ACTIVITY AND EXERCISE

Anthony P. Olalia Jr.

 Hippocrates
“all parts of the body… if used in moderation…
become thereby healthy, well developed and
age more slowly, but if unused and left idle,
they become liable to disease, defective in
growth, and age quickly”
 Definition of terms
Activity- Exercise pattern
• Person’s routine of exercise, activity, leisure and
recreation
It includes
a. ADLs that require energy expenditure
b. Type quality quantity of exercise
Mobility
• Ability to move freely, easily, rhythmically and
purposefully in the environment
 Normal movement and stability
Requires
- Intact muskuloskeletal system
- Intact nervous system
- Intact inner ear structure (equilibrium)
4 basic elements
- Alignment and posture
- Joint mobility
- Balance
- Coordinated movement
 Alignment and posture
• Balance is achieved when a persons line of
gravity (line drawn through the body’s center
of gravity) passes through the center of
gravity (point at which all of body’s mass is
centered) and the base of support
(foundation on which the body rests)
 Joint Mobility
Joints – functional units of the muskuloskeletal system
Muscles attached to joints are called
- Flexors
- Extensors
- Internal rotators
- Etc
- Flexors (strongest – inactivity = flexion of extremity)
– if not corrected muscles may permanently shorten
and the joint fixed in a flexed position (contractures)
 TYPES OF JOINT MOVEMENT
• Flexion
• Extension
• Hyperextension
• Abduction
• Adduction
• Rotation
• Circumduction
• Eversion
• Inversion
• Pronation
• supination
 Range of motion
• Is the maximum movement possible for a joint
 BALANCE
• Proprioception – describes awareness of posture,
movement and changes in equilibrium
• Labyrinth – equilibrium
- Cochlea - H
- Vestibule – E (vestibular apparatus)
- Semicircular canals – E (vestibular apparatus)
= with equilibrium receptors (sensory hair cells) –
brain stem - initiate reflexes to make required
changes in position
 Coordinated Movement
• Result of proper functioning of
- Cerebral cortex – initiates voluntary motor
activity
- Cerebellum – coordinates motor acivities
- Basal ganglia – maintain posture
 EXERCISE
• Physical activity – bodily movement produced by
skeletal muscle contraction that increases energy
expenditure
• Exercise – planned, structured and repetitive bodily
movement
• Activity tolerance – type and amount of activity an
individual is able to perform without experiencing
adverse effects
• Functional strength – ability of the body to perform
work
 TYPES OF EXERCISE
Classified according to the type of muscle
contraction
• ISOTONIC
• ISOMETRIC
• ISOKINETIC
• Isometric Exercise
– Muscle contraction without joint movement
– Muscle length remains constant
– Exerting pressure against solid object
– Indications: Muscle toning and strengthening when joint
use is restricted
• Strengthen abdominal, gluteal, and quadriceps muscles
• Toning of immobilized muscles in casts or traction
• Endurance training
- Blood flow to other parts of the body not improved
• Isotonic Exercise
– Constant muscle resistance applied to joint range
of motion (e.g. jogging, swimming, walking)
– Muscle shortens to produce muscular contraction
and active movement
– Example: using a trapeze, weight lifting
– Indications: general muscle conditioning (tone,
mass, strength, joint flexibility and circulation)
• Isokinetic (resistive) Exercise
– Variable resistance with fixed speed
– Can be isotonic or isometric but against a
resistance
• Eccentric Exercises
– Muscle lengthens while it contracts
– Example: Triceps lengthens during elbow extension
• Core Muscle Exercises
– Muscle strengthening of the low back and abdomen
– Examples: Pilates, Medicine Ball, Sit-Up
• Variable resistance throughout Range of Motion
– Maximum overload training with cams and pulleys
• Plyometrics
– Eccentric loading with concentric muscle action
– Trained with Hops, bounds, and depth jumps
 AEROBIC
• Amount of oxygen taken is greater than that used to perform
the activity
• You'll breathe faster and more deeply. = This maximizes the
amount of oxygen in your blood.
• Your heart will beat faster, = which increases blood flow to
your muscles and back to your lungs.
• Your small blood vessels (capillaries) will widen = to deliver
more oxygen to your muscles and carry away waste products,
such as carbon dioxide and lactic acid.
