DOW INSTITUTE OF NURSING AND MIDWIFERY

UNIT X:

Activity and Exercise Pattern

Misbah khan
Lecture ,DION&M,DUHS
 Objectives
At the completion of this unit learners will be able to:
1. Define terms mobility, joint mobility, body alignments and body
mechanics.
2. Discuss the benefits of activity and exercise.
3. Identify the principles of gravity that affects balance.
4. Discuss factors affecting mobility.
5. Discuss the effects of immobility on human body.
6. Review A&P of muscular skeletal system and characteristics of
normal movement.
7. Describe the impact of immobility on Physiologic and
Psychological functioning.
8. Apply nursing process while planning for the client with altered
muscular skeletal system.
 Anatomy And Physiology of Muscular
Skeletal System
• The musculoskeletal system is made up of bones, cartilage,
ligaments, tendons and muscles, which form a framework for
the body.
• Tendons, ligaments and fibrous tissue bind the structures
together to create stability.
– ligaments connecting bone to bone
– tendons connecting muscle to bone

• These systems work together to provide support, movement,

and protection for the body.
 Anatomy And Physiology of Muscular
Skeletal System

• The muscular and skeletal systems work together to support

and move the body.
– The bones of the skeletal system serve to protect the body's
organs, support the weight of the body, and give the body
shape.

– The muscles of the muscular system attach to these bones,

pulling on them to allow for movement of the body.
 Activity Exercise Pattern
• An activity-exercise pattern refers to a person’s routine of
exercise, activity, leisure, and recreation.

• It includes
(a) Activities of daily living (ADLS) that require energy
expenditure such as hygiene, dressing, cooking, shopping,
eating, working, and home maintenance,
(b) the type, quality, and quantity of exercise, including
sports.
 Terminology
• Mobility:
• Mobility refers to the ability of an individual or a body part to
move or be moved freely and without restrictions.
• It encompasses various types of movements, such as :
– walking, running, bending, and rotating joints.

• Joint Mobility:
• Joint mobility specifically refers to the range of motion and
freedom of movement at a particular joint in the body.
• Body Mechanics:
• Body mechanics refers to the efficient use of the body during
activities, such as
– lifting, carrying, pushing, and pulling, to minimize the risk
of injury and maximize physical performance.
– The primary purpose of using proper body mechanics is to
reduce the risk of injury to both the nurse and the patient.
• Principles of Body Mechanics:

• Maintain proper alignment: Keep the back straight and

avoid twisting.
• Use a wide base of support: Stand with feet shoulder-width
apart.
• Bend at the knees: Use leg muscles to lift, not the back.
• Keep objects close to the body: Reduces strain on the back.
• Use assistive devices: Utilize transfer belts, lifts, and other
devices to prevent injury.
• Range of motion (ROM): means the extent or
limit to which a part of the body can be moved around a joint
or a fixed point; the totality of movement a joint is capable of
doing.
• Body Alignments:
• Body alignments refer to the positioning and arrangement of
various body parts in relation to each other, with an emphasis
on maintaining proper posture and balance.

• It involves maintaining a straight and aligned posture, with the

head, shoulders, hips, and feet in proper alignment.
 Body Alignment /Posture
• It promotes optimal balance and maximal body function whether the
client is standing, sitting or lying down.
• - Line of gravity
• - Centre of gravity Maintain Balance
• - Base of support

• When body is well aligned, strain on the joints, muscles, tendons, or

ligaments is minimized and internal structures and organs are supported.
Body Alignment /Posture
Principles Of Gravity That Affects Balance
• Applying the principles of gravity can help individuals improve
their balance, prevent falls, and enhance overall stability
• Center of Gravity:
– The center of gravity is the point at which the body's mass is
evenly distributed.
– In an upright standing position, the center of gravity is located
around the pelvic area.

