**Activity and Exercise Nursing** refers to the role of nurses in promoting, planning, and assisting with physical activity and exercise as part of patient care. This approach aims to improve or maintain a patient's physical health, mobility, and overall well-being. Nurses assess a patient’s physical condition, provide guidance on safe exercise practices, and monitor progress throughout the process. ### Key Components of Activity and Exercise Nursing: 1. **Assessment of Physical Function:** Nurses assess a patient's baseline activity level, range of motion, and overall physical health to determine appropriate activity goals. This includes considering factors such as age, chronic conditions (e.g., cardiovascular disease, diabetes), and current functional status. 2. **Exercise Prescription:** Nurses often collaborate with other healthcare providers, such as physical therapists, to create individualized exercise plans that meet the patient’s specific needs. This could involve aerobic exercise, strengthening exercises, or flexibility training, depending on the patient’s health condition. 3. **Patient Education:** Nurses educate patients about the importance of physical activity in managing their condition or promoting recovery. This includes teaching patients how to perform exercises correctly, how often to do them, and any modifications needed based on their health status. 4. **Monitoring and Support:** Nurses monitor the patient’s response to physical activity, including vital signs, signs of fatigue, pain, or discomfort. They provide encouragement and motivation while ensuring that exercise is safe and effective. 5. **Encouragement of Independence:** In some cases, nurses aim to encourage patients to become more independent in their exercise routines, especially for those with chronic conditions or recovering from surgery. Nurses may suggest home-based exercises or guide patients to exercise programs that they can follow on their own. 6. **Collaborative Care:** Nurses often work with physiotherapists, occupational therapists, and other healthcare professionals to ensure that exercise interventions align with the patient's overall treatment plan and health goals. ### Benefits of Activity and Exercise Nursing: - **Improved Mobility**: Helps patients regain strength and independence. - **Enhanced Circulation**: Boosts blood flow and reduces the risk of cardiovascular problems. - **Better Mental Health**: Regular exercise has proven benefits for mental well-being, reducing stress, anxiety, and depression. - **Prevention of Complications**: Regular physical activity helps prevent complications from conditions like diabetes, obesity, and heart disease. Overall, activity and exercise nursing is a vital aspect of holistic patient care, ensuring that patients are encouraged and supported in maintaining or improving their physical health through safe and effective physical activity.

1. Fundamentals of Nursing
Level 1
Dr Abdulaazi Baalawi
T. Ammar Alqahwee
Body mechanics

2. LEARNING OUTCOMES
At the end of this lecture students are able to:
1.Describe the four basic elements of normal movement.
2.Identify factors affecting activity level
1.Compare the effects of exercise and immobility on
body
2.Assess activity-exercise pattern, movement of joints, mobility
capabilities and limitations, muscle mass and strength, activity
tolerance, and problems related to immobility.
3.Uses safe practices when positioning, moving, lifting and
ambulating clients
4.Compare and contrast active, passive, and active-assistive
range-of-motion (ROM) exercises.
2

3. FOUR ELEMENTS FOR NORMAL
MOVEMENT
Balance
Coordinated
movement
Alignment and
posture
Joint mobility
3

4. 1
.
ALIGNMENT & POSTURE
•
•
•
•
•
• Brings body parts into a
position to:
Promotes optimal balance and
body functions
Minimizes strain on joints,
muscles, tendons or ligaments
Supports internal structures
Enhances lungs expansion
Promotes efficient circulatory,
renal and intestinal functions
4

5. 2
.
JOINT MOBILITY
• Range of motion (ROM) is the maximum and possible
movement of a joint
• ROM varies and determined by:
• Genetic makeup
• Developmental patterns
• Presence or absence of disease
• Physical activity
• Inactivity may lead to joints to flex, muscle shorten
and contracture of joint
5

