Activity and Exercise

Introduction
• Ability to move is essential to well-
being.
• Activity and exercise
– Exercise can prevent and even reverse
many chronic diseases.
• Mobility
- Ability to move freely, easily, rhythmically,
and purposefully
Basic elements of Normal
Movement

Body
alignment Joint
(posture) mobility

Coordinated
Balance
movement
 Alignment and Posture
• Brings body parts
into a position that
promotes optimal
balance and body
function
• Balance maintained
as long as line of
gravity passes
through center of
gravity and base of
support
Which is normal?
 Joint Mobility
• Flexors stronger than extensors
• Without exercise, joints flex, muscles
shorten, and joints may become
permanently flexed (contracture).
• Range of motion (ROM) is maximum
movement possible for joint.
 Balance

• Complex mechanisms
– Ear
– Eye
– Stretch receptors of muscles and tendons
• Proprioception
– Awareness of posture, movement, changes
in equilibrium
– Knowledge of position, weight, resistance
of objects in relation to body
 Coordinated movement
• Balanced, smooth, purposeful
• Result of proper functioning of:
– Cerebral cortex
• Initiates voluntary movement
– Cerebellum
• Coordinates motor activity
– Basal ganglia
• Maintains posture
SELECTED JOINT MOVEMENTS
Neck movements
Shoulder Movements
Shoulder Movements (cont.)
Elbow Movements
Wrist Movements
Hand and fingers Movements
Hip Movements
Knee Movements
Ankle Movements
Foot and Toes Movements
Trunk Movements
Factors Affecting Alignment &
Activity
Growth and • Postural changes in adolescence often carry into
adulthood.
development • Osteoporosis (Common in older women)

Nutrition • (Under-/ over nutrition)

Personal values
and attitudes
• (Temperature, Humidity, Availability of
External factors recreational facilities, Safety of the neighborhood

Prescribed • (Casts, braces, traction, activity restrictions, Bed

rest)
limitations
BODY MECHANICS
 Using body mechanics
– Efficient, coordinated, and
safe use of the body to move
objects and carry out ADLs
– Body balance can be greatly
enhanced by:
• Widening the base of support
• Lowering the center of gravity,
bringing load closer to the base
of support
 Preventing back injury
– Protect your health while providing
care
– Positioning, lifting, and transferring
are risk factors for nurse injuries.
– Avoid twisting (rotation) of
thoracolumbar spine
– Avoid acute flexion of back with hips
and knees straight (stooping)
 Lifting
• No more than 35 lb ( kg) 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)
 Pulling and pushing
• Easier to pull toward center of gravity than to
push against it
• Easier to move object if person increases base
of support in direction of movement
– Pivoting
• Turn without twisting spine
• Weight on balls of feet
• Keep body aligned when turning
POSITIONING CLIENTS
 Positioning clients
– Provide good alignment when
positioning
– Turning clients systematically (q 2hr) is
good nursing practice.
– To 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
 Positions
– Fowler's position (45°–60°)
• Semi-Fowler's (15°–45°)
• High Fowler's (60°–90°)
– Orthopneic position
 Positions
– Dorsal recumbent/supine position
– Prone position
• Ensure proper support, alignment of the
spine
– Lateral position
– Sims' position
Which is which?
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
 General guidelines
– Explain procedure to the client
– Raise height of the bed
– Lock wheels
– Face the direction of movement
– Assume a broad stance
– Determine and document
• Client's comfort
• Body alignment
• Tolerance of the activity
• Ability to assist
• Use of support devices
• Safety precautions required
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 leg when
pulling client
– Rock from back leg to front leg when
pushing client
 Transferring clients
– Safe transfer bed to chair
• Gait belt (transfer belt)
• Sliding board
– Plan what to do and how to do it
– Obtain essential equipment before starting
– Remove obstacles
– Explain transfer to ….
– Support or hold client rather than equipment
– Explain what client should do
– Document, including client's tolerance (e.g.,
pulse, RR)
Thank you!