07.03 Types of Exercise

Overview

  1. Exercise
    1. Benefits of exercise
    2. Mechanics
    3. Types of exercise
    4. Nursing considerations

Nursing Points

General

  1. Benefits
    1. Heart and lung improvement
      1. Improved cardiac efficiency
      2. Improved lung capacity
      3. Decrease in hypertension
    2. Increases strength and mobility
      1. Improves:
        1. Coordination
        2. Alignment
        3. Balance
        4. Endurance
    3. Burns fat
      1. Improves body composition
    4. Cognitive functions
      1. Improves mood
      2. Enhances memory
      3. Slows neurodegenerative decline
  2. Mechanics
    1. PROM (Passive Range of Motion)
      1. Done by the provider
      2. Used immediately after surgery
      3. Improves mobility
      4. Reduces swelling
    2. AROM (Active Range of Motion)
      1. Done by the patient
      2. Engages muscles fibers
      3. Builds strength
      4. More challenging
  3. Types of exercise
    1. Isotonic
      1. Goes through range of motion
      2. Builds muscle
      3. Strengthens bones
      4. Improves strength at different ranges of motion
      5. Usually used with repetition
      6. Ex: Bicep curls, squats, pushups
    2. Isometric
      1. No movement through a range of motion
      2. Great for rehab
      3. Requires little time
      4. Ex: Planks, yoga poses, wall sits
    3. Aerobic
      1. With oxygen
      2. Jogging, biking or swimming
      3. Benefits
        1. Increases endurance
        2. Improves cardiac function
        3. Lowers blood pressure
        4. Regulates weight
    4. Anaerobic
      1. Without oxygen
      2. Benefits
        1. Improves strength
        2. Burns fat
        3. Builds muscle
      3. Ex: Sprinting or weight lifting
  4. Nursing considerations
    1. Consider patient beliefs about exercise
    2. Understand patient’s knowledge
      1. Misinformation promotes noncompliance
    3. Exercise tolerance
      1. Impacted by diagnosis, disease or illness
      2. Influenced by patient’s overall ability to complete exercise

Assessment

  1. Assess patient’s knowledge about exercise
    1. Fill gaps of knowledge with evidence
  2. Assess patient’s ability to complete exercise
    1. Examine range of motion, weight bearing, and tolerance to challenge
    2. Consider cardiovascular ability
    3. Consider injury or limitations in range of motion

Therapeutic Management

  1. Use active range of motion for patients who are capable after surgery, during rehabilitation
  2. Use passive range of motion for patients with mobility problems
  3. Employ speciality disciplines such as physical and occupational therapists for evaluation and treatment plans
    1. Follow up on exercises and education for reinforcement

Nursing Concepts

  1. Health Promotion
  2. Mobility
  3. Safety

Patient Education

  1. Educate patient on proper body mechanics
  2. Educate patient on proper exercise based on:
    1. Needs
    2. Activity level
    3. Goals
    4. Tolerance
    5. Mobility
  3. Reinforce education provided by PT/OT

Reference Links

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Video Transcript

In this lesson, we’re going to take a look at different types of exercise for your patients.

Alright guys, I’m really excited to go over this lesson. This is one of my favorite topics, both as a nurse and personally.

When we talk about exercise, I want you to think about exercise and the patient, not just exercise as a whole. There are tons of different exercises, but let’s cater those to our patients needs.

Let’s look at the benefits of exercise, because this is the information you’re going to pass to your patients.

Exercise solidly supports heart and lung function. It reduces blood pressure, improves cardiac output, improves lung performance and overall endurance. Exercise also strengthens the entire body, not just muscle. It improves mobility in joints and limbs, improves joint pain and also helps build up the supportive tissue around muscle and joints. Exercise also burns fat.

And some of the most interesting information about exercise is that it helps to improve cognitive functions. It helps with mood, depression, neurodegenerative diseases like Parkinson’s disease and helps with sleep. Now that we’ve looked at some overall benefits of exercise, let’s get into some mechanics.

When we talk about mechanics (or body motion), how a particular body part moves, or range of motion. You have passive and you have active.

With passive range of motion, it’s done by the provider. So think about a patient with a recent knee surgery. The physical therapist will come in and work on bending the knee through all angles. Passive range of motion is really utilized after surgery and sometimes with chronic issues, maybe like edema. It improves mobility and decreases swelling.

With active range of motion, it’s done by the patient. The way to remember the difference is that the patient “activates” the muscles through their own use. Because they’re using their own resistance they focus on building strength. You’d see this more in your rehab setting after the knee surgery. It’s definitely more challenging for the patient, but that’s because it really forces the patient to use their own muscles.

Now that we’ve covered range of motion, let’s look at how we build on that by looking at different types of exercise.

