Fundamental Nursing Chapter 24 Therapeutic Exercise Inst.: Dr. Ashraf El - Jedi

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 • Benefits of Physical Exercise Improved cardiopulmonary function Reduced blood pressure Increased muscle tone and strength Greater physical endurance Increased lean mass and weight loss Reduced blood glucose level Decreased low-density blood lipids Improved physical appearance Increased bone density Regularity of bowel elimination Promotion of sleep Reduced tension and depression

Fitness Assessment Fitness means capacity to exercise. Factors such as a sedentary lifestyle, health problems, compromised muscle and skeletal function, obesity, advanced age, smoking, and high blood pressure can impair a client's fitness and stamina.

Body Composition Body composition is the amount of body tissue that is lean versus the amount that is fat. Determining factors include anthropometric measurements such as height, weight, body-mass index, skinfold thickness, and midarm muscle circumference. Inactivity without reduced food intake tends to promote obesity.

Vital Signs Vital signs—temperature, pulse rate, respiratory rate, and blood pressure—reflect a person's physical status.

Fitness Tests Fitness tests provide an objective measure of a person's current fitness level and potential for safe exercise. Two methods of fitness testing are a stress electrocardiogram and an ambulatory electrocardiogram.

Stress Electrocardiogram A stress electrocardiogram tests electrical conduction through the heart during maximal activity and is performed in an acute care facility or outpatient clinic (Fig. 24-1)

Figure 24-1 • Stress electrocardiogram.

An 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.

Figure 24-2 • Ambulatory electrocardiography.

Exercise Prescriptions The prescription for an exercise program involves determining the person's target heart rate

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 50% to 85% of the maximum heart rate.

Beginners should not exceed 50%, intermediates can exercise up to 70%, and competitive athletes can tolerate from 70% to 85% 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.

Types of Exercise The two major types of exercise are: fitness exercise therapeutic exercise.

1. Fitness Exercise Fitness exercise means physical activity performed by healthy adults. Fitness exercise develops and maintains cardiorespiratory function, muscular strength, and endurance (Fig. 24-3). The two categories of fitness exercise are isotonic and isometric.

Figure 24-3 • Stationary cycling.

Isotonic exercise is activity that involves movement and work Isotonic exercise is activity that involves movement and work. The example is aerobic exercise, which involves rhythmically moving all parts of the body at a moderate to slow speed without hindering the ability to breathe. In other words, the person can talk comfortably if the exercise is within his or her level of fitness.

Isometric exercise consists of stationary exercises generally performed against a resistive force. Examples include body building, weight lifting, and less intense activities such as simply contracting and relaxing muscle groups while sitting or standing.

2. Therapeutic Exercise 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

Active 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 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

Range-of-Motion Exercises Range-of-motion (ROM) exercises are therapeutic activities that move the joints. They are performed for the following reasons: To assess joint flexibility before initiating an exercise program To maintain joint mobility and flexibility in inactive clients To prevent ankylosis (permanent loss of joint movement) To stretch joints before performing more strenuous activities To evaluate the client's response to a therapeutic exercise program

During ROM exercises, the client moves or is assisted to move unused joints in the positions that the joint normally permits (Table 24-4). Whenever possible, the client actively exercises as many joints as possible while the nurse assists with those that are compromised. See Nursing Guidelines 24-1.

Nursing Implications Impaired Physical Mobility Risk for Disuse Syndrome Unilateral Neglect Risk for Delayed Surgical Recovery Activity Intolerance