• Your body will even release endorphins, natural painkillers
that promote an increased sense of well-being
Keep excess pounds at bay Combined with a healthy diet, aerobic exercise helps you lose weight — and
keep it off.
Increase your stamina Aerobic exercise may make you tired in the short term. But over the long term, you'll
enjoy increased stamina and reduced fatigue.
Ward off viral illnesses Aerobic exercise activates your immune system. This leaves you less susceptible to
minor viral illnesses, such as colds and flu.
Reduce your health risks Aerobic exercise reduces the risk of many conditions, including obesity, heart
disease, high blood pressure, type 2 diabetes, stroke and certain types of cancer. Weight-bearing aerobic
exercises, such as walking, reduce the risk of osteoporosis.
Manage chronic conditions Aerobic exercise helps lower high blood pressure and control blood sugar. If
you've had a heart attack, aerobic exercise helps prevent subsequent attacks.
Strengthen your heart A stronger heart doesn't need to beat as fast. A stronger heart also pumps blood
more efficiently, which improves blood flow to all parts of your body.
Keep your arteries clear Aerobic exercise boosts your high-density lipoprotein (HDL or "good") cholesterol
and lowers your low-density lipoprotein (LDL or "bad") cholesterol. The potential result? Less buildup of
plaques in your arteries.
Boost your mood Aerobic exercise can ease the gloominess of depression, reduce the tension associated
with anxiety and promote relaxation.
Stay active and independent as you age Aerobic exercise keeps your muscles strong, which can help you
maintain mobility as you get older. Aerobic exercise also keeps your mind sharp. At least 30 minutes of
aerobic exercise three days a week seems to reduce cognitive decline in older adults.
Live longer Studies show that people who participate in regular aerobic exercise live longer than those who
don't exercise regularly.
 AEROBIC
• Intensity of exercise can be measured by
1.Target heart rate
Determine maximum heart rate = 220-current age
Take 60-85 % of the maximum 119-169
2. Talk test
Labored breathing but still able to talk
3. Borg scale of perceived exertion
Person rates the hardness of the exercise from 1-20
Ideal aerobic exercise is 13 “somewhat hard”
 UNAEROBIC
• absence of oxygen
• These exercises are fueled by the energy in your
muscles
• Weight lifting is the best example of anaerobic
exercises
• One of the greatest benefits of weight lifting is
that as you build more muscle, you'll burn more
fat - even at rest! Muscles burn more calories per
unit volume than any other tissue in your body
• Strengthens Bones By properly performing your anaerobic exercises, you will increase the density and weight of your bones
more than you can with any other type of exercises. While osteoporosis may not be a concern for you now, taking care of
your body with the right anaerobic exercises can pay huge dividends for you and your body down the road. 
• Hardens JointsIt is a very simple rule: build muscle to protect joints. An example of this rule is found when you do squats.
Squats are an exercise that “hardens” the knee joint and this happens by building bigger ligaments and muscles. By
hardening your joints through anaerobic exercise, you are giving your body an edge against potential injuries.
• Increases Your Energy In order to understand how anaerobic exercise can boost your energy levels, just remember this:
muscles store glycogen (sugar) and this energy is called into action when you are performing physically challenging
exercises. When you perform your anaerobic exercises, you increase muscle size and ultimately your ability to store energy.
Building bigger muscles is the natural way to increase your energy and be healthy in the process.
• Increases Sports Performance Suppose you're a tennis fanatic. Chances are you are always looking for ways to improve your
serve and ground strokes. Anaerobic exercises, by working on the strength of the muscle groups in your shoulder, for
instance, can have a dramatic impact on your serve and hitting. The same is true for virtually all sports: anaerobic exercises
help build muscles that will ultimately help improve your game.
• Lowers Blood Sugar The primary destination for the sugar (glycogen) we consume is the muscle. For people already with an
active lifestyle (and who perform anaerobic exercises weekly! -hint, hint), this sugar is either burned immediately or simply
stored for future use as fuel. If you are a couch potato or have a less-active lifestyle, then this sugar is turned to fat.
Furthermore, insulin, the hormone that regulates blood sugar, does not work as well for inactive individuals. The result may
be an increase in blood sugar levels. Anaerobic exercise is vital to maintaining healthy and steady blood sugar levels. 
• Recaptures Youth After we hit 40, the body can lose upwards of six pounds of muscle every ten years. Turn back the clock by
acquiring and maintaining the same muscle mass you had in your early twenties. Anaerobic exercises will help you build
back this muscle and increase your energy level and overall health in the process!