6. Table 44-2 Selected Joint Movements and Example of Corresponding
Activity of Daily Living (ADL)
and

7. TABLE 44-2 (CONTINUED)
SELECTED JOINT MOVEMENTS AND
EXAMPLE OF CORRESPONDING ACTIVITY OF DAILY
LIVING (ADL)

8. Table 44-2 (continued) Selected Joint Movements and
Example of Corresponding Activity of Daily Living
(ADL)

9. Table 44-2 (continued) Selected Joint Movements and Example of
Corresponding Activity of Daily Living (ADL)

10. Table 44-2 (continued) Selected Joint Movements and
Example of Corresponding Activity of Daily Living
(ADL)

11. Table 44-2 (continued) Selected Joint Movements and
Example of Corresponding Activity of Daily Living
(ADL)

12. Table 44-2 (continued) Selected Joint Movements and Example of Corresponding Activity of Daily Living (ADL)

13. Table 44-2 (continued) Selected Joint Movements and
Example of Corresponding Activity of Daily Living
(ADL)

14. Table 44-2 (continued) Selected Joint Movements and
Example of Corresponding Activity of Daily Living
(ADL)

15. Table 44-2 (continued) Selected Joint Movements and Example of
Corresponding Activity of Daily Living (ADL)

16. Table 44-2 (continued) Selected Joint Movements and
Example of Corresponding Activity of Daily Living
(ADL)

17. Table 44-2 (continued) Selected Joint Movements and Example of Corresponding
Activity of Daily Living (ADL)

18. 3
.
BALANCE
3. Balance
Proprioception or
awareness:
Awareness of posture,
movement and changes
in equilibrium and the
knowledge of position,
weight and resistance of
objects in relation to the
body
-vestibulo-
ocular
input
Cochlea
(hearing)
vestibule amd
semicular canal
(equilibrium
Reflex centers in
the brain stem
18

19. 4
.
COORDINATED MOVEMENT
Cerebral cortex:
Initiate voluntary motor activity
Cerebellum:
Coordinates the motor activities
of movement
Basal ganglia:
Maintain posture
19

20. 20

21. EFFECTS OF EXERCISE AND
IMMOBILITY ON
MUSCULOSKELETAL SYSTEM
21
Exercise
▪ Maintain size, shape, tone,
and strength of muscles
(including the heart muscle)
▪ Nourish joints
▪ Increase joint flexibility,
stability, and ROM
▪ Maintain bone density and
strength
Immobility
▪ Osteoporosis
▪ Atrophy
▪ Contractures
▪ Stiffness and pain in the
joints

22. EFFECTS OF EXERCISE AND
IMMOBILITY ON
CARDIOVASCULAR SYSTEM
22
Exercise
▪ Increases HR
▪ Strength of contraction, and
blood supply to the heart
and muscles
▪ Mediates harmful effects of
stress
Immobility
▪ Diminished cardiac reserve
▪ Increased use of the
Valsalva maneuver
▪ Orthostatic
hypotension
▪ Venous vasodilation and
stasis
▪ Dependent edema
▪ Thrombus formation

23. EFFECTS OF EXERCISE AND
IMMOBILITY ON
RESPIRATORY SYSTEM
23
Exercise
▪ Increase ventilation and
oxygen intake improving gas
exchange
▪ Prevents pooling of
secretions in the bronchi
and bronchioles
Immobility
▪ Decreased respiratory
movement
▪ Pooling of respiratory
secretions
▪ Atelectasis
▪ Hypostatic
pneumonia

24. EFFECTS OF EXERCISE AND
IMMOBILITY ON
METABOLIC SYSTEM
24
Exercise
▪ Elevates the metabolic rate
▪ Decreases serum
triglycerides and cholesterol
▪ Stabilizes blood sugar and
make cells more responsive
to insulin
Immobility
▪ Decreased metabolic rate
▪ Negative nitrogen balance
▪ Anorexia
▪ Negative calcium balance

25. EFFECTS OF EXERCISE AND
IMMOBILITY ON
URINARY SYSTEM
25
Exercise
▪ Promotes blood flow to the
kidneys causing body
wastes to be excreted more
effectively
▪ Prevents stasis (stagnation)
of urine in the bladder
Immobility
▪ Urinary stasis
▪ Renal calculi
▪ Urinary retention
▪ Urinary infection

26. EFFECTS OF EXERCISE AND
IMMOBILITY ON
GASTROINTESTINE (GI)SYSTEM
26
Exercise
▪ Improves the appetite
▪ Increases GI tract tone
▪ Facilitates peristalsis
Immobility
▪ Constipation

27. EFFECTS OF EXERCISE AND
IMMOBILITY ON
METABOLIC/ENDOCRINE
SYSTEM
27
Exercise
▪ Elevates metabolic rate
▪ Helps reduce serum
triglycerides and
cholesterol
▪ Stabilizes blood sugar and
makes cells more
responsive to insulin
Immobility
• Increase blood glucose

28. EFFECTS OF EXERCISE AND
IMMOBILITY ON IMMUNE
SYSTEM
28
Exercise
▪ Pumps lymph fluid from
tissues into lymph
capillaries and vessels
▪ Increases circulation
through lymph nodes
Immobility
• Reduce immune function

