Unit 10:

Activity & Exercise

ASHA RUSSEL
ASST. SCIENCE TUTOR ‘A’
 Objectives
1. Describe the four basic elements of normal movement.
2. Differentiate isotonic, isometric, isokinetic, aerobic and
anaerobic exercise.
3. Identify factors influencing a person body alignment and
activity.
4. Compare the effects of exercise and immobility on body
system.
5. Discuss the components of mobility assessment.
6. Specify nursing strategies to maintain or promote body
alignment and mobility. (Self -Learning)
7. Describe various positions used to ensure proper
alignment and promote client comfort and safety.
 Activity – Exercise Pattern
• It refers to a person’s routine of exercise, activity,
leisure and recreation.

• It includes:
a) ADLs that require energy expenditure
b) The type, quality and quantity of exercise,
including sports.
 Objective 1
Describe the four basic elements of normal movement
 Four Basic Elements of Normal Movement
• Normal movement & stability are the result of an
intact musculoskeletal system, nervous system and
inner ear structures responsible for equilibrium.

• It involves 4 basic elements:

1. Body alignment (Posture)

2. Joint mobility

3. Balance

4. Coordinated movement
 1. Body Alignment/Posture

• Brings body parts into position

that promotes optimal balance
and maximal body function.

• A person maintains balance as

long as line of gravity passes
through center of gravity and
base of support.
 Advantages of Well-Aligned Body
1. Strain on the joints, muscles,
tendons or ligaments are
minimized

2. Internal structures & organs are

supported

3. Enhances lung expansion &

4. Promotes efficient circulatory,

renal & GI functions.
 Posture
• A person’s posture is one criterion for assessing (1)
general health, (2) physical fitness & (3) attractiveness.

• Posture reflects the (1) mood, (2) self-esteem & (3)

personality of an individual & vice versa.

• The extensor muscles, often referred to as the

antigravity muscles, carry the major load.
 2. Joint Mobility
• Joints are the functional units of the musculoskeletal
system.

• ROM of a joint is the maximum movement that is

possible for that joint.

• ROM varies and determined by:

Genetic makeup
Developmental patterns
Presence or absence of disease
Amount of physical activity in which the person normally
engages.
Types of Joint Movements
Table 1, Pg. No: 1144
 3. Balance
• Requires input from inner ear, vision and stretch
receptors of muscles & tendons.

• Sense of balance is called equilibrium.

• Proprioception: Term used to describe awareness of

posture, movement, and changes in equilibrium and
the knowledge of position, weight, and resistance of
objects in relation to the body.
 4. Coordinated Movement
• Is balanced, smooth & purposeful movement

• Is the result of proper functioning of:

Cerebral cortex
Initiates voluntary motor activity
Cerebellum
Coordinates motor activities of movement
Basal ganglia
Maintains posture
 Objective 2
Differentiate isotonic, isometric, isokinetic, aerobic
and anaerobic exercise
 Exercise
• Is a type of physical activity defined as a planned,
structured and repetitive bodily movement performed to
improve health & maintain fitness to achieve an optimal
state of health.
- U.S Department of Health & Human Services (2008)
 Types of Exercise
• Exercise involves the active contraction and relaxation of
muscles.

• Can be classified according to the:

1. Type of muscle contraction (isotonic, isometric or isokinetic)
2. Source of energy (aerobic or anaerobic)
 Isotonic (Dynamic) Exercises
• Are those in which the muscle shortens to produce muscle
contraction and active movement.

• Increases muscle tone, mass, and strength.

• Maintains joint flexibility and circulation.

• Both HR and CO quicken to increase blood flow to all parts

of the body.
 Isotonic (Dynamic) Exercises - Examples
1. Physical Conditioning Exercises:
 Isotonic (Dynamic) Exercises - Examples
2. ADLs:
 Isotonic (Dynamic) Exercises - Examples
3. Active ROM Exercises:
 Isotonic (Dynamic) Exercises - Examples
4. Isotonic Bed Exercises:
 Isometric (Static or Setting) Exercises
• Are those in which there is muscle contraction without moving
the joint (muscle length does not change).