Let’s first look at isotonic versus isometric exercises. Isotonic exercise is what you think of when you think about exercising – it’s the actual movement, especially through the range of motion. Think of a bicep curl. You lift the dumbbell up, and then lower it down, with resistance all the way through. That’s an isotonic exercise. This one is definitely beneficial for rehab on surgeries like knee replacement.

Isometric exercises focus on a single contraction, with no range of motion. So think planks or yoga poses or stretching. Kegels are another one. It focuses on the most intense part of the contraction. It’s also great for mobility too.

Another concept we want to look at is aerobic versus anaerobic exercises. First off, the main difference is oxygen. It’s exercise with or without the presence of oxygen. Your aerobic exercises are things like running, jogging, or swimming and it requires oxygen to perform them, because they are longer lasting exercises. Aerobic exercises improve heart performance, build endurance, burn fat and lowers blood pressure. Aerobic exercises are done without oxygen, and they’re done for really short periods of time. So, things like weight lifting or sprinting – really intense exercise. These exercises build muscle and strength in muscle and bone, and they also work to burn fat as well.

The big thing you need to know though are how these exercise types fit into your patient’s plan of care. And we’ll look at things you need to consider next.

The first thing you need to do is understand how your patient views exercise. Do they want to learn? Are they willing? Also what do they understand about exercise? They may think they need to look like Arnold everytime they go to the gym, and that’s not true. Using the incentive spirometer after any surgery is considered an exercise. So make sure you dispel any myths or rumors about it.

The other thing to think about is how well will your patient do with exercise. How tolerant are they? If your patient is in heart failure and has blood pressure issues, don’t expect to throw them on a treadmill at 10 miles per hour. What level of activity can they tolerate? Physical therapists are great at pushing your patient’s limits, but they do it to encourage rehabilitation, not to torture them. So consider their illness, injury or disease, and how well they’ll tolerate any exercise overall.

And like I said about physical and occupational therapists, they do a great job. They’ll work hard with your patients to formulate plans and exercises. Just make sure you’re encouraging those plans, and also to make sure your patient is performing them correctly. If you have a question about one of them because you’re unsure, grab PT or OT and have them re-educate the patient and you watch them, so that you get a proper lesson too.
Ok, so let’s recap.

Remember all of the benefits of exercise. Improved heart and lung function, better cognition, improved sleep, and strength and mobility.

Passive range of motion is the provider helping the patient move through range of motion, where active range of motion is the patient “actively” moving the muscles.

Remember that aerobic exercise are your longer lasting exercise that require oxygen, and anaerobic exercises are your shorter ones that are without.

Find out what your patient knows and understands about exercise and fill in the gaps.

Most importantly, know your patient’s level of tolerance and make sure that use your nursing judgment to encourage them through appropriate exercises, and ask the other healthcare providers for plans if you need to.

That’s it for our lesson on types of exercise. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 10

An interdisciplinary team works in pulmonary rehabilitation to provide education and pulmonary support to respiratory care clients and their families. Part of the rehabilitation process is reviewing a log or journal with the client for recording exercises that the client performs at home. Which member of the team would most likely be responsible for reviewing this information with the client?

  • Question 2 of 10

A 68-year-old client with COPD is being seen for pulmonary rehabilitation. The nurse is instructing the client on exercise guidelines for managing the disease. Which information must the nurse include as part of exercise guidelines for this client?

  • Question 3 of 10

A 67-year-old client tells the nurse that he used to run marathons, but no longer has the stamina to run as far. Which of the following changes in exercise tolerance are associated with the aging process? Select all that apply.

  • Question 4 of 10

A 19-year-old college student is seen in the university health clinic for symptoms of dehydration and weight loss. The client is a member of the school’s track team and spends several hours a day training. Which information should the nurse give to this client to prevent dehydration associated with excessive exercise?

  • Question 5 of 10

A nurse is helping an immobile client by performing passive range of motion exercises. Which of the following principles should the nurse keep in mind when performing these exercises?

  • Question 6 of 10

The nurse is caring for a client who has recently finished chemotherapy. The client asks if it is appropriate to begin exercising. Under which conditions would exercise be contraindicated for this client? Select all that apply.

  • Question 7 of 10

A client who had a total knee replacement has returned from the surgical procedure with a CPM machine in place for range-of-motion exercise. The client asks the nurse why he needs to wear the machine. Which of the following responses from the nurse is correct?

  • Question 8 of 10

A nurse is caring for a client who had foot surgery and who has returned to the clinic for a follow up appointment. The nurse is instructing this client about performing range of motion exercises in his toes to promote circulation. Which of the following range of motion exercises can be performed using the toes? Select all that apply.

  • Question 9 of 10

A client who sustained a fractured arm requires range-of-motion exercises to promote circulation. The nurse educates the client about performing active range of motion. Which of the following best describes how this motion is performed?

  • Question 10 of 10

A patient has a new prescription for propanolol (Inderal). The patient tells the nurse that he is training for a 10K and wants to know if he can still exercise. Which information is true regarding beta blockers and exercise? Select all that apply.

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