Chapter 12 - Exercise
the prevalence of adult and childhood obesity has increased and is now considered ..?
an epidemic
a common medical and social problem frequently associated with disability and absence from work
low back pain
strength and endurance of muscles permitting ADLs (daily activities) without injury
muscular fitness
Intensity is defined by..?
Intensity is defined by the objective measure of heart rate (HR) and the subjective measure of perceived exertion.
high-intensity, short-duration activity that increases the efficiency of the phosphocreatine and glycolytic energy-producing systems and increases muscle strength, power, and speed of reactivity. causes you to be out of breath quickly
anaerobic exercise (sprinting or lifting heavy weight)
upsets the balance of joint health. impaired joint function
arthritis
The amount of exercise required to achieve the goals of promoting optimal cardiorespiratory fitness and significantly increase muscle strength and endurance is determined by the parameters of an exercise prescription. What is the exercise prescription?
(F)Frequency -Aerobic exercise 3-5 times/week -Resistance training 2-3 times/week (I)Intensity -Moderate to rigorous Resistance exercise 8-12 repetitions (T)Time -20-60 minutes plus warm-up/cool-down -15-30 minutes series resistance exercise (T) Type -Aerobic (walking, jogging, biking, swimming, rowing, cross-country skiing, elliptical trainer, NordicTrack, StairMaster, aerobics, dancing, skating, or rollerblading) -Resistance training (weight machines, free weights, and calisthenics such as push-ups, sit-ups, or pull-ups)
how does exercise benefit arthritis ?
-Improves joint function and ROM (range of motion) -Increases muscle strength and aerobic fitness: enhances ADLs (daily activities) -Improves psychological state -Decreases loss of bone mass -Decreases risk of chronic disease
how does exercise benefit the problem of obesity?
-Promotes negative energy balance; Increases metabolic rate for extended period -Increases metabolic efficiency for burning calories (increases lean body mass) -Counteracts decrease in metabolic rate by preserving lean body mass -Alternative to stress eating
What is the relaxation response (RR)?
-an inborn set of physiological changes that offset those of the fight-or-flight (stress) response. -When elicited, the RR results in a "letting go" of physical, emotional, and mental tension. It is a physiological response inborn in everyone and, although it can sometimes occur without the individual being aware of it, people generally need to develop techniques that help them let go on a more regular basis. -Some techniques that are used commonly to elicit the RR include diaphragmatic breathing, meditation, imagery, mindfulness, yoga stretching, and repetitive exercise. -2 basic components for successful RR: 1. repetitive focus (breath, mantra, physical activity) 2. nonjudgemental attitude regarding thoughts and performance
how does exercise affect immune function? specifically HIV?
-doesn't risk health status -Enhances physiological/psychological well-being -Uncertain of effect on immune system markers -May stimulate immune system/decrease infection -High-intensity exercise: may suppress immune system -May have protective effect in some cancers
How does exercise affect mental health?
-feel better (physically/mentally) -increased self-esteem -more positive outlook on life -protective and intervention effects for mild/moderate depression -Promotes mental health/well-being -Prevents/treats mental disorders -Strategy in psychosocial rehabilitation
what are the effects of exercise on the aging process?
-improves functional independence/improve the quality of life -decreases falls/hospitalization -improves blood lipid profiles-->therefore reduces fat -prevents osteoporosis (increases bone mass measurement - BMD) -improves cardiovascular and cardiopulmonary functions -improves metabolic functions such as glucose tolerance and insulin sensitivity
How does exercise help with Coronary Heart Disease (CHD)?
-risk decreases with increase in physical activity -acts as both primary and secondary prevention -less likely to develop CHD -more likely to survive myocardial infarction (MI or AKA heart attack) -decreases cardiac mortality in heart failure patients and improves metabolic/functional indicators -positive effects on CHD risk factors such as cholesterol levels, blood pressure, glucose tolerance, obesity, platelet function -prevents hypertension by decreasing blood pressure -hyperinsulinemia and glucose tolerance- increases insulin sensitivity, decreases obesity, improves glycemic control, helps prevent progression of diabetes II during early disease stages
what does physical activity include?