• Involves exerting pressure against a solid object.

• Useful for:
Strengthening abdominal, gluteal and quadriceps muscles used in
ambulation.
Maintaining strength in immobilized muscles in casts or traction.
Endurance training.
 Isometric (Static or Setting) Exercises

• Produce a mild increase in

HR and CO

• No apparent increase in
blood flow to other parts of
the body
 Isokinetic (Resistive) Exercises
• Involve muscle contraction or tension against resistance.

• Can either be isotonic or isometric.

• Person moves (isotonic) or tenses (isometric) against

resistance.

• Special machines or devices provide resistance to the

movement.
 Isokinetic (Resistive) Exercises

• Are used in physical conditioning

& are often done to build up
certain muscle groups.

• An increase in blood pressure and

blood flow to muscles occurs
 Aerobic Exercises
• Activity during which the amount of oxygen taken in the
body is greater than that used to perform the activity.

• They use large muscle groups that move repetitively.

• Improve cardiovascular conditioning and physical fitness.

 Anaerobic Exercises
• Activity in which the muscles cannot draw enough
oxygen from the bloodstream.

• Anaerobic pathways are used to provide additional

energy for a short time.

• Used in endurance training for athletes.

 Objective 3
Identify Factors Influencing a Person’s Body
Alignment & Activity
 Factors Affecting Body Alignment, Mobility,
and DAL
1. Growth and development

2. Nutrition

3. Personal values and attitudes

4. External factors
i.e., Temperature, humidity, availability of recreational facilities,
safety of the neighborhood

5. Prescribed limitations
i.e., Casts, braces, traction, activity restrictions including bed rest
 1. Growth and Development
• A person’s (1) age, (2) musculoskeletal and (3) nervous
system development affect:
Posture
Body proportions
Body mass
Body movements
&
Reflexes
 2. Nutrition
• Both (1) undernutrition and (2) overnutrition can influence
body alignment & mobility.
 2. Nutrition
• Poorly nourished Muscle weakness & Fatigue.

• Vit.D deficiency Bone deformity during growth.

• Inadequate Calcium intake + Vit.D synthesis & intake

Increases risk of osteoporosis.

• Obesity Distort movement & stress joints

Affect posture, balance & joint health.
3. Personal Values & Attitudes
4. External Factors
 5. Prescribed Limitations

Bed Rest: (1) To relieve edema, (2) To reduce metabolic & O2

needs, (3) To promote tissue repair or (4) To decrease pain.
 Objective 4
Compare the effects of exercise & immobility
on body system
 1. Effects on Musculoskeletal System
Exercise Immobility
• Maintain size, shape, tone, and • Disuse osteoporosis.
strength of muscles (including
the heart muscle).
• Disuse atrophy.

• Nourish joints.
• Contractures.

• Increase joint flexibility,

stability, and ROM. • Stiffness and pain in the joints.

• Maintain bone density and

strength.
 2. Effects on Cardiovascular System
Exercise Immobility
• Increases HR, strength of • Diminished cardiac reserve
contraction, and blood supply
to the heart and muscles
• Increased use of the
Valsalva maneuver
• Mediates harmful effects of
stress
• Orthostatic hypotension

• Venous vasodilation and

stasis

• Dependent edema

• Thrombus formation
 3. Effects on Respiratory System
Exercise Immobility
• Increase ventilation and oxygen • Decreased respiratory
intake improving gas exchange movement

• Prevents pooling of secretions • Pooling of respiratory

in the bronchi and bronchioles secretions

• Atelectasis

• Hypostatic pneumonia
 4. Effects on Metabolic System
Exercise Immobility
• Elevates the metabolic rate • Decreased metabolic rate

• Decreases serum triglycerides • Negative nitrogen balance

and cholesterol
• Anorexia
• Stabilizes blood sugar and
make cells more responsive to
insulin • Negative calcium balance
 5. Effects on GI System
Exercise Immobility
• Improves the appetite • Constipation

