Physical Activity and Aging

Activity and Exercise

• Activity encompasses any skeletal muscle movement consuming energy, including walking, gardening, dancing, sports, and fidgeting.
• Exercise is a planned, structured, and repetitive form of physical activity aiming for physical fitness improvement.
  • Key characteristics: planned, structured, repetitive
• Exercise types:
  • Aerobic: raises heart rate and breathing, improves cardiovascular health (e.g., brisk walking, jogging).
  • Strength training: builds and maintains muscle mass, enhances balance, coordination and bone density (e.g., weightlifting, resistance bands).
  • Flexibility exercises: improves range of motion and flexibility, reducing injury risk (e.g., yoga, Pilates).
  • Balance exercises: improves balance and coordination, reducing fall risk (e.g., tai chi, standing on one leg).
• Types of physical activity: Occupational, transportation, household/gardening, leisure-time.

Factors Affecting Patient Movement

• Medical conditions:
  • Neurological disorders (stroke, Parkinson's, MS, spinal cord injuries) impact motor function, coordination, balance, and muscle strength.
  • Musculoskeletal disorders (arthritis, osteoporosis, muscle/joint problems) limit range of motion and cause pain during movement.
  • Cardiovascular issues (heart disease, respiratory problems) reduce endurance and limit physical activity.
  • Chronic pain discourages movement.
• Physical factors:
  • Age: natural decline in muscle mass, bone density, and joint flexibility affects movement.
  • Weight: excess weight puts additional stress on joints and muscles, making movement difficult.
  • Physical fitness level: sedentary lifestyle leads to muscle weakness, impacting movement.
• Environmental factors:
  • Accessibility: physical barriers like stairs, uneven surfaces limit mobility.
  • Safety: concerns about falls or injuries discouraging movement, especially in older adults.
  • Climate: extreme temperatures or weather hindering outdoor activity.
• Psychological factors:
  • Pain perception: influences willingness to move
  • Motivation: lack of motivation hinders movement.
  • Fear of falling: significant barrier to movement, especially in older adults.
• Social factors:
  • Social support: encourages physical activity and movement assistance.
  • Access to resources: access to healthcare providers, physical therapists, and exercise facilities facilitates movement.

Barriers to Patient Movement

• Patient-related barriers:

  • Pain (acute or chronic) limits willingness and ability to move.
  • Fear of falling: discourages movement, prevalent in older adults.
  • Fatigue: illness or treatments reduce motivation and energy.
  • Lack of motivation: patients might not understand benefits.
  • Cognitive impairment: affects patient's ability to move.

• Healthcare provider-related barriers:

  • Time constraints: busy schedules and staffing shortages limit mobility interventions.
  • Lack of knowledge or training: some healthcare providers might lack knowledge for early mobility protocols.
  • Concerns about patient safety: potential complications (falls or hemodynamic instability) deter providers from early mobilization.

• Environmental barriers:

  • Physical limitations of the hospital environment (limited space, clutter) hindering movement.
  • Lack of accessibility: physical barriers (stairs, narrow hallways, heavy doors) hinder navigation for patients with mobility limitations.
  • Lack of clear protocols: absence of clear guidelines for early mobility.
  • Lack of interdisciplinary collaboration: communication issues among healthcare providers.

Methods for Overcoming Barriers to Patient Movement

• Pain management: effective strategies to reduce pain and encourage movement.
• Early mobility protocols: implementing standardized protocols for consistent and timely interventions.
• Multidisciplinary collaboration: fostering collaboration among providers (physicians, nurses, physical therapists) for better coordination and outcomes.
• Patient education: educating about early mobility benefits and addressing concerns.
• Supportive environment: modifying hospital environments to be patient-friendly (wider hallways, accessible equipment).
• Addressing staff concerns: providing training and support to improve confidence in implementing early mobility programs.

Benefits of Activity and Exercise

• Physical benefits:

  • Improved cardiovascular health (reduced risk of heart disease, stroke, and high blood pressure).
  • Improved cardiovascular fitness (efficiency of heart and lungs, enabling physical activity with less effort).
  • Increased muscle strength and endurance (improved muscle mass and bone density, preventing age-related muscle loss).
  • Enhanced daily functioning (stronger muscles facilitate everyday activities).
  • Weight management (calorie burning aids weight loss or maintenance).
  • Improved metabolism.
  • Stronger bones (reduced risk of osteoporosis).
  • Reduced risk of chronic diseases (e.g., type 2 diabetes).
  • Reduction in certain types of cancer risk

• Mental benefits: Exercise can reduce stress by releasing endorphins and natural mood boosters. Improve mood and alleviate symptoms of depression and anxiety. Exercise can improve brain function, memory, and cognitive skills. It can improve sleep quality and ease falling asleep.

• Social benefits: Encourage social interaction (group exercise classes, team sports). Achievement of fitness goals enhances self-esteem providing a sense of accomplishment.