• Improves Your Appearance There is no better solution for the slouch-shouldered, bent-over look of middle age than an
increase in muscle mass. If you're tired of "looking your age," anaerobic exercises can go a long way to help make you look
younger and stronger! 
• Gives You Some Control of Your Life The ability to control how you look and feel is a wonderful thing that should not be
taken for granted. Anaerobic exercise is a great way to gain strength and feel better about yourself and your self-discipline.
The results are gratifying and are due to you—and you alone! You are the master of your own destiny with anaerobic
exercises.
As you can see, the benefits of anaerobic exercise are numerous so don't neglect them as you put together your fitness
program!
EFFECTS OF IMMOBILITY
musculoskeletal System
• Muscle atrophy. Disuse leads to decreased muscle
size, tone, and strength.
• Contracture. Decreased joint movement leads to
permanent shortening of muscle tissue, resistant to
stretching. The strong flexor muscles pull tight,
causing a contraction of the extremity or a
permanent position of flexion.
• Ankylosis. Consolidation and immobility of a joint in
a particular position due to contracture.
• Osteoporosis. Lack of stress on the bone causes an
increase in calcium absorption, weakening the
bone.
Cardiovascular System.
• Venous stasis caused by prolonged inactivity that restricts or slows venous
circulation. Muscular activity, especially in the legs, helps move blood toward
the central circulatory system.
• Thrombus and embolus formation caused by slow flowing blood, which may
begin clotting within hours, and an increased rate in the coagulation of blood.
During periods of immobility, calcium leaves bones and enters the blood,
where it has an influence on blood coagulation.
• Increased cardiac workload due to increased viscosity from dehydration and
decreased venous return. The heart works more when the body is resting,
probably because there is less resistance offered by the blood vessels and
because there is a change in the distribution of blood in the immobile person.
The result is that the heart rate, cardiac output, and stroke volume increase.
• Orthostatic hypotension probably due to a decrease in the neurovascular
reflexes, which normally causes vasoconstriction, and to a loss of muscle
tone. The result is that blood pools and does not squeeze from veins in the
lower part of the body to the central circulatory system. The immobile person
is more susceptible to developing orthostatic hypotension. The person tends
to feel weak and faint when the condition occurs
Respiratory System
• Hypostatic pneumonia. The depth and rate of respirations and the
movement of secretions in the respiratory tract is decreased when a
person is immobile. The pooling secretions and congestion predispose
to respiratory tract infections. Signs and symptoms include:
 Increased temperature.
 Thick copious secretions.
 Cough.
 Increased pulse.
 Confusion, irritability, or disorientation.
 Sharp chest pain.
 Dyspnea.
• Atelectasis. When areas of lung tissue are not used over a period of
time, incomplete expansion or collapse of lung tissue may occur.
• Impaired coughing. Impairment of coughing mechanism may be due
to the patient's position in bed decreasing chest cage expansion.
•  Nervous System.
• Altered sensation caused by prolonged
pressure and continual stimulation of nerves.
Usually pain is felt at first and then sensation
is altered, and the patient no longer senses
the pain.
• Peripheral nerve palsy.
• Gastrointestinal System.
• (1) Disturbance in appetite caused by the slowing of
gastrointestinal tract, secondary immobility, and
decreased activity resulting in anorexia.
• (2) Altered digestion and utilization of nutrients
resulting in constipation.
• (3) Altered protein metabolism. f. Integumentary
System. Risk of skin breakdown, which leads to
necrosis and ulceration of tissues, especially on bony
area
•  Urinary System.
• (1) Renal calculi (kidney stones) caused by
stagnation of urine in the renal pelvis and the
high levels of urinary calcium.
• (2) Urinary tract infections caused by urinary
stasis that favors the growth of bacteria.
• (3) Decreased bladder muscle tone resulting in
urinary retentio
• Metabolism.
• (1) Increased risk of electrolyte imbalance. An
absence of weight on the skeleton and
immobility causes protein to be broken down
faster than it is made, resulting in a negative
nitrogen balance.
• (2) Decreased metabolic rate.
• (3) Altered exchange of nutrients and gases
• (1) Decrease in self-concept and increase in sense of
powerlessness due to inability to move purposefully and
dependence on someone for assistance with simple self-care
activities.
