Exercise Introduction

Introduction

The coordinated efforts of the musculoskeletal and nervous systems maintain balance, posture, and body alignment during lifting, bending, moving and performing activities of daily living. Exercise and physical activity are important parts of healthy life. Exercise is physical activity that is planned, structured and repetitive for the purpose of conditioning any part of the body, improving health and maintaining fitness or it may be used as a therapeutic measures. An exercise is the movement of the patient's body parts or joints through its full range of motion. Range of motion (ROM) is the ability to move all joints through the full extent of intended function. It is the functional activities of muscle, nerve and joint as well as cardiovascular and respiratory system. Range of motion is done to preserve flexibility and mobility of the joints on which they are performed. This motion is influenced by several structures: configuration of bone surfaces within the joint, joint capsule, ligaments, tendons, and muscles. It helps to prevent contractures and joint stiffness by moving all of the patients' joints through their complete range of motion. They are usually performed once or twice daily, or according to the provider's order and can be performed independently or with assistance.

Active Range of Motion (AROM): Active range-of-motion exercises are those the patient performs, with a nurse or a physical therapist supervising to ensure that the patient is doing them correctly. They involve moving each joint through its complete range of motion. These exercises maintain and increase muscle strength and prevent keep joint problems and contractures from developing.

Active Assistive Range of Motion (AAROM): The patient uses the muscles surrounding the joint to perform the exercise but requires some help from the therapist or equipment (such as a strap).

Passive Range of Motion (PROM): Passive range-of-motion exercises are performed for patients by a nurse or a physical therapist. Therapist or equipment moves the joint through the range of motion with no effort from the patient. These exercises are performed so that patients who are completely immobilized can retain as much joint range of motion as possible. When performing passive range-of-motion exercises, cradle the patient's joint to support it both above and below. Put each joint being exercised through as full range of motion as possible, starting with the neck and moving down to the lower extremities. If the patient reports pain or discomfort at any time, stop the exercise. Another way to exercise a patient's joints is with a continuous passive range of motion (CPM) device. It is used to restore range of motion in a variety of joints, including the ankle, knee, shoulder, and wrist. It is most commonly used after knee surgery; the provider usually prescribes it on the day of surgery or on the first postoperative day.

Types of Exercises

Anaerobic: It is one which requires little or no extra cardiopulmonary efforts e.g. relaxing and exercising alternatively the muscle group while in stationary position. These exercises are those done at a higher intensity for shorter periods of time. These build strength and help your body to become accommodated to working hard. Paired with a healthy diet, these exercises can also help you to lose weight, as body's caloric use will increase. Some examples of rapid, intense anaerobic exercise include lifting heavy objects or sprinting.

Aerobic Exercise: Aerobic exercise is one in which additional demand is put in cardiopulmonary system e.g. running, swimming, playing football. Aerobic exercise is often called a "cardio" workout, since it is designed to increase and improve blood flow. It also affects body weight composition, by burning excess calories.

Isometric: An isometric exercise is a form of exercise involving the static contraction of a muscle without any visible movement in the angle of the joint. Isotonic: It is a dynamic form of exercise with constant muscle tension, muscle contraction and active movement e.g. walking, running.

Types of Body Movement

Flexion: Flexion is moving the bones attached to a joint towards each other, such as with the elbow, bringing your fist toward your shoulder. It is the state of being bent.

Extension: Extension is opposite of flexion; movement in the sagittal plane that increases the angle of the joint or distance between two bones or parts of the body. It is the state of being in a straight line.

Hyperextension: Hyperextension is a continuation of movement past the anatomical position, which can cause injury. It is the state of exaggerated extension. The cervical spine is hyperextended when the person looks overhead, toward the ceiling.

Abduction: Abduction is movement away from the center, such as, when standing with your arms at your sides, you raise an arm so it is parallel to the floor, away from the midline of your body. 

Adduction: Adduction is opposite of abduction; movement of a limb toward the body midline. It is lateral movement of a body part toward the midline of the body.

Rotation: Rotation involves turning the or a limb around the longitudinal axis. The head is rotated when moved from side to side to indicate "no."

Circumduction: Circumduction is a special type of angular motion, described as making circular movements as moving the in a loop. It is a combination of abduction, adduction, extension, and flexion.

Dorsiflexion: Dorsiflexion is the movement of the ankle while elevating the sole, as if digging in the heel.

Plantar flexion: It is the opposite movement, extending the ankle and elevating the heel, as if standing on tiptoes.

Inversion: It is turning the sole of the foot medially

Eversion: It is turning the sole of the foot laterally.

