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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 24
Therapeutic Exercise
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Beneficial to all age groups
• Sedentary lifestyl...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Fitness: capacity to exercise
• Factors interferi...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Body composition: lean body tissue versus
fat
– D...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Vital signs: temperature, pulse rate,
respiratory...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Fitness tests objectively measure current
fitness...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Stress electrocardiogram
– Tests electrical condu...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stress Electrocardiogram
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Ambulatory electrocardiogram
– Continuous recordi...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Ambulatory electrocardiogram
– Client keeps a dia...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Step test
– Submaximal fitness test: timed steppi...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Walk-a-mile test
– Measures the time it takes a p...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•Which of the following tests
assesses ele...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
b. Stress electrocardiogram
A stress electro...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Target heart rate
– Goal for heart rate during ex...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•Is the following statement true or false?...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
Exercising at the target heart rate f...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Metabolic energy equivalent
– Fitness levels vary...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Fitness exercise: develops and maintains
cardiore...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Isotonic exercise
– Involves movement and work
– ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Isometric exercise
– Stationary exercise, usually...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•Is the following statement true or
false?...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
Isotonic exercise is activity that in...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Therapeutic exercise: activity performed by
peopl...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Range-of-motion exercises
– Therapeutic activitie...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Continuous passive motion machine
– Electrical de...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Range of Motion of the Knee With a
Continuous Passi...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Nursing diagnoses to be treated with activity
or ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Balance physical activity with rest
• Shortness o...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Families, caregivers of cognitively impaired
– En...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Swimming or exercising in water is less
stressful...
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  1. 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 24 Therapeutic Exercise
  2. 2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Beneficial to all age groups • Sedentary lifestyle is a health risk • Individualized • Nurses assess fitness level before initiating exercise program Exercise
  3. 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Fitness: capacity to exercise • Factors interfering with fitness: sedentary lifestyle, health problems, impaired musculoskeletal function, obesity, advanced age, smoking, and high blood pressure • Assessment of fitness level necessary • Assessment techniques: measuring body composition, evaluating trends in vital signs, performing fitness tests Fitness Assessment
  4. 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Fitness Assessment (cont’d)
  5. 5. 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)
  6. 6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Fitness tests objectively measure current fitness level and potential for safe exercise – Methods o Stress electrocardiogram o Ambulatory electrocardiogram o Submaximal fitness test Fitness Assessment (cont’d)
  7. 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Stress electrocardiogram – Tests electrical conduction through the heart during maximal activity – Pulse oximeter measures peripheral oxygenation o Test stopped if abnormal heart rhythm, cardiac ischemia, elevated blood pressure, or exhaustion occur Fitness Assessment (cont’d)
  8. 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Electrocardiogram
  9. 9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Fitness Assessment (cont’d)
  10. 10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Ambulatory electrocardiogram – Client keeps a diary of the time and type of activities performed – Physician compares the client’s diary with the electrocardiogram Fitness Assessment (cont’d)
  11. 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Fitness Assessment (cont’d)
  12. 12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Walk-a-mile test – Measures the time it takes a person to walk 1 mile Fitness Assessment (cont’d)
  13. 13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Which of the following tests assesses electrical conduction through the heart during maximal activity? a. Ambulatory electrocardiogram b. Stress electrocardiogram c. Step test d. Walk-a-mile test
  14. 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
  15. 15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 – Target heart rate is 60% to 90% of maximum heart rate during exercise Exercise Prescriptions
  16. 16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
  17. 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
  18. 18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Metabolic energy equivalent – Fitness levels vary: exercise prescribed by metabolic energy equivalent o Measure of energy and oxygen consumption during exercise Fitness Assessment (cont’d)
  19. 19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Fitness exercise: develops and maintains cardiorespiratory function, muscular strength, endurance – 2 categories o Isotonic o Isometric Types of Exercise
  20. 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Isotonic exercise – Involves movement and work – Increases cardiorespiratory function o Aerobic exercise o Jogging Types of Exercise (cont’d)
  21. 21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Isometric exercise – Stationary exercise, usually against resistance – Increases circulation but does NOT promote cardiorespiratory function o Weight lifting o Body building Types of Exercise (cont’d)
  22. 22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Is the following statement true or false? Isotonic exercise consists of stationary exercises generally performed against a resistive force.
  23. 23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Isotonic exercise is activity that involves movement and work. Isometric exercise consists of stationary exercises generally performed against a resistive force.
  24. 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 – Isotonic or isometric o Active exercise: performed independently by client after instruction o Passive exercise: performed by client with assistance when client is unable to move body parts Types of Exercise (cont’d)
  25. 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; stretch joints for strenuous activities; and evaluate response to therapeutic exercise program – Performed for care of inactive client Types of Exercise (cont’d)
  26. 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. 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. 28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Nursing diagnoses to be treated with activity or exercise regimen – Impaired physical mobility – Disuse syndrome – Unilateral neglect – Delayed surgical recovery – Activity intolerance Nursing Implications
  29. 29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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
  30. 30. 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)
  31. 31. 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)
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