-transportation -vocational (job) -leisure-time activity such as sports, recreational activities, and exercise training
what usually causes low back pain?
-work -obesity
___ of the population exercises at an intensity necessary to promote cardiorespiratory fitness
10%
How much fluid should you drink 4 hours before exercise?
16-20 oz
how much fluid should you drink after exercise?
20-24 oz for every lb lost
only ____ of the adult population performs enough regular, sustained exercise to gain any significant health benefit,
23%
how long do children spend on their computers and in sedentary activity?
3+ hours per day
how often should you do aerobic exercises and for how long? (walking, jogging, biking, swimming, rowing, cross-country skiing, elliptical trainer, NordicTrack, StairMaster, aerobics, dancing, skating, or rollerblading, aquatic)
3-5 times a week 20-60 minutes
____ of adults 18 years or older in 2013 reported no leisure-time physical activity
30.3%
How much fluid should you drink 10-15 minutes prior to exercise?
8-12 oz
A nurse is reviewing an exercise prescription for a person. Which of the following aspects should be included? (select all that apply) a. Frequency of exercise b. Intensity level of exercise c. Time and duration of exercise d. Type of exercise
A, B, C, D
A nurse is providing an educational program addressing the importance of being physically active. The nurse states that individuals should engage in exercise for a minimum of 30 minutes of activity on most days of the week. For which of the following individuals is that recommendation appropriate? (select all that apply) a. A 54-year-old with hypercholesterolemia b. A 66-year-old with hypertension c. A 48-year-old with obesity d. A 58-year-old with Type 2 diabetes mellitus
A, B, D The risk of CHD decreases with an increase in physical activity. Exercise positively affects lipoprotein metabolism and is a common part of the treatment for hypertriglyceridemia. Regular exercise also decreases blood pressure in adults. Exercise improves glycemic control by increasing insulin sensitivity in people with Type 2 diabetes mellitus. The Physical Activity Guidelines for Americans advise adults to perform at least 150 minutes of moderate intensity or 75 minutes of vigorous activity per week. Exercise also has a positive effect on obesity. However, the American College of Sports Medicine recommends a minimum of 40 to 60 minutes of exercise 5 to 7 days a week for those with obesity.
what are the exercise guidelines to help with obesity?
Low-impact aerobic exercise, increase in daily activities, and resistance training 5-7 times a week for 40-60 minutes daily
what are the strategies for exercise success?
Chooses an enjoyable activity Feels competent doing the activity Feels confident in overcoming barriers Feels safe doing the activity Can access activity on a regular basis Perceives no negative social or financial cost Experiences minimal musculoskeletal discomfort
what are the exercise guidelines for problems like arthritis?
Daily: develop joint ROM and flexibility Two to three times a week: muscle strengthening Most days: aerobic exercise, recreational activities (cardio machines, spinning, running, swimming, walking, hiking, aerobics classes, dancing, cross country skiing, and kickboxing)
what are the exercise guidelines that will help with problems like osteoporosis?
Duration: 20-30 minutes Frequency: 3-5 times a week
how does exercise help with low back pain? What are the exercise guidelines that can help with problems like low back pain?