Common Movement Disorders

• Chorea: brief, irregular, somewhat rapid involuntary movements.
• Ataxia: affects the brain part controlling coordinated movement, resulting in clumsy movements and balance loss.
• Dystonia: involuntary muscle contractions causing twisting and irregular postures or movements.
• Tremor: rhythmic shaking of body parts.

Causes of Movement Disorders

• Genetics: inherited movement disorders due to altered genes (e.g., Huntington's, Wilson's).
• Medicines: anti-seizure and anti-psychotic medicines can cause movement disorders.
• Illegal drugs or excessive alcohol: individuals abusing illegal drugs like cocaine and excessive alcohol use can cause chorea or ataxia.
• Vitamin deficiency: vitamin B-1, vitamin B-12, or vitamin E deficiency can result in ataxia.
• Medical conditions: thyroid issues, multiple sclerosis, stroke, viral encephalitis, and brain tumors can contribute to movement disorders.
• Head injury: head trauma can cause movement disorders.

Diagnostic Tests for Movement Disorders

• Blood tests: for diagnosing specific movement disorders and ruling out other causes.
• Electromyography (EMG): assesses muscle and nerve health, and electrical activity.
• Electroencephalogram (EEG): checks the electrical activity of the brain.
• Lumbar puncture: analyzes cerebrospinal fluid for diagnosis.
• Muscle biopsy: distinguishes between nerve and muscle conditions.
• Nerve conduction study: measures electrical current flow through the nerve.

Walking Assistive Devices

• Aids for individuals with mobility challenges. Includes canes, walkers, crutches, and gait belts.

Common Patient Positions in the Hospital

• Supine: lying flat on back with face upward.
• Prone: lying on stomach with face downward.
• Fowler's: head of bed raised at 45 degrees.
• Semi-Fowler's: head of bed raised slightly less than 45 degrees.
• Lateral: lying on their side.
• Sims': lying on left side with right knee and thigh flexed.
• Trendelenburg: head of bed lower than the feet.

Range of Motion (ROM)

• Extent to which a body part can be moved. Includes:
  • Active ROM (AROM): patient independently moves the joint using their muscles.
  • Passive ROM (PROM): healthcare professional or caregiver moves the joint for the patient.
  • Active-assisted ROM (AAROM): patient initiates movement with minimal support

Importance of Range of Motion Exercise

• Prevents complications (e.g., contractures, muscle atrophy, stiffness).
• Promotes healing: (improved circulation, and reduced stiffness).
• Maintains function: helps regaining independence in daily life.
• Reduces pain (gentle ROM exercises can help).

The Role of the Nurse in Promoting Physical Activity

• Assessment: evaluate patient's activity level, barriers to exercise, readiness to change, identify medical conditions limiting activity.
• Planning: create individualized exercise plans based on needs, preferences, and abilities. Set realistic achievable goals.
• Implementation: provide education on exercise benefits, assist patients overcome barriers, monitor progress, adjust plans as needed.
• Evaluation: evaluate exercise plan effectiveness, make necessary adjustments.

Nursing Care Plan for Patient with Impaired Mobility

• Assessment (Subjective Data): gather patient's complaints (weakness, fatigue, dizziness, or pain). Patient's perception of limitations due to immobility. Patient, family understanding of the need for activity.
• Assessment (Objective Data): musculoskeletal (decreased muscle strength/range of motion; contractures), cardiovascular (decreased cardiac output, hypotension), respiratory (decreased lung expansion, risk of infections), integumentary (skin breakdown), gastrointestinal (constipation), urinary (stasis, infections), psychosocial (depression, anxiety, social isolation) evaluation.
• Nursing Diagnoses: Risk for impaired skin integrity, impaired physical mobility, risk for constipation, risk for disuse syndrome, risk for fall and injury.
• Expected Outcomes: maintain skin integrity, increase range of motion, prevent complications, improve bowel function, maintain hydration and nutrition.
• Interventions: skin care (repositioning every 1-2 hours, use pressure-relieving devices), cardiovascular (early mobilization, compression stockings, anticoagulants), respiratory (deep breathing, coughing, exercises), musculoskeletal (range of motion exercises, support for weak limbs), gastrointestinal (monitor bowel movements, encourage fluid intake, high-fiber diet), urinary (monitor intake/output, assist with toileting, manage urinary catheters), psychosocial (emotional support, encourage social interaction).
• Evaluation: Monitor patient's skin integrity, assess patient's ability to perform ADLs (activities of daily living), evaluate response to interventions, and adjust the care plan if needed.

This quiz explores the critical aspects of early mobility, pain management, and the role of exercise in enhancing well-being among older adults. It emphasizes the importance of multidisciplinary collaboration and patient education for promoting physical activity. Evaluate your understanding of the benefits of strength training, flexibility, and balance exercises in the context of aging.