• Increases GI tract tone

• Facilitates peristalsis
 6. Effects on Urinary System
Exercise Immobility
• Promotes blood flow to the • Urinary stasis
kidneys causing body wastes to
be excreted more effectively
• Renal calculi
• Prevents stasis (stagnation) of
urine in the bladder
• Urinary retention

• Urinary infection
 7. Effects on Immune System
Exercise
Advantages
• Pumps lymph fluid from tissues into lymph capillaries and vessels
• Increases circulation through lymph nodes
Disadvantage
• Strenuous exercise may reduce immune function
Leaving window of opportunity for infection during recovery phase
 8. Effects on Integumentary System
Immobility
• Reduced skin turgor

• Skin breakdown
 9. Effects on Psychoneurologic System
Exercise Immobility
• Elevates mood • Decline in mood elevating
substances
• Relieves stress and anxiety
• Perception of time intervals
deteriorates
• Improves quality of sleep for
most individuals
• Problem-solving and decision-
making abilities may
deteriorate

• Loss of control over events can

cause anxiety
 10. Effects on Cognitive Function
Exercise
• Positive effects on decision-making and problem solving processes,
planning, and paying attention.

• Induces cells in the brain to strengthen and build neuronal

connections.
 11. Effects on Spiritual Health
Exercise
• Yoga-style exercise improves the mind–body–spirit connection,
relationship with God, and physical well-being by establishing
balance in the internal and external environment.
 Objective 5
Discuss the Components of Mobility Assessment
 Assessment of Activity and Exercise
• Nursing History

• Physical Examination:
Body alignment
Gait
Appearance and movement of joints
Capabilities and limitations for movement
Muscle mass and strength
Activity tolerance
Problems related to immobility
 Nursing History
• Activity-Exercise history is usually part of the comprehensive
nursing history.

• In case of recent pattern change or difficulties with mobility,

detailed history is required.
 Nursing History
• A detailed history should include:
The specific nature of the problem
When it first began
Its frequency
Its causes if known
How the problem affects daily living
What the client is doing to cope with the problem

&
Whether these methods have been effective.
Assessment Interview
Assessment Interview
 t i o n
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 1. Body Alignment
• It includes an inspection of the client while the client stands.

• The purpose of body alignment assessment is to identify:

Normal developmental variations in posture
Posture and learning needs to maintain good posture
Factors contributing to poor posture, such as fatigue, pain,

compression fractures, or low self-esteem

Muscle weakness or other motor impairments.
 1. Body Alignment
• To assess alignment, the nurse inspects client from lateral,
anterior & posterior views.
 1. Body Alignment
• Abnormal body alignments:
 2. Gait
• The characteristic pattern of a person’s gait (walk) is assessed
to determine the client’s mobility and risk for injury due to
falling.
• Two phases of normal gait are (a)stance and (b)swing.
 2. Gait
• The nurse assesses gait as the client walks into the room or asks the
client to walk a distance of 10 feet down a hallway.

• The nurse may also assess pace (the number of steps taken per
minute), which often slows with age and disability.
 2. Gait
• A normal walking pace is 70 to 100 steps per minute.

• The pace of an older person may slow to about 40 steps per minute.

• The nurse should also note the client’s need for a prosthesis or
assistive device.
 3. Appearance & Movement of Joints
• Physical examination of the joints involves:
Inspection
Palpation
Assessment of active ROM
Assessment of passive ROM
 3. Appearance & Movement of Joints
• The nurse should assess the following:
Any joint swelling or redness.
Any deformity, such as a bony enlargement or contracture, and
symmetry of involvement.
The muscle development associated with each joint and the
relative size and symmetry of the muscles on each side of the
body.
Any reported or palpable tenderness.
 3. Appearance & Movement of Joints
• The nurse should assess the following:
Crepitation (palpable or audible crackling or grating sensation
produced by joint motion)
Increased temperature over the joint.
Degree of joint movement.
 3. Appearance & Movement of Joints
• Assessment of ROM performed by moving joints smoothly, slowly,
and rhythmically.

• No joint should be forced.

