Activity and

Exercise

Nursing 101
Fall 2023
Jessica Sweat, MSN, RN, CDCES
 Learning Objectives

1. Review the anatomy and physiology of movement.

2. Discuss the use of proper body mechanics when providing patient care.
3. Describe types of exercise.
4. Assess for factors affecting mobility and exercise.
5. Plan and implement nursing interventions for patients with alterations in
mobility.
 Definitions

Mobility is defined as body movement.

Physical Fitness is the ability to carry out activities of daily living without fatigue.

Physical Activity is any bodily movement produced by the contraction of skeletal

muscle that increases energy expenditure above baseline.
Exercise is a subconcept of physical activity. It is planned, structured, repetitive and
purposeful for improving or maintaining physical fitness and health.
 Skeletal System
The skeleton forms the framework of the body, protects the
internal organs, produces blood cells, and stores mineral salts.

Long Bones – femur and humerus

Short Bones – phalanges and metacarpals
Flat Bones – sternum and cranial bones
Irregularly shaped bones – vertebrae and tarsal bones
When two bones are close together, a joint is formed.
Ligaments are fibrous tissues that connect most movable joints.
Tendons are connective tissues that attach muscles to the bone.
Cartilage is smooth, elastic, connective tissue that acts as a
cushion around the joints and other parts of the body (rib cage,
nose).
 Muscles

Skeletal muscles move the skeleton.

Smooth muscle occurs in the digestive tract and
hollow structures like the bladder and blood
vessels.
Cardiac muscle is a unique form of muscle that
contracts spontaneously.

What happens when the cardiac muscle isn’t

used?
How would your client present if their heart
muscle was “weak”?
 Body Mechanics

Body mechanics is a term used to describe the way we

move our bodies.
Principles of body mechanics are rules to move your body
while reducing risk of injury.
Body alignment, or posture is an important aspect of
body mechanics.
Balance is when the body is in alignment.
Use a wide stance to avoid injury when lifting and to
make it easier to maintain balance. With a wide stance
the center of gravity is closer to the base of support.
With a narrow stance, the body is less stable.
 • Avoid standing in one position for a long period
Tips to Maintain of time.
Proper Posture and • Do not lock knees when standing upright.
Avoid Injury • Do not bend forward at the waist or neck to
work in a low position.
• Sit with your feet flat on the floor and your
knees below hips.
• Team Lift
• Use resources
 Types of Exercise
Aerobic Exercise uses large muscle groups and can be maintained continuously.
Jogging, aerobics, and brisk walking are aerobic exercises.
Anaerobic Exercise occurs when muscles must obtain energy from metabolic
pathways that do not use oxygen. Rapid, intense exercises like sprinting and power
lifting are examples of anaerobic exercises.
Isometric Exercise is an exercise in which muscle contraction occurs without motion. It
doesn’t require any equipment. Bedbound patients use isometric exercises to gain
some strength. For example, asking the patient to press their hand against yours.
Planking is an isometric exercise.
Isotonic Exercise involves movement of the joint during muscle contraction. Almost
any resistance exercise would be considered an isotonic exercise. For example, weight
training or push ups.
Isokinetic Exercise is exercise performed with specialized apparatuses that provide
variable resistance to movement. It is a type of strength training. Machines at health
clubs and physical therapy departments can be used for this form of exercise.
 Modes of Exercise

The mode of exercise refers to the type of activity.

