ch. 38 ACTIVITY AND EXERCISE

Activity Tolerance

Activity tolerance is the kind and amount of exercise or activity that a person is able to perform. Assessment of activity tolerance is necessary when planning physical activity for health promotion and for patients with acute or chronic illness. This assessment provides baseline data about the patient's activity patterns and helps determine which factors (physical, psychological, or motivational) affect activity tolerance (Box 38-6).

Isometric exercises

Isometric exercises involve tightening or tensing muscles without moving body parts (isometric contraction). Examples are quadriceps set exercises and contraction of the gluteal muscles. This form of exercise is ideal for patients who do not tolerate increased activity. A patient who is immobilized in bed can perform isometric exercises. The benefits are increased muscle mass, tone, and strength, thus decreasing the potential for muscle wasting; increased circulation to the involved body part; and increased osteoblastic activity.

Isotonic exercises

Isotonic exercises cause muscle contraction and change in muscle length (isotonic contraction). Examples are walking, swimming, dance aerobics, jogging, bicycling, and moving arms and legs with light resistance. Isotonic exercises enhance circulatory and respiratory functioning; increase muscle mass, tone, and strength; and promote osteoblastic activity (activity by bone-forming cells), thus combating osteoporosis.

Noninflammatory diseases

Noninflammatory diseases have none of these characteristics, and the synovial fluid is normal. Joint degeneration, which can occur with inflammatory and noninflammatory disease, is marked by changes in articular cartilage combined with overgrowth of bone at the articular ends. Degenerative changes commonly affect weight-bearing joints.

Osteogenesis imperfeca

Osteogenesis imperfecta is an inherited disorder that affects bone. Bones are porous, short, bowed, and deformed; as a result, children experience curvature of the spine and shortness of stature.

Proprioception

Proprioception is the awareness of the position of the body and its parts. Proprioceptors located on nerve endings in muscles, tendons, and joints monitor proprioception. The nervous system regulates posture, which requires coordination of proprioception and balance

Effects of exercise on the Musculoskeletal System

- Improved muscle tone - Increased joint mobility - Improved muscle tolerance to physical exercise - Possible increase in muscle mass - Reduced bone loss

Effects of exercise on Activity Tolerance

- Improved tolerance - Decreased fatigue

Effects of exercise on the Metabolic System

- Increased basal metabolic rate - Increased use of glucose and fatty acids - Increased triglyceride breakdown - Increased gastric motility - Increased production of body heat

Effects of exercise on the Pulmonary System

- Increased respiratory rate and depth followed by a quicker return to resting state - Improved alveolar ventilation - Decreased work of breathing - Improved diaphragmatic excursion

Balance

A person needs adequate balance to stand, run, lift, or perform ADLs. The nervous system controls balance specifically through the cerebellum and the inner ear. The cerebellum coordinates all voluntary movement, particularly highly skilled movements such as those required in skiing.

Articular disruption

Articular disruption involves trauma to the articular capsules and ranges from mild, such as a tear resulting in a sprain, to severe, such as a separation leading to dislocation. Articular disruption usually results from trauma but sometimes is congenital, as with developmental dysplasia of the hip

Cartilage

Cartilage is nonvascular, supporting connective tissue with the flexibility of a firm, plastic material. Because of its gristle-like nature, cartilage sustains weight and serves as a shock absorber between articulating bones.

Cartilaginous joints

Cartilaginous joints have little movement but are elastic and use cartilage to unite separate body surfaces such as the synchondrosis that attaches the ribs to the costal cartilage.

General Guidelines for Initiating an Exercise Program

Five steps to beginning an exercise program: Step 1: Assess fitness level. Step 2: Design the fitness program. Step 3: Assemble equipment. Step 4: Get started. Step 5: Monitor progress.

Exercise

Exercise conditions the body, improves health, maintains fitness, and provides therapy for correcting a deformity or restoring the overall body to a maximal state of health. When a person engages in physical activity, physiological changes occur in body systems (Box 38-5).

Inflammatory joint disease

Inflammatory joint disease (e.g., arthritis) is characterized by inflammation or destruction of the synovial membrane and articular cartilage and by systemic signs of inflammation.

Resistive isometric exercises

Resistive isometric exercises are those in which the individual contracts the muscle while pushing against a stationary object or resisting the movement of an object. A gradual increase in the amount of resistance and length of time that the muscle contraction is held increases muscle strength and endurance. Examples of resistive isometric exercises are push-ups and hip lifting, in which a patient in a sitting position pushes with the hands against a surface such as a chair seat and raises the hips. Resistive isometric exercises help promote muscle strength and provide sufficient stress against bone to promote osteoblastic activity.

Osteomalacia

Osteomalacia is an uncommon metabolic disease characterized by inadequate and delayed mineralization, resulting in compact and spongy bone. Mineral calcification and deposition do not occur. Replaced bone consists of soft material rather than rigid bone.

Osteoporosis

Osteoporosis, a well-known and well-publicized disorder of aging, results in the reduction of bone density or mass. The bone remains biochemically normal but has difficulty maintaining integrity and support. The cause is uncertain, and theories vary from hormonal imbalances to insufficient intake of nutrients.

Scoliosis

Scoliosis is a structural curvature of the spine associated with vertebral rotation. Muscles, ligaments, and other soft tissues become shortened. Balance and mobility are affected in proportion to the severity of abnormal spinal curvatures

Synergistic muscles

Synergistic muscles contract to accomplish the same movement. When the arm is flexed, the strength of the contraction of the biceps brachii is increased by contraction of the synergistic muscle, the brachialis. Thus with synergistic muscle activity there are now two active movers (i.e., the biceps brachii and the brachialis), which contract while the antagonistic muscle, the triceps brachii, relaxes.