Exercise reduces pain, improves function, decreases loss of work days -Goal: prevent debilitation from inactivity; improve endurance, strength, and flexibility -Individualized program -Trunk and extremity muscle strengthening -Aerobic conditioning (cardio machines, spinning, running, swimming, walking, hiking, aerobics classes, dancing, cross country skiing, and kickboxing)
A nurse is providing care for a 10-year-old child with a BMI at the 80th percentile. Which of the following best describes this child? a. Normal weight b. Overweight c. Obese d. Morbidly obese
a. normal weight Children are considered normal if under 85th percentile. Children are considered abnormal (overweight/obese) if over 85th percentile.
activity that uses large muscle groups in a repetitive, rhythmical fashion over an extended period to increase the efficiency of the oxidative energy-producing system and increase cardiorespiratory endurance
aerobic exercise (cardio machines, spinning, running, swimming, walking, hiking, aerobics classes, dancing, cross country skiing, and kickboxing)
A nurse is developing a primary prevention strategy to address the problem of obesity. Which of the following interventions is being created? a. Encouraging an active lifestyle during childhood years b. Prescribing orlistat (Alli) c. Recommending the Jenny Craig program d. Recommending gastric banding surgery
a. Encouraging an active lifestyle during childhood years Exercise is an important component of primary prevention. Less active children increase their risk of sedentary lifestyles as adults. Sedentary lifestyles lead to obesity. Therefore, a primary prevention method for obesity is to encourage an active lifestyle during the childhood years.
A nurse is counseling a 19-year-old person who has recently been diagnosed with Type 1 diabetes mellitus. The person asks if there is anything specific that should be done before going to play tennis with a friend. Which of the following instructions should the nurse give the person to avoid hypoglycemia? a. Inject the insulin into the abdomen. b. Inject the insulin into the arm. c. Inject the insulin into the thigh. d. Skip taking any insulin before exercising.
a. Inject the insulin into the abdomen. When insulin is injected in a muscle that will be active, it will speed up the absorption of insulin and quickly decrease blood glucose. Because tennis involves a lot of leg and arm movement, insulin should be given in the abdomen. Additionally, not all insulins have the same onset or duration of action. Changes in insulin dosage schedules should not be made without knowing the onset or duration of action.
A nurse is educating a 35-year-old woman about the best exercises to engage in to prevent bone loss. Which of the following exercises would the nurse recommend? a. Walking b. Swimming c. Weight training d. Bike riding
a. Walking Weight-bearing activities have a positive effect on bone density, and walking is a weight-bearing activity. In young women, the goal is to increase bone mineral density; thus, walking is the best exercise to prevent osteoporosis in this woman.
Activity that uses large muscle groups in a repetitive, rhythmic fashion over an extended period to improve the efficiency of the oxidative energy producing system and improve cardiorespiratory endurance is known as: a. aerobic activity. b. anaerobic activity. c. flexibility. d. muscular fitness.
a. aerobic activity.
how does exercise benefit osteoporosis?
osteoporosis- disease in which the density and quality of bone are reduced. As bones become more porous and fragile -exercise increased bone mass measurement (BMD) -weight bearing, aerobic, and resistance training are important -goal is to increase mechanical stress on bone
children are considered to be obese if their BMI is over what percentile for age/gender growth charts?
over 85th percentile
According to the 2009-2010 National Health and Nutrition Examination Survey, what percentage of 6- to 11-year-old children are overweight? a. 14% b. 18% c. 24% d. 28%
b. 18% According to the 2009-2010 National Health and Nutrition Examination Survey conducted by the CDCs National Center for Health Statistics, 18% of 6- to 11-year-old children are overweight.
An occupational health nurse is trying to promote regular activity at her institution. Which of the following interventions would most likely be the most successful? a. Educate all employees regarding the benefits of exercise. b. Initiate a lunchtime walking group that employees can join. c. Provide all employees with an exercise prescription. d. Recommend that employees who do not exercise be terminated from their positions.
b. Initiate a lunchtime walking group that employees can join.
A nurse is discussing exercise intensity with a client. Which of the following medications that the client is taking may limit the usefulness of heart rate as an indicator of exercise intensity? a. Ciprofloxacin (Cipro) b. Metoprolol (Toprol) c. Atorvastatin (Lipitor) d. Lansoprazole (Prevacid)
b. Metoprolol (Toprol) Beta-blockers may alter the relationship between heart rate and the rate of perceived exertion. Metoprolol is a beta-blocker and thus may limit the usefulness of heart rate as an indicator of exercise intensity.
