Fitness and Therapeutic Exercise Chapter 24: Fitness and Therapeutic Exercise

Exercise Purposeful physical activity Beneficial to all age groups Sedentary lifestyle is a health risk Exercise is individualized Nurses are responsible to assess fitness level before initiating exercise program

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 Before an exercise program begins, assessment of fitness level necessary Assessment techniques: measuring body composition, evaluating trends in vital signs, performing fitness tests

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

Body Mass Index

Skin fold testing

Mid arm circumference

Omron BMI scanner

Fitness Assessment (cont’d) Vital signs: temperature, pulse rate, respiratory rate, and blood pressure Reflect a person’s physical status Elevated BP, HR ,RR while resting may indicate life-threatening cardiovascular symptoms during exercise Modified exercise: vital signs may decrease and reducing potential for heart related complications

Fitness Assessment (cont’d) Fitness tests objectively measure current fitness level and potential for safe exercise Methods Stress electrocardiogram Ambulatory electrocardiogram Submaximal fitness test

Fitness Assessment (cont’d) Stress electrocardiogram Tests electrical conduction through the heart during maximal activity Pulse oximeter measures peripheral oxygenation Test stopped if abnormal heart rhythm, cardiac ischemia, elevated blood pressure, or exhaustion occur

Fitness Assessment (cont’d) Ambulatory electrocardiogram Continuous recording of heart rate and rhythm during normal activity 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

Fitness Assessment (cont’d) Ambulatory electrocardiogram Client keeps a diary of the time and type of activities performed Not to be worn in the shower or while swimming Physician compares the client’s diary with the electrocardiogram

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

Fitness Assessment (cont’d) Walk-a-mile test Measures the time it takes a person to walk 1 mile on a flat surface as fast as possible. If a person walks at a brisk pace, 3-4 mph, it will take about 30 min to complete 1-2 miles.

Question Which test assesses electrical conduction through the heart during maximal activity? a. Ambulatory electrocardiogram b. Stress electrocardiogram c. Step test d. Walk-a-mile test

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.

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 Thus a 20 year old has a maximum HR of 200 bpm Target heart rate is 50% to 85% of maximum heart rate during exercise depending on your fitness level

Hint: target heart rate% on page 540. Practice What is the maximum heart rate and the minimum target rate for a person who is 25 years old and a competitive athlete who is 32 years old? Hint: target heart rate% on page 540.

Practice Answer: The maximum heart rate for a person who is 25 years old is 195 beats per minute (220-25=195). The minimum target heart rate for a 25 year old is 50% of the maximum heart rate or 98 beats per minute. A 32 year old competitive athlete’s maximum heart rate is 188 beats per minute (220-32=188) and the target heart rate could range between 132 beats per minute (70% of maximum) and 160 beats per minute (85% of maximum).

Practice With your elbow partner: Obtain your partner’s maximum heart rate (subtract persons age from 220) b. Calculate your partner’s target heart rate Beginners 50% ( % x max HR) Moderate 70% Competitive Athlete 85% Be prepared to discuss your findings with the class.

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.

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.

Fitness Assessment (cont’d) Metabolic energy equivalent(MET) Fitness levels vary: exercise prescribed by metabolic energy equivalent Measure of energy and oxygen consumption during exercise For example Sewing is a MET 1 where playing contact football is >MET10 Find your favorite activities on table 24-4 page 540.

Benefits of Exercise

Types of Exercise 2 types of exercise: Fitness and therapeutic exercise Fitness exercise: develops and maintains cardiorespiratory function, muscular strength, endurance 3 categories Isotonic Isometric Isokinetic

Types of Exercise (cont’d) Isotonic exercise Involves movement and work Muscles being exercised change length Increases cardiorespiratory function Aerobic exercise Jogging

Types of Exercise (cont’d) Isometric exercise Stationary exercise, usually against resistance No change in length of contacting muscles Increases circulation but does NOT promote cardiorespiratory function Weight lifting Body building

Types of Exercise (cont’d) Isokinetic exercise Combines movement at a constant speed with a form of resistance For example stationary bikes Used to rehab athletes after an injury or a person recovering from a stroke or accident

Question Is the following statement true or false? Isotonic exercise consists of stationary exercises generally performed against a resistive force.

Answer False. Isotonic exercise is activity that involves movement and work. Isometric exercise consists of stationary exercises generally performed against a resistive force.

Types of Exercise (cont’d) Therapeutic exercise: activity performed by people with health risks that prevents complications and restores lost function Isotonic or isometric Active exercise: performed independently by client after instruction Passive exercise: performed by client with assistance when client is unable to move body parts

Joint positions

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

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

Nursing Implications Nursing diagnoses to be treated with activity or exercise regimen Impaired physical mobility Disuse syndrome Unilateral neglect Delayed surgical recovery Activity intolerance

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

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

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

Putting it into Practice A 60-year-old client complains of shortness of breath, tiredness, and joint pain after walking short distances. The client also has vertigo, which makes him reluctant to walk without assistance. The client constantly expresses his aversion to an exercise regimen, which according to him, tires him out completely. However, the physician has emphasized the importance of exercise for this client. a. What changes should the nurse make in the client’s fitness regimen, in consultation with the physician? b. How should the nurse encourage the client to follow an exercise routine?