Transcript Therapeutic exercise

Fundamental Nursing
Chapter 24
Therapeutic Exercise
Inst.: Dr. Ashraf El - Jedi
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Exercise (purposeful physical activity) is
beneficial to people of all age groups (Box 241), and the health risks of a sedentary lifestyle
are well documented.
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Box 24-1 • Benefits of Physical Exercise
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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
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Fitness Assessment
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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.
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Body Composition
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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, bodymass index, skinfold thickness, and midarm
muscle circumference.
Inactivity without reduced food intake tends
to promote obesity.
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Vital Signs
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Vital
signs—temperature,
pulse
rate,
respiratory rate, and blood pressure—reflect a
person's physical status.
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Fitness Tests
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Fitness tests provide an objective measure of a
person's current fitness level and potential for
safe exercise.
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Two methods of fitness testing are a stress
electrocardiogram
and
an
ambulatory
electrocardiogram.
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Stress Electrocardiogram
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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)
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Figure 24-1 • Stress electrocardiogram.
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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.
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Figure 24-2 • Ambulatory electrocardiography.
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Exercise Prescriptions
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The prescription for an exercise program
involves determining the person's target heart
rate
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Target Heart Rate
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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.
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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.
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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.
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Types of Exercise
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The two major types of exercise are:
fitness exercise
 therapeutic exercise.
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1. Fitness Exercise
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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.
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Figure 24-3 • Stationary cycling.
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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.
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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.
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2. Therapeutic Exercise
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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
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Active Exercise
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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
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Passive Exercise
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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
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Range-of-Motion Exercises
Range-of-motion (ROM) exercises are therapeutic activities that
move the joints. They are performed for the following reasons:
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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
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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.
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Nursing Implications
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Impaired Physical Mobility
Risk for Disuse Syndrome
Unilateral Neglect
Risk for Delayed Surgical Recovery
Activity Intolerance
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