A nurse is providing care to a person who has lower back pain. Which of the following exercises would the nurse recommend to assist with pain reduction? a. Walking b. Pilates c. Swimming d. Bike riding
b. Pilates Maintaining proper curves of lordosis and kyphosis in the vertebrae is important for sustaining the spring and shock absorption quality of the spine. Poor posture can increase stress on the back and lead to pain. Exercises that train the paraspinal muscles to improve posture (like Pilates) are effective for people with lower back pain. Aerobic activity is recommended to maintain endurance and prevent debilitation from inactivity.
During an office visit, a nurse meets with a woman who states she does not have time to exercise. Which of the following actions should the nurse take next? a. Do nothing because she has already made the decision to not exercise. b. Provide her with information on the benefits of exercising. c. Develop an exercise prescription with her. d. Schedule a follow-up in 2 months to see if she still feels the same way.
b. Provide her with information on the benefits of exercising. The woman is in the precontemplation state and thus should not be forced into a plan at this time. However, exercise has many benefits and it implementation should be encouraged. The nurse should continue to ask at each visit because when individuals are counseled by clinicians they are more likely to increase physical activity. As a result, providing the woman with information regarding the benefits of exercising and bringing up the topic of exercise is the best approach at this stage.
A nurse is working with a group of individuals to start an exercise program. Which of the following would require the most attention and assistance? a. White man who works 50 to 60 hours a week as a business executive b. Unemployed, obese Hispanic woman c. Employed White woman with hypertension d. White man with a high school diploma
b. Unemployed, obese Hispanic woman The number of adults with no leisure-time physical activity varies by race, ethnicity, gender, education level, geographic location, disability status, and age. Women are less active than men. Lower income and less educated people are not as physically active as those with higher socioeconomic and educational levels. In addition, African Americans and Hispanics are less active. The unemployed, obese Hispanic woman has three risk factors for inactivity: (1) she is unemployed and therefore likely has no or a low income level; (2) she is a woman, and (3) she is Hispanic. All of these factors place her at risk for inactivity
During a home visit, a nurse notes that a person with hypertension lives on the third floor of a subsidized housing project on a busy road with no sidewalks and few street lights. Which of the following would be the best recommendation for exercise for the nurse to make to the person? a. Do not exercise because you have high blood pressure. b. Use the stairs whenever you are entering or leaving the building. c. Go for short walks around the block during the daytime only. d. Purchase an exercise bike.
b. Use the stairs whenever you are entering or leaving the building. Exercise decreases blood pressure and thus should be encouraged in those with hypertension, especially aerobic activity. Participation in physical activity depends on the availability of facilities and a safe environment. Walking in the road is not safe, and it is also unlikely that this person, who lives in a subsidized housing project, has the funds to purchase an exercise bike. Therefore, using the stairs as much as possible would be a safe, inexpensive form of exercise for this person.
During an office visit, a nurse provides counseling to a 70-year-old woman with osteoporosis who is otherwise very healthy. Which of the following information should the nurse provide to the woman? a. Avoid all forms of exercise because of the risk of fractures. b. Walk with a partner at least 30 minutes a day 5 days a week. c. Use a wheelchair to get around so that she can prevent falls. d. Take a step aerobics class 5 days a week
b. Walk with a partner at least 30 minutes a day 5 days a week. Regular physical activity helps maintain functional independence and improve quality of life throughout the aging process. The benefits of exercise have been documented for both healthy and chronically ill older adults. Exercise improves bone mineral density, especially weight-bearing activities such as walking, aerobic, and dance. Women 30 to 40 years past menopause also need to consider decreasing the risk of fractures by preventing falls. Advanced age and osteoporosis should not exclude anyone from exercise. Therefore, walking with a partner provides the exercise that is needed as well as a companion to help prevent falls or notify someone if a fall occurs.