 4. Capabilities and Limitations for Movement
• The nurse needs to obtain data that may indicate hindrances or
restrictions to the client’s movement.
How the client’s illness influences the ability to move and
whether the client’s health contraindicates any exertion, position,
or movement.
Encumbrances to movement.
Mental alertness and ability to follow directions.
Balance and coordination.
 4. Capabilities and Limitations for Movement
• The nurse needs to obtain data that may indicate hindrances or
restrictions to the client’s movement.
Presence of orthostatic hypotension before transfers.
Degree of comfort.
Vision.
 4. Capabilities and Limitations for Movement
• The nurse also assesses the amount of assistance the client requires
for the following:
Moving in the bed.
Rising from a lying position to a sitting position on the edge of
the bed.
Rising from a chair to a standing position.
Coordination and balance.
 5. Muscle Mass and Strength
• Before the client attempts to ambulate or change position, it is
essential for the nurse to assess the client’s strength and ability to
move.

• Providing appropriate assistance lowers the risk of muscle strain and

body injury to both the client and nurse.

• Assessment of upper extremity strength is especially important for

clients who use ambulation aids, such as walkers and crutches.
 6. Activity Tolerance
• By determining an appropriate activity level for a client, the nurse
can predict whether the client has the strength and endurance to
participate in activities that require similar expenditures of energy.

• The most useful measures in predicting activity tolerance are:

Heart rate, strength, and rhythm
Respiratory rate, depth, and rhythm &
Blood pressure.
 6. Activity Tolerance
• These data are obtained at the following times:
Before the activity starts (baseline data), while the client is at rest
During the activity
Immediately after the activity stops
Three minutes after the activity has stopped and the client has
rested.
 6. Activity Tolerance
• The activity should be stopped immediately in the event of any
physiological change indicating the activity is too strenuous or
prolonged for the client.

• These changes include the following:

Sudden facial pallor
Feelings of dizziness or weakness
Change in level of consciousness
 6. Activity Tolerance
• These changes include the following (cont.…):
Heart rate or respiratory rate that significantly exceeds baseline
or pre-established levels
Change in heart or respiratory rhythm from regular to irregular
Weakening of the pulse
Dyspnea, shortness of breath, or chest pain
Diastolic blood pressure change of 10 mmHg or more.
 6. Activity Tolerance
• If, however, the client tolerates the activity well, and if the client’s
heart rate returns to baseline levels within 5 minutes after the
activity ceases, the activity is considered safe.

• This activity, then, can serve as a standard for predicting the client’s
tolerance for similar activities.
 7. Problems Related to Immobility
• When collecting data pertaining to the problems of immobility, the
nurse uses the assessment methods of:
Inspection
Palpation
Auscultation
Checks results of laboratory tests and
Takes measurements, including:
Body weight,
Fluid intake, and
Fluid output.
Assessing Problems of Immobility
Table 3
 7. Problems Related to Immobility
• Clients at risk for developing complications of immobility, include
those who:
a) are poorly nourished
b) have decreased sensitivity to pain, temperature, or pressure
c) have existing cardiovascular, pulmonary, or neuromuscular
problems &
d) have an altered level of consciousness.
 Objective 6
Specify Nursing Strategies to Maintain or
Promote Body Alignment and Mobility
(Self -Learning)
 Nursing strategies to maintain/promote body alignment and
mobility
• It involves:

1. Positioning clients appropriately

2. Moving and turning clients in bed
3. Transferring clients
4. Providing ROM exercises
5. Ambulating clients with or without mechanical aids &
6. Strategies to prevent the complications of immobility.
Nursing strategies to maintain/promote body alignment and
mobility
• Whenever positioning, moving & ambulating clients, nurses must
use proper body mechanics.

• Body mechanics helps to avoid musculoskeletal strain & injury.

