1. Fitness and Therapeutic Exercise
Chapter 24:
Fitness and Therapeutic Exercise

2. 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

3. 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

4. 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

5. Body Mass Index

6. Skin fold testing

7. Mid arm circumference

8. Omron BMI scanner

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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.

18. 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

19. 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.

20. 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).

21. 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.

22. 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.

23. 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.

24. 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.

25. Benefits of Exercise

26. 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

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

28. 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

29. 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

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

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

32. 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

33. Joint positions

34. 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

35. 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

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

37. 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

38. 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

39. 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

40. 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?