anaerobic exercise uses what as a major fuel source?
phosphagens and glucose-glycogen
body movement that is produced by the contraction of skeletal muscles and that substantially increases energy expenditure
physical activity
ability to perform physical activity without undue fatigue or injury
physical fitness
A nurse is monitoring the exercise of a 42-year-old woman. Which of the following would be the estimated maximum heart rate (MHR) for this woman? a. 126 b. 142 c. 178 d. 184
c. 178 A generic formula for determining MHR is 220 minus age: 220-42 = 178
A nurse is counseling a 40-year-old person who is going to start an exercise program. Which of the following heart rate ranges would the nurse encourage the person to maintain while exercising? a. 70 to 140 beats/min b. 80 to 143 beats/min c. 90 to 153 beats/min d. 100 to 180 beats/min
c. 90 to 153 beats/min The maximum heart rate for a 40-year-old is 180. Exercise should produce a heart rate that is 50% to 85% of maximum heart rate. This percentage corresponds to a rate of perceived exertion of 11 to 14: 50% of 180 = 90, 85% of 180 = 153. Thus, the range should be 90 to 153
A nurse is caring for a man who states he is ready to start exercising. Which of the following actions should the nurse take next? a. Do nothing because he has already made the decision to implement a change. b. Provide him with information on the benefits of exercising. c. Develop an exercise prescription with him. d. Schedule a follow-up in 2 months to see if he still feels the same way
c. Develop an exercise prescription with him.
A nurse is providing health education for a group of older adults about the risks of developing coronary heart disease. Which of the following group members is at highest risk? a. Takes a beta-blocker for hypertension b. Has a total cholesterol level of 201 c. Doesnt participate in any form of regular physical activity d. Has a family history of Type 2 diabetes mellitus
c. Doesnt participate in any form of regular physical activity Physical inactivity affects more people in the development of coronary heart disease than any other risk factor. At any level or combination of risk factors, sedentary individuals are at greater risk of developing coronary heart diseases. Exercise provides both primary and secondary prevention. Thus, the person who does not participate in any form of regular physical activity is at most risk of developing coronary heart disease.
The nurse is discussing an exercise prescription with a person. To help him determine the appropriate intensity, the nurse tells him that he should monitor his rate of perceived exertion. Which of the following should the nurse tell the man he should experience while exercising? a. Talking and singing without difficulty b. Feeling extremely fatigued c. Having mild musculoskeletal discomfort d. Being out of breath
c. Having mild musculoskeletal discomfort The rate of perceived exertion helps people determine a comfortable, beneficial level of exercise intensity. Being slightly short of breath, able to talk with difficulty, being pleasantly fatigued, and having mild musculoskeletal pain reflect a rate of perceived exertion that corresponds well with 50% to 85% of maximum heart rate, an appropriate target range for most individuals.
A nurse is providing care for a 40-year-old adult with a BMI of 32. Which of the following best describes this person? a. Normal weight b. Overweight c. Obese d. Morbidly obese
c. Obese An adult 20 years of age or older is considered overweight if his or her BMI is 25 to 29.9, obese if his or her BMI is 30 or higher, and morbidly obese if his or her BMI is 40 or higher. Thus, the 40-year-old adult with a BMI of 32 is considered obese.
An inborn set of physiological changes that offset those of the fight or flight response is known as: a. Self-efficacy b. Catecholamine surge c. Relaxation response d. Metabolism
c. Relaxation response
A nurse is developing an exercise program for a person with moderate osteoarthritis of the knees. Which of the following forms of exercise would the nurse include in this program? a. Step aerobics b. Running c. Water aerobics d. Bike riding
c. Water aerobics Water activities are good exercise alternatives for people with musculoskeletal limitations who need some weight relief with exercise. The water provides buoyancy while also providing resistance to the limbs as they move. Studies have also demonstrated that people who participate in aquatic exercise experienced greater pain reduction than those who participated in land activities. Thus, water aerobics would be the most appropriate form of exercise for this individual
A nurse is discussing resistance training with a 24-year-old woman. The woman is resistant to weight lifting because she does not want to get too muscular. She prefers a program that is strictly aerobic. Which of the following would be the most appropriate response from the nurse? a. Ok, just make sure you perform one hour of aerobics every day. b. Lifting weights is a necessary part of exercise. c. Weight lifting has many purposes and benefits; can we talk about them? d. Looking muscular at your age is attractive.