Synovial joints

Synovial joints, or true joints, such as the hinge type at the elbow, are freely movable and the most mobile, numerous, and anatomically complex body joints.

Tendons

Tendons are white, glistening, fibrous bands of tissue that connect muscle to bone.

Effects of exercise on Psychosocial Factors

-Improved tolerance to stress - Reports of "feeling better" - Reports of decrease in illness (e.g., colds, influenza)

Effects of exercise on the Cardiovascular System

-Increased cardiac output -Improved myocardial contraction, thereby strengthening cardiac muscle -Decreased resting heart rate -Improved venous return

Friction

A force that occurs in a direction to oppose movement. A patient who is passive or immobilized produces greater friction to movement.

Facture

A fracture is a disruption of bone tissue continuity. Fractures most commonly result from direct external trauma. They also occur because of some deformity of the bone (e.g., with pathological fractures of osteoporosis)

Joint

An articulation, or joint, is the connection between bones. Each joint is classified according to its structure and degree of mobility.

Fibrous joints

Fibrous joints fit closely together and are fixed, permitting little, if any, movement such as the syndesmosis between the tibia and fibula.

Musculoskeletal Trauma

Musculoskeletal Trauma often results in bruises, contusions, sprains, and fractures.

The 3 types of muscle groups pertaining to posture

The nervous system coordinates the antagonistic, synergistic, and antigravity muscle groups that are responsible for maintaining posture and initiating movement.

Principles of Transfer and Positioning Techniques

Using principles of safe patient transfer and positioning during routine activities decreases work effort (Box 38-1). Teach colleagues and patients' families how to transfer or position patients properly.

Factors that Influence Activity Tolerance

- Physiological Factors: • Skeletal abnormalities • Muscular impairments • Endocrine or metabolic illnesses (e.g., diabetes mellitus, thyroid disease) • Hypoxemia • Decreased cardiac function • Decreased endurance • Impaired physical stability • Pain • Sleep pattern disturbance • Prior exercise patterns • Infectious processes and fever - Emontional Factors: • Anxiety • Depression • Chemical addictions • Motivation - Developmental Factors: • Age • Sex -Pregnancy: • Physical growth and development of muscle and skeletal support

Antagonistic muscles

Antagonistic muscles cause movement at the joint. During movement the active mover muscle contracts while its antagonist relaxes. For example, during flexion of the arm the active mover, the biceps brachii, contracts; and its antagonist, the triceps brachii, relaxes. During extension of the arm the active mover, now the triceps brachii, contracts; and the new antagonist, the biceps brachii, relaxes.

Antigravity muscles

Antigravity muscles stabilize joints. These muscles continuously oppose the effect of gravity on the body and permit a person to maintain an upright or sitting posture. In an adult the antigravity muscles are the extensors of the leg, the gluteus maximus, the quadriceps femoris, the soleus muscles, and the muscles of the back.

Range of Motion (ROM)

Assessing ROM is one assessment technique used to determine the degree of damage or injury to a joint. By measuring the ROM of a joint you are able to answer questions about joint stiffness, swelling, pain, limited movement, and unequal movement. Limited ROM often indicates inflammation such as arthritis, fluid in the joint, altered nerve supply, or contractures.

Assessment of mobility

Assessment of mobility helps to determine the patient's coordination and balance while walking, the ability to carry out ADLs, and the ability to participate in an exercise program. The assessment of mobility has three components: ROM, gait, and exercise.

Congenital Defects and their effects on the musculoskeletal system

Congenital abnormalities affect the efficiency of the musculoskeletal system in regard to alignment, balance, and appearance. Some examples of congenital abnormalities are Osteogenesis imperfecta and Scoliosis.

Factors Influencing Activity and Exercise

Factors influencing activity and exercise include developmental changes, behavioral aspects, family and social support, cultural and ethnic origin, and environmental issues.

What diseases effect joint mobility?

Joint mobility is altered by inflammatory and noninflammatory joint diseases and articular disruption.

3 classifactions of joints

Joints are classified as fibrous, cartilaginous, or synovial

Ligaments

Ligaments are white, shiny, flexible bands of fibrous tissue that bind joints and connect bones and cartilage. They are elastic and aid joint flexibility and support.

3 things that supports the skeletal system

Ligaments, tendons, and cartilage support the skeletal system

Pathological Influences on Body Alignment and Mobility

Many pathological conditions affect body alignment and mobility. These conditions include congenital defects; disorders of bones, joints, and muscles; central nervous system damage; and musculoskeletal trauma.

Behavioral Aspects related to activity and exercise

Patients are more likely to incorporate an exercise program into their daily lives if supported by family, friends, nurses, health care providers, and other members of the health care team. Information about the benefits of regular exercise is often helpful to the patient who is not at the stage of readiness to act. Patients' decisions to change behavior and include a daily exercise routine in their lives sometimes occur gradually with repeated information individualized to patients' needs and lifestyle.

Gait

The manner or style of walking, including rhythm, cadence, and speed. Assessing gait allows you to draw conclusions about balance, posture, and the ability to walk without assistance. Assessment findings in patients with normal gait include a regular, smooth rhythm; symmetry in the length of leg swing; smooth swaying related to the gait phase; and a smooth, symmetrical arm swing

The 3 categories of exercise

Three categories of exercise are isotonic, isometric, and resistive isometric.

Developmental Changes related to activity and exercise

Throughout the life span the appearance and functioning of the body undergo change. The greatest change and effect on the maturational process occurs in childhood and old age.