29. EFFECTS OF EXERCISE AND
IMMOBILITY ON PSYCH-
NEUROLOGIC SYSTEM
29
Exercise
▪ Elevates mood
▪ Relieves stress and
anxiety
▪ Develops relaxation
response (RR)
▪ Improves quality of sleep
for most individuals
Immobility
•
•
•
•
Depression
Anxiety
Forgetfulness
Confusion

30. EFFECTS OF EXERCISE AND
IMMOBILITY ON
INTEGUMENTARY SYSTEM
30
Exercise
▪ Maintain skin elasticity
▪ Improve circulation and
nutrition supply
Immobility
•
•
Reduced skin turgor
Skin breakdown

31. 31

32. 32

33. 33

34. 34

35. 35

36. 36

37. NURSING DIAGNOSES
37
• Activity and exercise problems:
▪ Activity Intolerance
▪ Risk for Activity Intolerance
▪ Impaired Physical Mobility
▪ Sedentary Lifestyle
▪ Risk for Falls

38. PLANNING:
GOALS
• The client will have:
– Increased tolerance for physical activity
– Restored or improved capability to ambulate
and/or participate in ADLs
– Absence of injury from falling or improper
use of body mechanics
– Enhance physical fitness
– Absence of any complications associated with
immobility
38

39. PLANNING:
INTERVENTION
39
• Activity tolerance
• Body positioning,
transferring and
ambulating
• Joint movement
• Mobility
• Fall prevention
behavior

40. IMPLEMENTATION
40
✓Maintain or
promote body
alignment
and mobility
✓Position client
appropriately
✓Move and turn
client in bed
✓Transfer client

41. IMPLEMENTATION
• Provide ROM
exercises
• Ambulate client
with or without
mechanical
aids
• Prevent
complications
of
immobility
41

42. BODY
MECHANIC
42
▪ Efficient, coordinated,
and safe use of the
body to move objects
and carry out ADLs
▪ Follow
▪ "no manual lift"
▪ "no solo lift"
Healthcare
workers work
hazard
“low back
pain”

43. BODY MECHANIC
43
• Using body
mechanics
▪ Body balance can be
greatly enhanced by:
• Lowering the center
of gravity, bringing
load closer to the
base of support
• Widening the base
of support

44. 44

45. BODY MECHANICS
Balance Balance is precious Not Balance
The closer the line of gravity to the center of the base of support, the greater the
person’s stability
The broader the base of support and the lower the center of gravity, the greater
the stability and balance
45

46. IMPLEMENTATION
• Use body mechanics for:
▪ Lifting
▪ Pulling and pushing
▪ Pivoting
46

47. IMPLEMENTATION
47
Use body mechanics for Lifting
✓ No more than 16kg /35lb
without assistance
✓ Weight of lifted item becomes
part of body weight, so center
of balance shifts to
counterbalance the load.
✓ Hold weight close to center of
gravity
✓ Use levers when possible
(fulcrum or pivot point)

48. IMPLEMENTATION
48
Using body mechanics
for:
•
•
•
•
pushing
Rock from back leg to
front leg when
pushing
Pulling
Rock from front leg to
back leg when
pulling

49. IMPLEMENTATION
• Using body mechanics
for Pivoting
• Turn without twisting
spine
• Weight on balls of
feet
• Keep body aligned
when turning about
90 degrees in desired
direction 49

50. IMPLEMENTATION
50
Positioning
clients
▪ Provide good
alignment when
positioning
▪ Turning clients
systematically
(q 2 hr) is good
nursing
practice.
Rationale:
•Ensure comfort and
safety
•Firm mattress with
adequate support
•Clean, dry linens
•Support devices within
client's reach
•Prevent bony
prominences from
resting on each other
•24-hour schedule for
position changes
•Obtain client input
about preferred position

51. IMPLEMENTATION
51
• Positioning clients
– Orthopneic position
Patient sits either in
bed or side of the
bed with over bed
table across the lab.
Purposes to:
Facilitate respiration
by allowing
maximum chest
expansion

52. IMPLEMENTATION
52
Positioning
clients
•Dorsal recumbent
position
(supported).
•
•
Back-lying
patient’s head and
shoulder slightly elevated
on small pillow
Purposes to:
•
•
provide comfort
facilitate healing
following certain surgery
or anesthetics

53. IMPLEMENTATION
53
– Fowler's position
• 45°–60°
• Semi-Fowler's
– 15°–45°
• High Fowler's
– 60°–90°
For patient:
•difficulty in
breathing
•heart
problems
Purpose
To allow:
•greater chest
expansion
•lung
ventilation
Pillow:
to
prevent
hypere
xtensio
n of
neck