• Base of Support:
– The base of support refers to the area between the feet that
supports the body's weight.
– A wider base of support provides more stability and balance,
while a narrower base of support decreases stability.
• Line of Gravity:
– The line of gravity is an imaginary vertical line passing
through the center of gravity toward the ground.
– To maintain balance, the line of gravity should pass
through the base of support. When the line of gravity falls
outside the base of support, balance is compromised.
 Benefits of Activity and Exercise
• Regular activity and exercise contribute to overall physical
fitness by improving cardiovascular health, increasing muscular
strength and endurance, enhancing flexibility, and promoting
weight management.
• Physical activity helps to burn calories, build lean muscle mass,
and increase metabolism.
• Exercise releases endorphins, often referred to as "feel-good"
hormones, which can alleviate symptoms of stress, anxiety, and
depression.
• Engaging in regular physical activity boosts energy levels and
reduces fatigue.
• Exercise help to strengthen bones and increase bone density,
reducing the risk of osteoporosis and fractures.
• Physical activity and exercise reduce the risk of heart disease,
stroke, type 2 diabetes and metabolic syndrome.
• Regular physical activity promotes better sleep quality and
duration. it is recommended to avoid vigorous exercise close to
bedtime.
 Factors Affecting Mobility
• A number of factors affect an individual’s body alignment,
mobility, and daily activity level. These include :
• Growth and Development A person’s age and musculoskeletal
and nervous system development affect posture, body proportions,
body mass and body movements.
– Newborn movements are random. All extremities are generally
flexed
– As the neurologic system matures, control over movement
progresses during the first year.
– As age advances, muscle tone and bone density decrease , joints
lose flexibility, and bone mass decreases, particularly in women
who have osteoporosis.
– All of these changes affect older adults’ posture, gait, and
balance.
• Physical Health: Various health conditions or diseases
can impact mobility.
– For example, musculoskeletal disorders like arthritis,
fractures, or spinal cord injuries can limit movement and
mobility.
– Neurological conditions such as stroke, Parkinson's disease,
can also affect mobility.
– Chronic pain, obesity, and cardiovascular problems can
contribute to mobility issues as well.
• Nutrition: Both under nutrition and over nutrition
can influence body alignment and mobility.
– Poorly nourished people may have muscle weakness and
fatigue.
– Vitamin D deficiency causes bone deformity during
growth.
– Inadequate calcium intake and vitamin D synthesis and
intake increase the risk of osteoporosis.
– Obesity can distort movement and stress joints, adversely
affecting mobility.
• Personal Values And Attitudes :.
• In families that incorporate regular exercise in their daily
routine or spend time together in activities, children learn to
value physical activity.
– Values about physical appearance also influence some
people’s participation in regular exercise.
– People who value a muscular build or physical
attractiveness may participate in regular exercise programs
to produce the appearance they desire.
• External Factors • Many external factors affect a person’s
mobility.
– Excessively high/ low temperatures
– Availability of recreational facilities
– Unsafe environment
• Prescribed Limitations • Limitations to movement may be
Medically prescribed for some health problems
– . Eg: patient with plaster of paris
– Bed rest is the choice for certain clients, for example to
reduce metabolic and oxygen needs, to decrease pain.
– Clients who are short of breath may be advised not to
walkup stairs.
Effects of Immobility on Human Body.
• Immobility, or a lack of physical activity and movement,
can have significant effects on the human body.
 Musculoskeletal System:
o Muscle Weakness and Atrophy: Lack of movement and
physical activity can result in muscle weakness and atrophy
(muscle wasting).
o Without regular use, muscles lose strength and mass, which
can impair mobility and functional abilities.
o Joint Stiffness: Immobility can lead to joint stiffness.
Joints may become less flexible and more prone to
contractures (permanent shortening of muscles or tendons),
particularly in weight-bearing areas like hips, knees, and
ankles.
 Cardiovascular System:
o Decreased Cardiovascular Fitness: Immobility
contributes to decreased cardiovascular fitness.
o Without regular physical activity, the heart has to work
harder to pump blood, leading to decreased cardiac output
and impaired circulation.

 Increased Risk of Blood Clots:

o Prolonged immobility increases the risk of developing
blood clots, particularly deep vein thrombosis (DVT).
o Reduced movement slows blood flow, allowing blood to
pool and potentially form clots in the veins.
• Respiratory System:
o Decreased Lung Function: Reduced movement restricts
deep breathing, leading to shallow breathing and increased
risk of complications such as pneumonia and atelectasis
(collapsed lung tissue).
o Increased Risk of Respiratory Infections: Limited
mobility can contribute to a higher risk of respiratory
infections due to reduced lung function, weakened cough
reflex, and decreased clearance of mucus from the airways.
• Integumentary System:
o Pressure Ulcers: Immobility increases the risk of
developing pressure ulcers (bedsores).
• Metabolic System:
o Decreased Metabolic Rate: Immobility is associated with
a decrease in metabolic rate, which can lead to changes in
body composition and weight gain.

