NCM NOTES: ACTIVITY AND EXERCISE

Activity-exercise pattern a persons routine of exercise, activity, leisure, and

recreation. (ADL)
Mobility the ability to move freely, easily, rhythmically, and purposefully in
environment; it is also an essential part in living.

NORMAL MOVEMENT

Result of intact musculoskeletal system, intact nervous system, and intact

inner-ear structures responsible for equilibrium.

4 BASIC ELEMENTS OF NORMAL MOVEMENT

1. Alignment and Posture promotes optimal balance and maximal body
function.
a. Line of gravity an imaginary vertical line drawn through the bodys
center of gravity.
b. Center of gravity point at which all of bodys mass is centered.
c. Base of support foundation on which the body rests.
d. Balance is obtained when line of gravity passes through center of
gravity and base of support.
2. Joint Mobility
a. Joints functional units of musculoskeletal system.
b. Range of Motion maximum movement possible for the joint.
c. Types of Joint Movements:
i. Flexion decreasing the angle of the joint; bending the elbow.
ii. Extension increasing the angle of the joint; straightening
elbow.
iii. Hyperextension further extension of joint; bending head
backwards.
iv. Abduction movement of bone away from midline of the body.
v. Adduction movement of bone toward midline of the body.
vi. Rotation movement of bone round central axis.
vii. Circumduction movement of distal part of bone in a circle.
viii. Eversion turning sole of foot outward by moving ankle joint.
ix. Inversion turning sole of foot inward by moving ankle joint.
x. Pronation moving the bones of the forearm so that the palm of
the hand faces downward when held in front of the body.
xi. Supination moving the boned of the forearm so that the palm
of the hand faces upward when held in front of the body.
3. Balance
a. The mechanisms involved are complex and involve informational
inputs from:
i. Labyrinth (inner ear)
ii. Vision (vestibule-ocular input)
iii. Stretch receptors (vestibulospinal input)
b. Mechanisms of equilibrium = sense of balance.

NCM NOTES: ACTIVITY AND EXERCISE

c. Proprioception term used to describe awareness of posture,
movement, and changes in equilibrium and the knowledge of position,
weight and resistance of objects in relation to the body.
4. Coordinated Movement smooth, purposeful movement result of:
a. Cerebral Cortex initiates voluntary motor activity.
b. Cerebellum coordinates motor activities of movement.
c. Basal Ganglia maintains posture.
EXERCISE

Physical activity bodily movement that enhances health.

Exercise type of physical activity defined as planned, or structured and
repetitive bodily movement performed to improve health and maintain fitness
to achieve an optimal state of health.

GOALS OF EXERCISE

To decrease risk factors for cardiovascular disease

To increase health and well-being
Functional strength ability of body to perform work.
Activity tolerance type and amount of exercise an individual is able to
perform without experiencing adverse effects.

TYPES OF EXERCISE (classified according to the muscle contraction):

1. Isotonic (dynamic) exercise muscle shortens to produce muscle contraction
and active movement; strengthen and improve joint mobility.
a. Ex: running, walking, ADLs and active ROM exercises initiated by client.
b. Heart rate and cardiac output quicken to increase blood flow.
2. Isometric (static or setting) exercise muscle contraction without moving
joints; exerting pressure against a solid object.
a. Ex: Quad sets
b. Mild increase in heart rate and cardiac output, no increase in blood
flow.
3. Isokinetic (resistive) exercise muscle contraction against resistance; used in
physical conditioning; done to build up muscle groups.
a. Ex: Use of special machines or devices.
b. Increase in blood pressure and blood flow to muscles.
4. Aerobic exercise activity which the amount of oxygen taken into the body is
greater than that used to perform the activity; use large muscle groups to
move repetitively; improve cardiovascular conditioning and physical fitness.
a. Intensity of exercise:
i. Target heart rate
ii. Talk test
iii. Borg scale of perceived exertion
5. Anaerobic exercise activity which the muscles cannot draw out enough
oxygen from bloodstream; anaerobic pathways are used to provide additional
energy

NCM NOTES: ACTIVITY AND EXERCISE

a. Ex: Endurance training, weight lifting, sprinting.
b. Short exertion, high-intensity movement
BENEFITS OF EXERCISE TO:
1. Musculoskeletal system
a. Size, shape and tone of muscles are maintained with mild exercise and
increased with strenuous exercise.
b. Hypertrophy enlarge
c. Joints have increased blood supply through exercise (joint mobility).
d. Bone density and strength is maintained through weight-bearing
exercises.
2. Cardiovascular system regular exercise increases heart rate and
strengthens muscle contraction of heart. Exercise provides increased cardiac
output.
3. Respiratory system ventilation and oxygen intake increase during exercise.
4. Gastrointestinal system exercise can improve appetite and facilitate
peristalsis.
5. Endocrine system exercise elevates metabolic rate, thus increasing the
production of body heat and waste products and calorie use.
6. Urinary system with adequate exercise, body excretes wastes more
effectively.
7. Immune system lymph fluid is more efficiently pumped from tissues into
lymph capillaries.
8. Psychoneurologic system exercise can elevate a persons mood and relieve
stress.
a. Relaxation response can be elicited through deep relaxation
breathing; healthful psychological state.
9. Cognitive function physical exertion induces cells in the brain to strengthen
and build neuronal connections, thus improving decision making, etc.
10.Spiritual health yoga improves the mind-body-spirit relationship with God
FACTORS AFFECTING BODY ALIGNMENT AND ACTIVITY
Growth and Development a persons age affect posture, body proportions,
etc.
o Osteoporosis condition which the bones become brittle due to
calcium depletion.
Nutrition undernutrition and overnutrition can influence body alignment and
mobility.
Personal Values and Attitudes families can influence one to do exercise or
not; choices.
o Individualized exercise prescriptions tailor exercise mode and dose
and address; encourage patients to exercise.
External Factors temperature or humidity can affect a persons mobility.
Prescribed Limitations medically prescribed limitations to promote healing
(ex: casts)