• (2) Body image distortions (depends on diagnosis).
• (3) Decrease in sensory stimulation due to lack of activity, and
altered sleep-wake pattern.
• (4) Increased risk of depression, which may cause the patient to
become apathetic, possibly because of decreased sensory
stimulation; or the patient may exhibit altered thought processes.
• (5) Decreased social interaction
 BODY MECHANICS
• PLAY VIDEO
 HIGHLIGHTS
Body mechanics
• Describes efficient, coordinated, and safe use
of the body to move objects and carry out
activities of daily living
• Lifting, pushing, or pulling increases stress on
the musculoskeletal system
• Reduce energy requirements, fatigue and risk
for injury in the nurse’s part
• Proper Posture (the position of body parts in
relation to each other) and Body Mechanics
(using all body parts efficiently and in a careful
way) are necessary in to order to limit stress
and strain on the musculoskeletal system
 Principle
a. Use the larger and stronger muscles to perform work
(shoulders, upper arms, hip and thighs).
b. Maintain the center of gravity in the body close to
the center of the support base (feet provide a
support base for humans).
c. Keep centered within the support base the combined
center of gravity of the HealthCare worker and the
object or person to be moved (hold objects to be
moved close to you).
d. Have a support base that is the appropriate size and
shape
 RULES
Rules for proper body mechanics
A. Use stronger, larger muscles to perform tasks which require physical effort.
B. When moving a heavy object, try to push or pull it instead of lifting.
C. Maintain a wide base of support (feet approximately 12 inches apart).
D. Get help if the object feels too heavy to lift.
E. Lift in a smooth motion to prevent injury.
F. Maintain a good posture.
G. Avoid twisting the body; turn your whole body and face the area in which
you are working.
H. Bend your knees, keep your back straight, spread the feet about one foot
apart, and use your leg muscles while lifting.
I. Keep objects close to your body when lifting, moving, or carrying them.
J. Avoid unnecessary bending and reaching: raise the bed or overbed table to
your waist level.
When to use Body Mechanics
• A. At all times that you have to lift, move, or carry an
item
• 1. In everyday daily activities: for example, while
cleaning,
• carrying books to school and to class, or getting in and
out
• of a car.
• 2. In Healthcare settings: for example, while assisting a
• patient to a ch
 POSITIONING CLIENTS
• Change the clients position every two hours
considering good body alignment
• Assess skin and provide care before every
position change
 NURSING CONSIDERATIONS
• Make sure mattress is firm and level yet
supports natural body curvatures
• Ensure bed is clean and dry
• Avoid placing one body part against another
• Plan a systematic 24 hour schedule for
position changes
 SUPPORT DEVICES
• Pillows
• Mattreses
• Bed boards
• Chair beds
• Foot boot
• footboard
 FOWLERS POSITION
Semifowlers
• Semisitting
• Head and trunk raised to 45 degrees
Highfowlers
• Sitting
• Head and trunk raised to 90 degrees
- Position of choice for people with DOB and
some people with heart problem
 ORTHOPNEIC POSITION
• Client is in sitting position with an table across
the lap
• Facilitates respiration by allowing maximum
chest expansion
- Helpful for clients with difficulty exhaling
 DORSAL RECUMBENT
• Back lying
• Clients head and shoulders are slightly
elevated on a small pillow
• Not the same with dorsal or supine (body
parts not elevated by pillows)
- Provides comfort and facilitates healing
 PRONE POSITION
• Client lies on the abdomen with the head on the abdomen and
the head turned to one side
• Helps prevent flexion contractures of the hips and knees – only
position that allows full extension of hips and knee joints
• Promotes drainage from the mouth and is especially useful for
unconscious clients or those clients recovering from surgery of
the mouth or throat
• Disadvantage (lordosis ) – support abdomen with a pillow
• Not for people with problems of the cervical or lumbar spine
• Should only be used when clients back is correctly aligned,
short periods and no evidence of spinal abnormalities
 LATERAL POSITION
• Side-lying
• Person lies on one side flexing the top hip and
knee and placing this leg in front of the body
= to create breater stability
• Reduces lordosis and promotes good back
alignment
• Helps relieve pressure on the sacrum and
heels
 SIMS POSITION
• Semiprone
• Posture halfway between lateral and the
prone position
• May be used for unconscious clients – it
facilitates drainage from the mouth and
prevent aspiration of fluids