• Skeletal System:
o Decreased Bone Density: Lack of weight-bearing
activities and decreased stress on the bones can result in
decreased bone density and increased risk of osteoporosis.
Immobility-related bone loss makes individuals more
susceptible to fractures.
• Psychological Effects:
• Depression and Anxiety: Immobility can lead to feelings of
frustration, helplessness, and social isolation, which may
contribute to depression and anxiety.

• Decreased Cognitive Function:

• Lack of physical activity and stimulation can negatively
impact cognitive function, leading to decreased mental
alertness, attention, and memory.
 Characteristics of Normal Movement
1. Range of Motion: Normal movement involves a full range of
motion at joints. Each joint has a specific range of motion,
including:
– Flexion : Decreasing the angle of the joint (e.g., bending the
elbow)
– Extension: Increasing the angle of the joint (e.g., straightening
the arm at the elbow)
– Abduction: Movement of the bone away from the midline of
the body
– Adduction: Movement of the bone toward the midline of the
body
– Rotation: Movement of the bone around its central axis
– Circumduction: Movement of the distal part of the bone in a
circle while the proximal end remains fixed
2. Coordination: Normal movement is characterized by
coordinated muscle activation and smooth, precise
movements.
3. Strength and Endurance: Adequate muscle strength allows
for controlled movement against resistance, while endurance
enables the ability to sustain activity over time.
4. Postural Stability: Normal movement includes the ability
to maintain a stable and balanced posture during various
activities. It involves proper alignment of body segments and
the ability to make necessary adjustments to maintain
equilibrium.
5. Smoothness and Fluidity: Normal movement appears
smooth, fluid, and coordinated. Movements are devoid of
jerky or uncontrolled motions, and transitions between
different movements are seamless.
 Types of Range of Motion (ROM)

• Passive ROM (PROM):

– Performed by the nurse without client assistance. Helps prevent
joint stiffness and maintain flexibility.
• Active ROM (AROM):
– Performed independently by the client. Maintains joint
flexibility and muscle strength.
• Active-Assistive ROM (AAROM):
– Client performs exercises with some assistance. Suitable for
clients with limited mobility.
 Assessment
• Collect relevant data about the client's musculoskeletal condition,
including:
• Medical history, current symptoms, and any recent injuries or
surgeries.
• Assess the client's mobility, range of motion, strength, and any
limitations or disabilities they may have.
– Assess gait
– Inspect the spine
– Observe range of motion of joints
– Inspect muscles and extremities for size and symmetry
– Assess muscle strength
– Palpate extremities for tenderness
• Evaluate the client's pain level and its impact on their daily
activities.
 Diagnosis
o Analyze the collected data and identify actual or potential
nursing diagnoses related to the altered musculoskeletal
system. For example:
Impaired physical mobility related to musculoskeletal
impairment.
Risk for falls related to muscle weakness and limited
range of motion.
Chronic pain related to musculoskeletal condition.
Self-care deficit related to limited mobility.
 Implementation
o Position the patient to maintain normal body alignment
 Change position every 2 hourly
o Teach to use overhead trapeze
o Offer analgesics 30 mts prior to exercise
o Monitor vital signs before and after activity
o Instruct to stop activity if patient is unable to tolerate
o Keep side rails ,Do not leave the patient un attended
o Provide balance diet : Sufficient proteins,, vitamins and
minerals.
o Increase fluid intake
o Ambulate the patient at the earliest
 Implementation
o Provide education and support to the client and their family
regarding the importance of maintaining proper body
mechanics, performing exercises, and using assistive devices
if necessary.
o Administer prescribed medications for pain management or
other musculoskeletal conditions.
o Assist the client with activities of daily living, such as
bathing, dressing, and mobility exercises.
o Monitor the client's response to interventions and adjust the
plan of care as needed.
 References
• Berman, A., Snyder, S., Kozier, B., & Erb, G. L.
(2020). Kozier and Erb's fundamentals of nursing, volumes 1-
3 (10th ed.).

• White, L., Duncan, G., & Baumle, W. (2010). Foundations of

adult health nursing (3rd ed.). Cengage Learning.