54. IMPLEMENTATION
Positioning clients
•Prone position
•
•
•
Lies on abdomen
Head turned one side
Hip not flex
Purposes to:
•
•
Prevent flexion
contractures of hip
and knee
Promote drainage
from mouth
54

55. IMPLEMENTATION
Positioning clients
•Lateral position
(supported).
•
•
• Side lying- on one side
of the body
Head turned one side
Flexing the top hip and
knee
Purposes to:
• Promote good back
alignment
• For resting &
sleeping
• Relieve pressure on
sacrum and heel
55

56. IMPLEMENTATION
Positioning
clients
•Sims’ position
(supported).
• Semi prone
• Between lateral and prone
• Lower arm behind and upper
arm flex at shoulder and elbow
• Both legs flex in front but upper
is more
Purposes to:
•
•
•
Prevent aspiration of fluids
Relieve pressure on sacrum and
greater trochanter
Facilitate perineal exam/
treatment.
56

57. IMPLEMENTING
• Moving and turning clients
in bed
– Before moving, assess client
– If indicated, use pain relief
modalities
– Prepare any needed assistive
devices
– Plan around encumbrances (e.g.,
IV pole)
– Be alert to effects of any
medications
– Obtain required
assistance
57

58. IMPLEMENTING
• Moving and turning clients
in bed
– Explain procedure to the
client
– Raise height of the bed
– Lock wheels
– Face the direction of
movement
– Assume a broad
stance
58

59. IMPLEMENTING
g
g
• Moving and turning clients in
bed
– Lean your trunk forward, flex
your hips, knees, and ankles
– Tighten your muscles
– Rock from front leg to back le
when pulling client
– Rock from back leg to front le
when pushing client
59

60. IMPLEMENTING
60
• Moving and turning
clients in bed
– Determine and
document
• Client's comfort
• Body alignment
• Tolerance of the
activity
• Ability to assist
• Use of support
devices
• Safety precautions
required

61. IMPLEMENTATION
61
Guidelines for transferring a client:
•Plan what to do and how to do it
•Obtain essential equipment before starting
•Remove obstacles
•Explain transfer to client and assistive personnel
•Support or hold client rather than equipment
•Explain what client should do

62. IMPLEMENTATION
62
• Transferring Between Bed and Chair:
Using a gait/transfer belt.

63. IMPLEMENTATION
63
• Transferring Between Bed and Chair: Using a
slide board.

64. IMPLEMENTATION
64
• Assisting a Client to Ambulate: Using a gait/transfer
belt to support the client.

65. IMPLEMENTATION
65
• Assisting a Client to Ambulate: Lowering a fainting
client to the floor

66. IMPLEMENTATION
66
• Figure 44-67 The standing position for
measuring the correct length for crutches.

67. IMPLEMENTATION
67
Transferring Between Bed and Stretcher:
A lateral transfer board

68. IMPLEMENTATION
68
Providing ROM exercises
•Active:
▪ Moves each joint in the body
▪ Maximally stretching all muscle groups
•Passive:
▪ Another person moves each joint
▪ Maximally stretching all muscle groups
▪ Useful in maintaining joint flexibility

69. IMPLEMENTATION
Providing ROM exercises
• Passive ROM exercises
• Another person moves each joint
• Maximally stretches all muscle groups
• Useful in maintaining joint flexibility
69

70. IMPLEMENTING
70
• Guidelines to provide passive ROM
•
•
•
•
•
•
•
•
Expose only the limb being exercised
Support clients limb above and below the joint
If contractures are present, apply slow firm pressure
If rigidity occurs, press against rigidity
Use a firm comfortable grip
Move body parts smoothly, slowly, and rhythmically
Avoid moving or forcing body part beyond the existing
range of motion
If muscle spasticity occurs, stop

71. FIGURE 44-58
SUPPORTING A LIMB
ABOVE AND BELOW THE JOINT FOR
PASSIVE EXERCISE
.
71

72. FIGURE 44–59
HOLDING LIMBS
FOR SUPPORT DURING PASSIVE
EXERCISE: A, CUPPING; B, CRADLING
.
72

73. EVALUATION
73
• Evaluate established goals
• Achieved
• Not develop any compromised muscle
function
• If not achieved
• Explore the reasons.

74. SUMMARY
• Four elements that regulate body movement. Factors
affecting activity level
• The effects of exercise on body systems Assess
activity-exercise pattern
• Uses safe practices when positioning, moving, lifting and
ambulating clients
• Compare and contrast active, passive, and active- assistive
range-of-motion (ROM) exercises
•
•
•
•
•
•
74