Body Mechanics PNU 145 Chapter 24 Therapeutic Exercise Cheryl Proffitt, RN MSN September, 2014.

Body Mechanics Body Mechanics PNU 145

Chapter 24

Therapeutic Exercise

Cheryl Proffitt, RN MSN

September, 2014

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Therapeutic Exercises Therapeutic Exercises• Objectives

List at least five benefits of regular exercise

Define Fitness

Identify seven factors that interfere with fitness

Name at least two methods of fitness testing

Describe how to calculate a person’s target heart rate

Define metabolic energy equivalent

Differentiate fitness exercise from therapeutic exercise


Therapeutic Exercises Therapeutic Exercises• Objectives Cont’d

Differentiate isotonic exercise from isometric exercises

Give at least one example of isotonic and isometric exercises

Differentiate between active exercise and passive exercise

Discuss how and why range of motion exercises are performed

Provide at least two suggestions for helping older adults become or stay physically active.


Body Mechanics Body MechanicsWhat Is Therapeutic Exercise

Therapeutic exercise, any exercise planned and performed to attain a specific physical benefit, such as maintenance of the range of motion, strengthening of weakened muscles, increased joint flexibility, or improved cardiovascular and respiratory function.


• Introduction

• Exercise or purposeful physical activities

Beneficial to all age groups

Sedentary lifestyle is a health risk

It is Individualized

Nurses assess fitness level before initiating exercise program

Exercise Exercise


• Fitness means : capacity to exerciseFactors interfering with fitness: sedentary

lifestyle, health problems, impaired musculoskeletal function, obesity, advanced age, smoking, and high blood pressure

Before exercise assessment of fitness level is necessary

Assessment techniques: measuring body composition, evaluating trends in vital signs, performing fitness tests

Fitness Assessment Fitness Assessment


• Body composition: The amount of lean body tissue versus fat

Determined by height, weight, body-mass index, skin fold thickness, and mid arm muscle circumference

Inactivity without reduced food intake leads to obesity

Fitness Assessment (cont’d)Fitness Assessment (cont’d)


Examples of measurements Examples of measurements

Body mass index (BMI) is a number based on a person's weight and height that

provides a way to estimate the effect of weight on health.


• 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



• Fitness tests objectively measure current fitness level and potential for safe exercise. Also helps to determine safe/exercise plan

Methods

Stress electrocardiogram (EEG)

Ambulatory electrocardiogram (ECG) and

Submaximal fitness test



• Stress electrocardiogram

Tests electrical conduction through the heart during maximal activity(acute care/clinic).

Monitored – HR/R,BP, breathe, dizzy, CP

Pulse oximeter measures peripheral oxygenation

Test stopped if abnormal heart rhythm, cardiac ischemia (impaired blood flow to the heart), elevated blood pressure, or exhaustion occurs



Stress ElectrocardiogramStress Electrocardiogram


• Ambulatory electrocardiogram is Continuous recording of heart rate and

rhythm during normal activity. (client wears a Holter monitor for 24 hours, no shower, avoid magnets, metal detectors, high voltage ,electrical blankets)

Used when a client has had prior cardiac-related symptoms or when a stress electrocardiogram is contraindicated

Assessment: heart’s response to normal activity, cardiac rehabilitation, and medical therapy



• Ambulatory electrocardiogram Cont’d

Client keeps a diary of the time and type of activities performed/medication /symptoms

Physician compares the client’s diary with the electrocardiogram .

Test results helps to determine any abnormal oxygenation to the heart or abnormal rhythm during any activity.

Physician will advice the client.



Client with Holter monitor/ Readings Client with Holter monitor/ Readings


• Step test is

Submaximal fitness test: timed stepping activity

Variations: Harvard Step Test; Queens College Step Test; Chester Step Test

Client steps up and down at prescribed height. Shorten time when client develops discomfort.



Fitness Assessment (cont’d) Fitness Assessment (cont’d)• Step Test Cont’d

Uses a metronome or stopwatch to keep track of the rate and the time

Recovery index is then calculated: guide for determining a person’s fitness level.

How- see example book. Table 24

Step test should be used with caution. Certified CPR/Automatic cardiac defibrillator personnel should be at hand


• Walk-a-mile test

Measures the time it takes a person to walk 1 mile, on flat surface. Time is calculated start/finish. Interpret results using guidelines in table 24-2



• Target heart rate means

Goal for heart rate during exercise. It is determined by calculating

Maximum heart rate: (highest limit for heart rate during exercise); How-subtract client’s age from 220

Exercising beyond target heart rate reduces endurance by increasing fatigue.

Exercise Prescriptions Exercise Prescriptions


• Metabolic energy equivalent (MET)

Because fitness levels vary: exercise prescribed by metabolic energy equivalent (MET)

It is a Measure of energy and oxygen consumption during exercise

The prescribed amount the person’s cardiovascular system can safely support. (Table 24-3).



• Exercise is done to promote fitness/outcomes.

• There are 2 types: Fitness & Therapeutic exercises

• Fitness exercise: develops and maintains cardiorespiratory function, muscular strength, endurance

2 categories

Isotonic

Isometric

Types of ExerciseTypes of Exercise


• Isotonic exercise

Involves movement and work

Increases cardiorespiratory function

Prime Examples

Aerobic exercise-performed at moderate to slow speed. At the person’s own comfort level

Types of Exercise (Cont’d)Types of Exercise (Cont’d)


• Isometric exercise

Stationary exercise, usually against resistance

Increases circulation but does NOT promote cardiorespiratory function

Weight lifting

Body building

Types of Exercise (cont’d)Types of Exercise (cont’d)


• Therapeutic exercise: activity performed by people with health risks that prevents complications and restores lost function May be Isotonic or isometric

Active exercise: performed independently by client after instruction to a weakened part of body

Passive exercise: performed by client with assistance when client is unable to move body parts. For e.g. after stroke, ROM, or CPM.



• Range-of-motion exercises

Therapeutic activities to move joints

Performed to assess joint flexibility; maintain joint mobility and flexibility in inactive clients; prevent ankylosis( permanent loss of joint movement); stretch joints for strenuous activities; and evaluate response to therapeutic exercise program

Performed for care of inactive client



• 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



Range of Motion of the Knee With a Continuous Passive Motion Machine Range of Motion of the Knee With a Continuous Passive Motion Machine

(Refer to Skill 24-2 in the textbook.)


Functions of CPM Machine Functions of CPM Machine

Restores and increase joint ROM

Prevents the pooling of venous blood

Decreases the risks of blood clots

Accelerates the healing of wounds /synovial fluids circulates around the joints.


• DPH has established guidelines for Physical activity ( Table 24-5)

• Nursing diagnoses to be treated with activity or exercise regimen

Impaired physical mobility

Disuse syndrome

Unilateral neglect

Delayed surgical recovery

Activity intolerance

Nursing ImplicationsNursing Implications


• Older Adults:

• 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

General Gerontologic ConsiderationsGeneral Gerontologic Considerations


• 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

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




References References

Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

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Body Mechanics PNU 145 Chapter 24 Therapeutic Exercise Cheryl Proffitt, RN MSN September, 2014.

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