 Body Mechanics
• Is the term used to describe the efficient, coordinated, and safe
use of the body to move objects and carry out the ADLs.
 Body Mechanics

FON Lab Course Syllabus – Pg No: 216-217

 Objective 7
Describe Various Positions Used to Ensure Proper
Alignment and Promote Client Comfort and Safety
 Positioning Clients
• When positioning clients in bed, the nurse can do a number of
things to ensure proper alignment and promote client comfort
and safety:
1. Make sure the mattress is firm and level yet has enough give to
fill in and support natural body curvatures.
2. Ensure that the bed is clean and dry.
 Positioning Clients
3. Place support devices in specified areas according to the
client’s position.

A, Suspension boot; B, heel guard

Maintaining postoperative abduction

following total hip replacement
 Positioning Clients
4. Avoid placing one body part, particularly one with bony
prominences, directly on top of another body part.

5. Plan a systematic 24-hour schedule for position changes.

6. Always obtain information from the client to determine which
position is most comfortable and appropriate.
 Client positions for correct body alignment

1. Fowlers/ semi-sitting (low/semi, high)

2. Orthopneic

3. Dorsal recumbent

4. Lateral

5. Prone

6. Sims
 1. Fowler’s/ Semi Sitting Position
• Is a bed position in which the head and trunk are raised 45⁰ to 60⁰.
 1. Fowler’s/ Semi Sitting Position
• Semi-fowler’s: Head and trunk are raised 15⁰ to 45⁰.

• Low fowler’s: Head and trunk are raised 30⁰.

 1. Fowler’s/ Semi Sitting Position
• High fowler’s: Head and trunk are raised 60⁰ to 90⁰.
 1. Fowler’s/ Semi Sitting Position
• Is the position of choice for people who have difficulty breathing
and for some people with heart problems.

• In this position, gravity pulls the diaphragm downward, allowing

greater chest expansion and lung ventilation.
 2. Orthopneic position
• Client sits either in bed or on the side of the bed with an overbed
table across lap.
 2. Orthopneic position
• Advantages:
This position facilitates respiration by allowing maximum chest
expansion.

It is particularly helpful to clients who have problems exhaling,

because they can press the lower part of the chest against the
edge of the overbed table.
 3. Dorsal Recumbent/Back-Lying Position
• Client’s head and shoulders are slightly elevated on a small pillow.

• Advantages:
Is used to provide comfort.

Is used to facilitate healing following certain surgeries or

anesthetics (e.g., spinal).
 4. Prone Position
• The client lies on the abdomen with the head turned to one side.
 4. Prone Position
Advantages:
It is the only bed position that allows full extension of the hip
and knee joints.

When used periodically, the prone position helps to prevent

flexion contractures of the hips and knees.

It also promotes drainage from the mouth and is especially

useful for unconscious clients or those clients recovering from
surgery of the mouth or throat.
 4. Prone Position
Disadvantages:
Not recommended for people with cervical or lumbar spine
problems.

This position also causes plantar flexion.

Clients with cardiac or respiratory problems find the prone

position confining and suffocating.
 4. Prone Position
Precautions:
It should be used only when the client’s back is correctly
aligned.

Used only for short periods.

Used only for people with no evidence of spinal abnormalities.

 5. Lateral/Side-Lying position
• Client lies on one side with top hip and knee flexed.
 5. Lateral/Side-Lying position
• Advantages:
It reduces lordosis and promotes good back alignment.

It helps to relieve pressure on the sacrum and heels in people

who sit for much of the day or who are confined to bed.

People who have sensory or motor deficits on one side of the

body usually find that lying on the uninvolved side is more
comfortable.
 6. Sims/Semi-prone position
• Client assumes a posture halfway between the lateral and the
prone positions.
 6. Sims/Semi-prone position
• Advantages:
Used for unconscious clients because it facilitates drainage
from the mouth and prevents aspiration of fluids.

Used for paralyzed clients because it reduces pressure over the

sacrum and greater trochanter of the hip.

Used for clients receiving enemas and for clients undergoing

examinations or treatments of the perineal area.
 6. Sims/Semi-prone position
• Advantages:
Especially pregnant women, find this position comfortable for
sleeping.

Clients with sensory or motor deficits on one side of the body

usually find that lying on the uninvolved side is more comfortable.