Endurance, resistance, and flexibility are modes of exercise.
Endurance increases with repetition.
Resistance can increase strength and endurance.
Flexibility involves stretching before exercise and prevents
injury during exercise. Also, helps with balance.
A well-rounded fitness program will contain all 3 modes.
Duration is the amount of time one is exercising.
Frequency indicates how often one is exercising.
Intensity refers to how hard one is exercising.
 Planning a Fitness Program
• If you are older than 40, smoke or drink, are sedentary, are
overweight, or have a chronic health condition, you should
have a medical evaluation before starting an exercise
program.
• Choose a variety of exercises you ENJOY and feel
comfortable doing.
• Find allies.
• Vary your routine.
• Choose a comfortable time of day.
• Make exercise fun.
• Keep a daily log of activities.
• Think about joining a health club. The cost may give you
incentive.
 Exercise Tips
• Warm up your muscles for 5 to 10 minutes
before your main session of aerobic
exercises.
• Maintain your exercise intensity for 30-45
minutes.
• Cool down 5 to 10 minutes at the end of your
workout.
• Accumulate physical activity through the day.
• Wear good shock absorbing footwear.
• Alternate easy and hard exercise days.
• Drink at least 8 ounces of water before
exercise and more if thirsty.
 Activity Guidelines for Americans from the U.S.
Department of Health and Human Services
Children and Adolescents – Engage in at least 1 hour of
physical activity daily, at least 3 days per week. Most
activity should be aerobic, either moderate or vigorous
in intensity.
Adults and Older Adults – To gain substantial health
benefits, get at least 150 minutes per week of moderate
intensity exercise or 75 minutes of vigorous intensity
exercise. Exercise sessions should be at least 10 minutes
in length.
Older Adults – Walking is a good form of activity for
those who can walk safely. Older adults should be as
physically active as abilities and conditions allow.
Exercise should improve balance and muscle strength.
 Benefits and Risks Associated with Exercise
Exercise lowers risk of heart disease, stroke, type 2
diabetes, hypertension, hyperlipidemia, metabolic
syndrome, colon and breast cancers, and depression.
Exercise can reduce loss of bone density, promote weight
loss, and promote better heart and lung function. Along
with a healthy diet it can reduce risk of cognitive decline,
and Alzheimer’s disease.
Risks: cardiac injury, musculoskeletal injury, dehydration,
and temperature regulation problems
 What Affects Mobility and Activity?
Developmental Stage: Older patients may not be as active.
Obesity: leads to health problems and makes movement
more difficult.
Chronic Diseases: Inadequate amounts of protein to
maintain and build tissue. Muscle wasting and fatigue lead to
reduced activity.
Lifestyle: Personal values about exercise and fitness make
affect activity level.
Environmental Factors: Weather, neighborhood, finances,
and having support system can influence activity.

What do you notice about this street?

 Congenital Anomalies of the
Musculoskeletal System

Syndactylism is the fusion of two or more fingers or

toes.
Developmental dysplasia of the hip is a congenital
abnormality causing hip dislocation.
Foot deformities, such as club foot occur in about 4%
of all newborns.
Scoliosis is a lateral curvature of the spine.
 Conditions Related to Bone
Formation or Metabolism

Osteogenesis imperfecta is a congenital disorder of bone

and connective tissue characterized by brittle bones that
fracture easily.
Achondroplasia, or dwarfism, occurs when the bones
ossify or harden prematurely.
Paget’s disease is a metabolic bone disease in which
increased bone loss results in pain, fractures, and
deformities. This disorder usually affects the skull,
vertebrae, and pelvis.
 Diseases Affecting Joint Mobility

Osteoarthritis is a degenerative joint disease. It involves loss of cartilage in the joint,

with pain and stiffness as the primary symptoms.
Rheumatoid Arthritis is a systemic autoimmune disease involving chronic
inflammation of the joints and surrounding connective tissue, resulting in difficulties
performing ADL’s.
Ankylosing Spondylitis is a chronic inflammatory joint disease characterized by
stiffening and fusion of the spine and sacroiliac joints.
Gout is an inflammatory response to high levels of uric acid. Crystals form in the
synovial fluid and for nodules in the subcutaneous tissues.
 Bone Integrity Problems

Osteoporosis is a decrease in total bone density.

Normally bone mass increases up to the third
decade of life. After age 30, bone loss begins.
Women experience a rapid decline in bone mass at
menopause. Genetics, body frame, menopausal
status, and chronic disease can contribute to
osteoporosis. Smoking, low calcium, low vitamin D
intake, excess alcohol issues, and sedentary lifestyle
increase the risk, as well.
 Trauma
Trauma can affect bones, ligaments, muscles, and joints.
Fractures: breaks in the bone
s/s loss of function, tenderness at site, and swelling of
surrounding tissues, deformity of the area
Sprains and strains: more common than fractures
A sprain is a stretch injury of a ligament that causes the
ligament to tear.
A strain is an injury to muscle caused by excessive stress on the
muscle.

Most of the time, MRI or Xray are needed to determine whether there’s a
fracture or sprain.
 Disorders Affecting Mobility and Exercise

Cerebrovascular accident, spinal cord injury,

multiple sclerosis and other disorders affect
mobility.