Supination: It is forearm rotation laterally so that the palm is facing anteriorly and the radius and ulna are parallel. The palm or sole is rotated in an upward position

Pronation: Forearm rotation medially so that the palm faces posteriorly and the ulna and radius are crossed or palm or sole is rotated in a downward position.

Elevation/Depression occurs when a structure moves in a superior or inferior direction, as the mandible is depressed when the mouth is opened and elevated when the mouth is closed.

Opposition is a special movement of the thumb which enables it to grasp and hold an object.

Rotation involves turning the body or a limb around the longitudinal axis, as rotating the to screw in a light bulb.

Purpose of Exercise

• To stimulate circulation, preventing thrombus and embolus formation.
• To maintain muscle strength.
• To prevent contractures.
• To promote and maintain joint mobility.
• To increase the tolerance for more activity.
• To facilitate comfort for the patient.
• To facilitate activities of daily living and promote the patient's independence.
• To divert the patient's mind to optimum by building his/her strength and energy.

Physiological Effects of Exercise

Cardiovascular System

• Improve pumping action of heart.
• Increased cardiac output.
• Increased resting heart rate.
• Improved venous return.
• Makes the heart muscles stronger and more efficient.
• Vessels dilate during exercise which helps in the supply of O2 and nutrient to tissue.
• Prevent venous thrombosis and pulmonary embolism.

Pulmonary System

• Increased respiratory rate and depth followed by a quicker return to resting state.
• Improved alveolar ventilation.
• Increased work of breathing.
• Improved diaphragmatic excursion.
• Improves lungs ventilation, prevents atelectasis and hypostatic pneumonia.

Endocrine/Metabolic System

• Increased basal metabolic rate.
• Increased use of glucose of fatty acids.
• Increased triglyceride breakdown.
• Increased production of body heat. This promotes the burning up of the toxic substances in the body.

Digestive System

• Stimulated secretion of the digestive juices thus digestion becomes more efficient.
• Increased gastric motility.
• Stimulate the intestinal movements (peristalsis), resulting in more effective elimination of wastes.
• Prevent and corrects deformities.
• Improves digestive and absorption and utilization of food and increases appetite and prevents constipation.

Musculo-Skeletal System

• Improved muscle tone.
• Increased joint mobility.
• Improved muscle tolerance to physical exercise.
• Reduced bone loss.
• Promotes muscle development and increases their efficiency
• Stronger muscles lend better support to the joints.
• Prevents obesity and regulates body temperature.
• Improves good posture.

The Skin

• The pores of the skin open up during exercise.
• The result is a healthier skin, because of more efficient disposal of impurities and dirt.

Psychosocial Factors

• Improved tolerance to stress.
• Reports of "feeling better".
• Reports of decrease in illness e.g. colds, influenza.
• Improve self-esteem and body image.
• Increases positive health behaviors.
• Promotes physical and mental wellbeing, gives relaxation and sleep, improves memory power and relieves tension.

Contra-indications

• Joints with pathological condition e.g. acute arthritis, fracture, dislocated joints.
• Cardiac patient.
• In case the patient complains of severe pain, resistance or fatigue, one should stop exercise Lara immediately to prevent injury.
• Recent trauma with possible occult fractures or internal injuries.

Guidelines

• Always visit your doctor for a checkup before beginning an exercise program to ensure that you are healthy enough to exercise.
• Complete a thorough examination before patients start range-of-motion exercises to ascertain their range-of-motion capabilities and the amount of range of motion to include in each patient's care plan.
• Give the client as much room as possible to contribute.
• At a set period each day, typically during morning care, perform range-of-motion exercises in a methodical order. Exercises should ideally be performed once or twice day.
• Always warm up before activity and cool down after.
• The movement should be rhythmic and gradual, and the repetition rate should be kept constant. As you move slowly, keep an eye out for the patient's reaction to ROM.
• Smooth, gentle motion should be used when exercising your range of motion.
• By evaluating the patient, choose the best sort of exercise for the customer.
• Choose an appropriate workout that the patient will like performing rather than feeling it is a burden.
• Only individuals who are unable to exercise their range of motion independently should receive passive ROM therapy.
• Before exercising, plan the warm-up procedure by slowly and gently stretching the muscle to stimulate blood flow and reduce muscle and nervous stress.
• Reduce friction as much as possible to prevent skin damage.
• While moving the limb or body part of the person, support it with one hand. Typically, this entails placing a hand beneath each of a limb's joints.
• If a muscle cramps up while you're moving, stop moving temporarily, but keep applying slow, soft pressure to the affected area until the cramping stops. Then, resume your range-of-motion activities.
• Avoid over-exerting yourself in extremely hot conditions since heavy sweat depletes the body's supply of salt and water. If warning signs such as shortness of breath, dizziness, trembling sensation, muscle tightness, or weariness appear, stop or reduce the intensity of exercise. יסי
• Avoid wearing constrictive footwear and attire. Maintain support for the limbs while moving.
• If you have a cold, the flu, or another ailment, avoid exercising.