c. Weight lifting has many purposes and benefits; can we talk about them?
what are the benefits of sports drinks?
contain carbohydrates and electrolytes
if you are exercising for over 1 hour what fluid should you drink?
sports drink vs water
aerobic exercise uses what as a major fuel source?
stored adipose tissue
Watch TV Play computer games Sit all day examples of ?
what you should be doing little each week
A 51-year-old woman has begun menopause. The nurse emphasizes the importance of a diet high in calcium and vitamin D as well as exercise for this woman. This recommendation is important because by the time the client is 56, she will have experienced another _____ bone loss. a. 3% b. 7% c. 10% d. 15%
d. 15% The rate of bone loss accelerates rapidly during the first 5 postmenopausal years, with annual losses of 3% to 5% being common. Thus, if at least 3 % is lost over 5 years, 3% 5 years (56 51) = 15%.
According to the physical activity and fitness section of the Healthy People 2020 report, what percentage of adults 18 years of age or older report no leisure-time physical activity? a. 16% b. 26% c. 36% d. 30.3%
d. 30.3%
A woman is going for a 2-hour hike in the Grand Canyon and she asks the nurse how much fluid she should take along with her. Which of the following recommendations should be given by the nurse? a. Bring at least 24 ounces of water. b. Bring at least 72 ounces of water. c. Bring at least 24 ounces of sports drink. d. Bring at least 72 ounces of sports drink
d. Bring at least 72 ounces of sports drink
Which of the following statements about exercise is true? a. People who engage in high-intensity exercise are at lowest risk for illness. b. Aerobic exercise should be part of daily exercise routines. c. Regular exercise may cause people to experience fatigue and increased susceptibility to mental health disorders. d. Low-level physical activity may have a protective effect on gastric and pancreatic cancer.
d. Low-level physical activity may have a protective effect on gastric and pancreatic cancer. Low-level physical activity may have a protective effect on gastric and pancreatic cancer. People who engage in moderate-intensity activity are at lowest risk for illness, whereas those who engage in high-intensity activity are at higher risk for illness. Aerobic exercise is recommended at a frequency of three to five times per week. Every other day is a good frame of reference as it allows for recovery between training sessions. Cross-training is recommended as part of daily exercise routines. Regular exercise promotes positive well-being and decreased susceptibility to mental health disorders.
Mow the lawn Wash the car Rake the leaves Park the car a distance from the store Walk the dog Play with your children examples of..?
do some everyday of the week
Active sports or leisure activities as in tennis, gardening, golf examples of..?
doing 2-3 times a week
Aerobic activities for 30 minutes as in biking, stair climbing, walking, dancing, skiing, swimming examples of ...?
doing 4-6 times a week
what is cross-training?
doing different types of exercises on different days --> decreases risk of injury, aids in total body conditioning and improved compliance
how often should you hydrate during exercise?
every 15-20 minutes
planned, structured, and repetitive body movement performed to improve or maintain one or more components of physical fitness.
exercise
adequate muscle length and joint mobility to allow free and painless movement through a wide range of motion (wide ROM)
flexibility
The goal of the Physical Activity and Fitness focus area is to..
improve health, fitness, and quality of life through physical activity
in treating osteoporosis with exercise, older women need to be aware of what?
in older women who are already 30 to 40 years after menopause, a more realistic goal would be to decrease the risk of fractures through fall prevention...such as tai chi which increases muscle strength and improvements in balance and decreased risk of falling
