the procedure to the client
General Guidelines for Transferring
a Client




Plan what to do and how to do it
Obtain essential equipment before starting
Remove obstacles
Explain the transfer to the client and nursing
personnel who are assisting
Support or hold the client rather than the
equipment
 Explain step-by-step what the client should do
 Make a written plan including the client’s
tolerance
 Transferring Between Bed and Chair
 Transferring Between Bed and Stretcher

General Guidelines for Ambulating





Assess the amount of assistance the client
will require
Assess for signs and symptoms of postural
(orthostatic) hypotension and take
appropriate action
Prepare the client for ambulation
Appropriately assist the client to ambulate
Apply a transfer or walking belt
 Physically
support the client
 Obtain assistance of other nursing
personnel to follow with a wheelchair or
to assist with physical support
 Teach the client to correctly use
mechanical aids for walking
 Assisting the Client to Ambulate
Figure 44-42
A, Balance is maintained when the line of gravity falls close to the base of support. B, Balance is
precarious when the line of gravity falls at the edge of the base of support. C, Balance cannot be maintained when the
line of gravity falls outside the base of support.
Figure 44-42 (continued)
A, Balance is maintained when the line of gravity falls close to the base of support. B,
Balance is precarious (unstable) when the line of gravity falls at the edge of the base of support. C, Balance cannot be
maintained when the line of gravity falls outside the base of support.
Figure 44-42 (continued)
A, Balance is maintained when the line of gravity falls close to the base of support. B,
Balance is precarious when the line of gravity falls at the edge of the base of support. C, Balance cannot be maintained
when the line of gravity falls outside the base of support.
Figure 44-43
EZ Lift is an electric client lift that functions to lift clients from bed, chair, toilet, and floor.
Figure 44-46
Lifting heavy objects from the floor to waist level. A, Stand close to the load and flex the back and the
knees, lowering the body to grasp the load. B, Begin lifting with the back flexed, and gradually straighten the knees so
that the leg muscles bear most of the burden. C, To hold or walk with the object, maintain a less flexed but not a
completely straight position.
Figure 44-47
Low Fowler’s (semi-Fowler’s) position (supported). Note that arm support is omitted in this instance.
The amount of support depends on the needs of the individual client.
Figure 44-48
Orthopneic position.
Figure 44-49
Dorsal recumbent position (supported).
Figure 44-50
Prone position (supported).
Figure 44-51
Lateral position (supported).
Figure 44-52
Sims’ position (supported).
Figure 44-52 (continued)
Sims’ position (supported).
Figure 44-53
A one-piece seat hydraulic lift.
Figure 44-54
Supporting the limb above and below the joint for passive exercise.
Figure 44-55
Holding limbs for support during passive exercise: A, cupping; B, cradling.
Figure 44-55 (continued)
Holding limbs for support during passive exercise: A, cupping; B, cradling.
Figure 44-56
Tensing the quadriceps femoris muscles before ambulation.
Figure 44-57
A quad cane.
Figure 44-58
Steps involved in using a cane to provide maximum support.
Figure 44-58 (continued)
Steps involved in using a cane to provide maximum support.
Figure 44-59
Steps involved in using a cane when less than maximum support is required.
Figure 44-59 (continued)
Steps involved in using a cane when less than maximum support is required.
Figure 44-60
A, standard walker. B, Two-wheeled walker.
A
Figure 44-60 (continued)
A, standard walker. B, Two-wheeled walker.
B
Figure 44-61
Types of crutches: axillary, Lofstrand, and platform.
Figure 44-62
The standing position for measuring the correct length for crutches.
Figure 44-63
The tripod position.
Figure 44-64
The four-point alternate crutch gait.
Figure 44-65
The three-point crutch gait.
Figure 44-66
The two-point alternate crutch gait.
Figure 44-67
The swing-to crutch gait.
Figure 44-67 (continued)
The swing-to crutch gait.
Figure 44-68
The swing-through crutch gait.
Figure 44-68 (continued)
The swing-through crutch gait.
Figure 44-69
A client using crutches getting into a chair.
Figure 44-70
Climbing stairs: placing weight on the crutches while first moving the unaffected leg onto a step.
Figure 44-71
Descending stairs: moving the crutches and affected leg to the next step.