Procedure

• Examine the nursing care plan for the patient and the doctor's prescriptions.
• Determine the client's movement restriction and the client.
• Describe the procedure's order.
• Ensure privacy. Close the curtains or door to the room.
• Put the patient in comfortable clothes.
• Lift the mattress to a convenient working height.
• Don clean gloves and wash your hands.
• Help the patient find a comfortable position by assisting them to sit, lie down, or stand.
• Set the height of the bed appropriately.
• As you execute the exercises, lock the table or bed so that it cannot move.
• When exercising joints, stand on one side of the bed.
• Ensure that just the exercised area is shown.
• Exercise should be done slowly and softly while holding the area close to the joints for support.
• From the top down, perform ROM exercises.
• Support the patient.
• Request that the patient take a few long, deep breaths and to relax.
• If the client complains of discomfort or muscular spasms, stop the exercise or reduce the range of motion (ROM).
• On the other side, repeat the exercise. It's crucial to work both sides equally.
• After the activity is finished, position the patient such that they are comfortable.
• To increase safety, correctly position side railings.
• Wash your hands completely.
• Fill out the nurse's record sheet with the procedure details.
• Teach a family member to undertake passive range-of-motion exercises if the impaired patient needs ongoing therapy after discharge. not bluone

Range of Motion Exercise

Neck (Pivotal joint)

• Flexion: Move the chin to chest.
• Extension: Move the head from flexed to upright middle position or return the head to erect position.
• Hyperextension: Bend the head towards back as possible.
• Lateral Flexion: Tilt the head towards each the shoulder.
• Rotation: Rotate the head in circular motion.

Shoulder (Ball and socket joint)

• Raise the client's arm from side to above the head.
• Abduct and rotate the shoulder by raising the arm above the head with the palm up.
• Adduct the shoulder by moving the arm as for as possible.
• Rotate the shoulders internally and externally by flexing the elbow and moving the forearm, so that the palm touches the mattress; then reverse the motion so that the back of the client's hand touches the mattress.
• Move the shoulder in a full circle (circumduction).

Elbow (hinge joint)

• Flexion: Bend the elbow so that the forearm moves towards the shoulder.
• Extension: Straighten the arm or hyper-extend elbow as far as possible.
• Supination: With the arm at the side, the elbow bent, move the hand and forearm so that the palm is facing upward.
• Pronation: With the arm at the side, the elbow bent, move the hand and forearm so that the palm is facing downward.
• Abduction/ adduction and circumduction.

Wrist and Hand (condyloid joint)

• Flexion: Move the hands toward from the inner aspect of forearm.
• Extension: Straighten the wrist so that it is on the same plane as the forearm.
• Hyperextension: Bend the wrist as far back as possible toward the outer aspect of the forearm.
• Abduction (radial flexion): With the hands supinated, bend each wrist laterally toward thumb side.
• Adduct (ulnar flexion): Wrist by bending toward fifth finger.
• Flexion: Make a fist
• Extension: Extend the fingers.
• Hyper extension: Straighten the fingers of each hand back as far as possible.
• Abduction: Spread the fingers apart, then bring them together.
• Adduction: Move the thumb across the hand to the base of the fifth finger.

Thumb (Saddle joint)

• Flexion: Move the thumb across the palm of the hand toward the fifth fingers.
• Extension: Move the thumb laterally away from the fingers.

Elbow

Flexion, extension, pronation and supination.

Hip (Ball and socket joint)

• Flexion: Move the leg forward and up with the knee in extension.
• Extension: Move the leg back beside other leg while the knee joint remains in extension.
• Hyperextension: Move the leg back behind the body.
• Adduct and abduct the leg moving laterally away from the body and returning to medial position.
• Internally and externally rotate the hip by turning the hip inward and outward.
• Circumduction.

 Knee (Hinge joint)

• Flexion: Bring the heel back toward the back of the thigh.
• Extension: Return the heel to the floor.or bead adi ne

Ankle (Hinge joint)

• Dorsiflexion: Foot by moving it, so that the toes point upwards.
• Plantar flexion: By moving the foot so that the toes point downwards.

Foot (Gliding joint)

• Inversion: Turn the sole of the foot medially.
• Eversion: Turn the sole of the foot laterally.
• Extension: Straighten the toes of each the foot.
• Abduction: Spread the toes apart.
• Adduction: Bring the toes together. bonio) plonis Mit