NCM NOTES: ACTIVITY AND EXERCISE

o

Bed rest strict confinement to bed or given privileges to go bathroom.

EFFECTS OF IMMOBILITY

Paresis paralyzed
Spastic with too much muscle tone
Flaccid without muscle tone

1. Musculoskeletal System
a. Disuse osteoporosis bones become spongy and may gradually
deform easily.
b. Disuse atrophy unused muscles decrease in size, losing normal
functions.
c. Contractures permanent shortening of the muscle due to immobility.
d. Stiffness and pain in the joints collagens become anklyosed
(permanently immobile).
2. Cardiovascular System
a. Diminished cardiac reserve immobility can cause tachycardia.
b. Increased use of the Valsalva maneuver refers to holding of breath in
movement.
c. Orthostatic (postural) hypotension common result of immobilization
d. Venous vasodilation and stasis incompetent valves
e. Dependent edema some of the serous part of the blood is forced out
of the blood vessel into the interstitial spaces surrounding blood
vessels, causing edema.
f. Thrombous formation thromboplhetibis (clot that is loosely attached
to an inflamed vein wall)
3. Respiratory System
a. Decreased respiratory movement ventilation of lungs in altered.
i. Vital capacity maximum amount of air that can be exhaled
after a maximum inhalation.
b. Pooling of respiratory secretions interfering with the normal diffusion
of oxygen and carbon dioxide in the alveoli.
c. Atelectasis collapse of a lobe or an entire lung.
d. Hypostatic pneumonia severely impair oxygen-carbon dioxide
exchange in the alveoli.
4. Endocrine System
a. Decreased metabolic rate as energy requirements of the body
decrease.
i. Metabolism sum of all the physical and chemical processes by
which living substance is formed and energy is maintained in the
body.
ii. Basal metabolic rate minimal energy expended for the
maintenance of these processes.
b. Negative nitrogen balance imbalance between anabolism and
catabolism.

NCM NOTES: ACTIVITY AND EXERCISE

5.

6.
7.

8.

i. Anabolism protein synthesis.

ii. Catabolism protein breakdown.
c. Anorexia loss of appetite accompanying decreased metabolic rate
and negative nitrogen balance.
d. Negative calcium balance direct result of immobility.
Urinary System
a. Urinary stasis stoppage or slowdown of flow occurs after few days of
bed rest.
b. Renal calculi stones.
c. Urinary retention accumulation of urine in the bladder; urinary
incontinence.
d. Urinary infection static urine provides an excellent medium for
bacterial growth.
i. Urinary reflux backward flow.
Gastrointestinal System
a. Constipation decreased peristalsis and colon motility.
b. Excessive use of Vasalva maneuver
Integumentary System
a. Reduced skin turgor skin can atrophy as a result of prolonged
immobility.
b. Skin breakdown immobility impedes circulation and diminishes the
supply of nutrients to specific areas. Ex: Pressure or decubitus ulcers.
Psychoneurologic System
a. People who are unable to perform on their own become dependent on
others, which can result to lower self-esteem.
b. Problem-solving and decision-making abilities may deteriorate.

ACTIVITY AND EXERCISE PROBLEMS:

1. Activity Intolerance insufficient physiological or psychological energy to
endure or complete required or desired daily activities.
2. Risk for Activity Intolerance at risk for experiencing insufficient physiological
or psychological energy to endure or complete required or desired daily
activities.
3. Impaired Physical Mobility limitation in independent, purposeful physical
movement of the body or of one of extremities.
4. Sedentary Lifestyle reports a habit of life that is characterized by a low
physical activity level.
5. Risk for Disuse Syndrome at risk for deterioration of body systems as the
result of prescribed or unavoidable musculoskeletal inactivity.

Body mechanics the term used to describe the efficient, coordinated, and
safe use of the body to move objects and carry out ADLs.
Pivoting technique in which the body is turned in a way that avoids twisting
of the spine.
Ambulation act of walking.

NCM NOTES: ACTIVITY AND EXERCISE

DIFFERENT BED POSITIONS:
1. Fowlers position semi-sitting position.
2. Orthopneic position sits with pillow on lap.
3. Dorsal recumbent position head slightly elevated by placing a pillow
underneath.
4. Prone position abdomen on the bed.
5. Lateral position side-lying position.
6. Sims position semiprone position; between lateral and prone position.