Respiratory disorders, circulatory disorders, and

fatigue affect mobility and exercise.
 TERMS
Clonus – spasmodic
Atrophy – decrease in Hypertrophy- increase
contraction of opposing
the size of muscle in the size of muscle of
muscles resulting in
tissue due to lack of use organ
tremorous movement

Flaccidity – decrease or Hemiplegia – paralysis Paraplegia- paralysis in

absence in muscle tone on one side lower half of body

Spasticity – motor
Quadriplegia – paralysis Paresis – partial or disorder characterized
in all four extremities incomplete paralysis by increased muscle
tone
 Problem: Immobility

Prolonged immobility causes physiological changes in almost every body system, as well
as psychological changes.
Focused Nursing History and Assessment: Assess current activity level, any
musculoskeletal issues, congenital issues, history of sprains/fractures, weight issues, and
ability to perform ADL’s. Ask about use of assistive devices at home, home health
services, stairs, and living arrangements. Check body alignment, muscle strength, and
activity tolerance. Assess ROM, shoulder and hips level, toes forward, gait, posture,
spine, ability to stand and sit.
Crepitus is a grating sensation when the joint is moved. It can often be heard as well as
felt. Crepitus is associated with degenerative joint disease.
Gait is the way someone walks. For example, elderly people may shuffle because they’re
scared of falling. Pregnant women may waddle. Someone who uses a cane would have
an “unsteady gait.”
 Nursing Diagnosis

Activity Intolerance is a state in which a patient has insufficient physical or

psychological energy to carry out daily activities.
Impaired Physical Mobility is limitation of independent purposeful movement of
the body. This is a broad and general diagnosis. A more appropriate diagnosis may
be Impaired Walking, or Impaired Transferring.
Risk for Disuse Syndrome exist when a patients inactivity creates the risk for
deterioration of other body systems.
Risk for Injury r/t Unsteady Gait
 Planning and Intervention

• Work on energy conservation, building endurance, sleep patterns, ambulation, if

possible, coordinated movement, and self initiated body positioning.
• If appropriate, teach about medications for pain. Ask if specific movements
increase pain, ask about intensity, and frequency of pain.
• Promote Exercise – ask about barriers to exercise and discuss ways to overcome
those barriers
• Teach Stress Relief
• Assess caregivers abilities and needs. Assess resources. Assess the home
environment. Remember, we are planning our patients discharge needs
beginning at admission.
 Positioning Patients
Patients should be repositioned at least every 2 hours.
Avoid manual lifting as much as possible. Use assistive
equipment and devices, when possible.
Use pillows, trapeze bars, boots, and other assistive
devices to help position the patient.
When would you use Fowler’s?
Semi Fowlers – 30 degree head tilt
High Fowlers – 90 degree head tilt
What about Trendelenberg?
Prone?
 Transferring Out of Bed

Transfer Boards – wood or plastic device –

could be used with amputees or after a
stroke when one side is stronger than the
other
Mechanical Lifts – hydraulic device used
with a sling to move patients. Ideal for
assisting to a chair. Many lifts include scales.
Transfer Belts (gait belts) - heavy belts
placed around the abdomen when patients
are able to ambulate or pivot to a chair
 Assisting with Ambulation

Patients who have been in bed more than a week have sustained major injury and
will require conditioning before resuming walking.
Patients can perform isometric exercises in bed to prepare them for walking.
Arm exercises can be performed in bed.
Dangling allows patient to sit upright with limited risk of falling.
Avoid orthostatic hypotension by applying compression socks, abdominal binders,
and giving certain medications can help.
If the patient begins to fall, do not attempt to hold them up alone. Guide them
to a seated or lying position. Create a wide base, and slide patient down closest
leg to them. Protect their head and call for help.
 Range of Motion at the Joints

Range of motion (ROM) is the maximum movement possible at a joint.

Active ROM– movement can be performed by the individual
Passive ROM– involves moving the joints throuth their ROM when the patient is
unable to do so for themselves.
Flexion – flex at joints
Extension – flex in reverse of flexion
Abduction – moving limb AWAY from the body
Adduction – bringing the limb CLOSER to the body
Rotation – rotate the joint circular motion
 Performing ROM
• ROM
 Other Conditions Associated with Impaired
Nutrition
Muscle strength and atrophy occur quickly. Joints to become stiff.
Edema occurs due to fluid pooling.
Risk for blood clots increase.
Pooled secretions increase risk for pneumonia.
Shallow breathing associated with decreased chest wall expansion increase risk
for pneumonia.
Peristalsis occurs, leading to constipation and gas.
Urine becomes stagnant and increases risk of infection.
Moodiness, depression, anxiety, and poor body concept occurs.
 ALWAYS PROTECT YOUR BACK

1 2 3 4
Do not lift Avoid slippery Remove Lock wheels of
alone. Use or wet surfaces obstructions, furniture and
resources. during such as bedside equipment
ambulation or commodes and before moving
when moving chairs. patients.
patients.