1. Body Mechanics PNU 145 Chapter 24 Therapeutic Exercise Cheryl Proffitt, RN MSN September, 2014

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Exercises Objectives  List at least five benefits of regular exercise  Define Fitness  Identify seven factors that interfere with fitness  Name at least two methods of fitness testing  Describe how to calculate a person’s target heart rate  Define metabolic energy equivalent  Differentiate fitness exercise from therapeutic exercise

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Exercises Objectives Cont’d  Differentiate isotonic exercise from isometric exercises  Give at least one example of isotonic and isometric exercises  Differentiate between active exercise and passive exercise  Discuss how and why range of motion exercises are performed  Provide at least two suggestions for helping older adults become or stay physically active.

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Mechanics  What Is Therapeutic Exercise  Therapeutic exercise, any exercise planned and performed to attain a specific physical benefit, such as maintenance of the range of motion, strengthening of weakened muscles, increased joint flexibility, or improved cardiovascular and respiratory function.

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Exercise or purposeful physical activities  Beneficial to all age groups  Sedentary lifestyle is a health risk  It is Individualized  Nurses assess fitness level before initiating exercise program Exercise

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

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body composition: The amount of lean body tissue versus fat  Determined by height, weight, body-mass index, skin fold thickness, and mid arm muscle circumference  Inactivity without reduced food intake leads to obesity Fitness Assessment (cont’d)

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples of measurements Body mass index (BMI) is a number based on a person's weight and height that provides a way to estimate the effect of weight on health.

9. 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)

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fitness tests objectively measure current fitness level and potential for safe exercise. Also helps to determine safe/exercise plan  Methods  Stress electrocardiogram (EEG)  Ambulatory electrocardiogram (ECG) and  Submaximal fitness test Fitness Assessment (cont’d)

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress electrocardiogram  Tests electrical conduction through the heart during maximal activity(acute care/clinic).  Monitored – HR/R,BP, breathe, dizzy, CP  Pulse oximeter measures peripheral oxygenation  Test stopped if abnormal heart rhythm, cardiac ischemia (impaired blood flow to the heart), elevated blood pressure, or exhaustion occurs Fitness Assessment (cont’d)

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

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ambulatory electrocardiogram is  Continuous recording of heart rate and rhythm during normal activity. ( client wears a Holter monitor for 24 hours, no shower, avoid magnets, metal detectors, high voltage,electrical blankets)  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)

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ambulatory electrocardiogram Cont’d  Client keeps a diary of the time and type of activities performed/medication /symptoms  Physician compares the client’s diary with the electrocardiogram.  Test results helps to determine any abnormal oxygenation to the heart or abnormal rhythm during any activity.  Physician will advice the client. Fitness Assessment (cont’d)

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Client with Holter monitor/ Readings

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Step test is  Submaximal fitness test: timed stepping activity  Variations: Harvard Step Test; Queens College Step Test; Chester Step Test  Client steps up and down at prescribed height. Shorten time when client develops discomfort. Fitness Assessment (cont’d)

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fitness Assessment (cont’d) Step Test Cont’d  Uses a metronome or stopwatch to keep track of the rate and the time  Recovery index is then calculated: guide for determining a person’s fitness level.  How- see example book. Table 24  Step test should be used with caution. Certified CPR/Automatic cardiac defibrillator personnel should be at hand

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Walk-a-mile test  Measures the time it takes a person to walk 1 mile, on flat surface. Time is calculated start/finish. Interpret results using guidelines in table 24-2 Fitness Assessment (cont’d)

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Target heart rate means  Goal for heart rate during exercise. It is determined by calculating  Maximum heart rate: (highest limit for heart rate during exercise); How- subtract client’s age from 220  Exercising beyond target heart rate reduces endurance by increasing fatigue. Exercise Prescriptions

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Metabolic energy equivalent (MET)  Because fitness levels vary: exercise prescribed by metabolic energy equivalent (MET)  It is a Measure of energy and oxygen consumption during exercise  The prescribed amount the person’s cardiovascular system can safely support. (Table 24-3). Fitness Assessment (cont’d)

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise is done to promote fitness/outcomes. There are 2 types: Fitness & Therapeutic exercises Fitness exercise: develops and maintains cardiorespiratory function, muscular strength, endurance  2 categories  Isotonic  Isometric Types of Exercise

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Isotonic exercise  Involves movement and work  Increases cardiorespiratory function  Prime Examples  Aerobic exercise-performed at moderate to slow speed. At the person’s own comfort level Types of Exercise (Cont’d)

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

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  May be Isotonic or isometric  Active exercise: performed independently by client after instruction to a weakened part of body  Passive exercise: performed by client with assistance when client is unable to move body parts. For e.g. after stroke, ROM, or CPM. 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( permanent loss of joint movement); 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 Functions of CPM Machine  Restores and increase joint ROM  Prevents the pooling of venous blood  Decreases the risks of blood clots  Accelerates the healing of wounds /synovial fluids circulates around the joints.

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins DPH has established guidelines for Physical activity ( Table 24-5) Nursing diagnoses to be treated with activity or exercise regimen  Impaired physical mobility  Disuse syndrome  Unilateral neglect  Delayed surgical recovery  Activity intolerance Nursing Implications

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Older Adults: 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

31. 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)

32. 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)

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins References Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Google pictures. (2015, August 10). Retrieved from http://www.google.com