1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 24 Therapeutic Exercise

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Beneficial to all age groups Sedentary lifestyle is a health risk Individualized Nurses assess fitness level before initiating exercise program Exercise

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fitness: capacity to exercise Factors interfering with fitness: sedentary lifestyle, health problems, impaired musculoskeletal function, obesity, advanced age, smoking, and high blood pressure Assessment of fitness level necessary Assessment techniques: measuring body composition, evaluating trends in vital signs, performing fitness tests Fitness Assessment

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Fitness Assessment (cont’d)

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Assessment (cont’d)

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fitness tests objectively measure current fitness level and potential for safe exercise –Methods oStress electrocardiogram oAmbulatory electrocardiogram oSubmaximal fitness test Fitness Assessment (cont’d)

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress electrocardiogram –Tests electrical conduction through the heart during maximal activity –Pulse oximeter measures peripheral oxygenation oTest stopped if abnormal heart rhythm, cardiac ischemia, elevated blood pressure, or exhaustion occur Fitness Assessment (cont’d)

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Electrocardiogram

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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)

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ambulatory electrocardiogram –Client keeps a diary of the time and type of activities performed –Physician compares the client’s diary with the electrocardiogram Fitness Assessment (cont’d)

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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)

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Walk-a-mile test –Measures the time it takes a person to walk 1 mile Fitness Assessment (cont’d)

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following tests assesses electrical conduction through the heart during maximal activity? a. Ambulatory electrocardiogram b. Stress electrocardiogram c. Step test d. Walk-a-mile test

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 –Target heart rate is 60% to 90% of maximum heart rate during exercise Exercise Prescriptions

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Metabolic energy equivalent –Fitness levels vary: exercise prescribed by metabolic energy equivalent oMeasure of energy and oxygen consumption during exercise Fitness Assessment (cont’d)

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fitness exercise: develops and maintains cardiorespiratory function, muscular strength, endurance –2 categories oIsotonic oIsometric Types of Exercise

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Isotonic exercise –Involves movement and work –Increases cardiorespiratory function oAerobic exercise oJogging Types of Exercise (cont’d)

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Isometric exercise –Stationary exercise, usually against resistance –Increases circulation but does NOT promote cardiorespiratory function oWeight lifting oBody building Types of Exercise (cont’d)

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Isotonic exercise consists of stationary exercises generally performed against a resistive force.

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Isotonic exercise is activity that involves movement and work. Isometric exercise consists of stationary exercises generally performed against a resistive force.

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic exercise: activity performed by people with health risks that prevents complications and restores lost function –Isotonic or isometric oActive exercise: performed independently by client after instruction oPassive exercise: performed by client with assistance when client is unable to move body parts Types of Exercise (cont’d)

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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)

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Types of Exercise (cont’d)

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Range of Motion of the Knee With a Continuous Passive Motion Machine (Refer to Skill 24-2 in the textbook.)

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing diagnoses to be treated with activity or exercise regimen –Impaired physical mobility –Disuse syndrome –Unilateral neglect –Delayed surgical recovery –Activity intolerance Nursing Implications

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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)

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 General Gerontologic Considerations (cont’d)