1 Second semester Chapter 24 Therapeutic Exercise Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise

2 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Exercise Exercise (purposeful physical activity) is beneficial to people of all age groups (Box 24-1), and the health risks of a sedentary lifestyle are well documented.Box 24-1 Nurses assess fitness level before initiating exercise program.

3 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Box 24-1 Benefits of Physical Exercise 1. Improved cardiopulmonary function 2. Reduced blood pressure 3. Increased muscle tone and strength 4. Greater physical endurance 5. Increased lean mass and weight loss 6. Reduced blood glucose level 7. Decreased low-density blood lipids 8. Improved physical appearance 9. Increased bone density 10. Regularity of bowel elimination 11. Promotion of sleep 12. Reduced tension and depression

4 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Fitness Assessment Fitness means capacity to exercise Factors can impair a client's fitness : sedentary lifestyle, health problems, impaired musculoskeletal function, obesity, advanced age, smoking, and high blood pressure Assessment of fitness level necessary Assessment techniques include: measuring body composition, evaluating trends in vital signs, performing fitness tests

5 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Fitness Assessment (cont’d) Body composition: lean body tissue versus fat  Determining factors include anthropometric measurements such as height, weight, body-mass index, skinfold thickness, and mid arm muscle circumference.  Inactivity without reduced food intake leads to obesity 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

6 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Fitness Assessment (cont’d) Fitness tests Fitness tests provide an objective measure of a person's current fitness level and potential for safe exercise. Methods: 1. Stress electrocardiogram 2. Ambulatory electrocardiogram 3. Submaximal fitness test

7 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Fitness Assessment (cont’d) Stress electrocardiogram Tests electrical conduction through the heart during maximal activity and is performed in an acute care facility or outpatient clinic Test stopped if abnormal heart rhythm, cardiac ischemia, elevated blood pressure, or exhaustion occur

8 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Fitness Assessment (cont’d) Ambulatory electrocardiogram Is a continuous recording of heart rate and rhythm during normal activity It requires the client to wear a device called a Holter monitor for 24 hours. 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 Client keeps a diary of the time and type of activities performed

9 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Ambulatory electrocardiogram

10 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Walk-a-mile test The walk-a-mile test, measures the time it takes a person to walk 1 mile. The person is instructed to walk 1 mile on a flat surface as fast as possible. The examiner calculates the time from start to finish and interprets results using the guidelines in Table TABLE 24 EVALUATION CRITIRIA FOR THE WALK-A-AMILE TEST fitness levelperformance time for w0men performance time for men

11 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Exercise Prescriptions The prescription for an exercise program involves determining the person's target heart rate Target heart rate means the goal for heart rate during exercise. It is determined by first calculating the person's maximum heart rate (highest limit for heart rate during exercise). Maximum heart rate is calculated by subtracting a person's age from 220. The target heart rate is 60% to 90% of the maximum heart rate.

12 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Beginners should not exceed 60%, intermediates can exercise at 70% to 75%, and competitive athletes can tolerate 80% to 90% of their maximum heart rate. Exercising at the target rate for 15 minutes (excluding the warm-up and cool-down periods) 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.

13 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Types of Exercise The two major types of exercise are: Fitness exercise Therapeutic exercise.

14 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Types of Exercise (cont’d) 1. Fitness exercise: means physical activity performed by healthy adults. develops and maintains cardiorespiratory function, muscular strength, and endurance (Fig. 24-3). The two categories of fitness exercise: 1. isotonic 2. isometric.

15 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Isotonic exercise Involves movement and work. Increases cardiorespiratory function Aerobic exercise Jogging Isometric exercise Consists of stationary exercises usually performed against a resistive force. Increases circulation but doesn't promote cardiorespiratory function Weight lifting Body building Types of Exercise (cont’d)

16 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Types of Exercise (cont’d) 2. Therapeutic exercise is Activity performed by people with health risks or being treated for an existing health problem. Clients perform therapeutic exercise to prevent health- related complications or to restore lost functions  performed either:  Active exercise, or  Passive exercise

17 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Active and Passive Exercise Active exercise is therapeutic activity that the client performs independently after proper instruction. For example, clients who have undergone a mastectomy learn to exercise the arm on the surgical side Passive exercise is therapeutic activity that the client performs with assistance and is provided when a client cannot move one or more parts of the body. For example, for clients who are comatose or paralyzed from a stroke or spinal injury, nurses perform

18 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Types of Exercise (cont’d) Range-of-motion (ROM) exercises are therapeutic activities that move the joints. performed for the following reasons: 1. To assess joint flexibility before initiating an exercise program 2. To maintain joint mobility and flexibility in inactive clients 3. To prevent ankylosis (permanent loss of joint movement) 4. To stretch joints before performing more strenuous activities 5. To evaluate the client's response to a therapeutic exercise program Performed for care of inactive client

19 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise TermDescription Flexionbending to decrease the angle between two adjoining bones Extensionstraightening to increase the angle between two adjoining bones HyperextensionIncreasing the angle between two adjoining bones more than 180 degrees Abductionmoving away from the midline Adductionmoving toward the midline RotationTurning from side to side as in an arc External rotationturning outward, away from the midline of the body Internal rotationturning inward, toward the midline of the body CircumductionForming a circle PronationTurning downward SupinationTurning upward Plantar flexionBending toward the sole of the foot DorsiflexionBending the foot toward the dorsum or anterior side InversionTurning the sole of the foot toward the midline EversionTurning the sole of the foot away from the midline

20 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise

21 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise

22 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise

23 Second semester Bader A. EL Safadi BSN, MSc Fundamental of Nursing – B Therapeutic Exercise Nursing Implications Nursing diagnoses to be treated with activity or exercise regimen Impaired physical mobility Disuse syndrome Unilateral neglect Delayed surgical recovery Activity intolerance