• lowers resting blood pressure
• improve lipoprotein profile, C reactive protein and coronary heart disease biomarkers
• enhance insulin sensitivity
• play a role in weight management
• preserves bone mass and reduces the risk of falling
• increase joint flexibility/ range of motion
• maintain and improve balance, agility and coordination.
• prevent mild to moderate depressive disorders and anxiety
• enhance feeling of energy and well being
• lower risk of cognitive decline and dementia
• overall improves the quality of life for individuals

Muscle strength and endurance

body composition

joint flexibilty

cardiorespiratory fitness

Neuromotor fitness

ISOTONIC

•  cause muscle contraction and change in muscle length
• enhance circulatory and respiratory function
• increase muscle mass, tone, and strength
• Promote osteoblastic activity

• walking
• swimming
• jogging
•  bicycling

• alternately tightening or tensing muscles, then relaxing without moving body parts.
• increase muscle mass, tone and strength thus decreasing the potential for muscle wasting
• increase circulation to the involved muscle only

• kegel exercises
• tightening abdominal muscles

• contraction of the muscle while pushing against a stationary object or resisting the movement of a object
• increase muscle strength
• provide sufficient stress against bone to promote osteroblastic activity

Examples of Resistive isometric

• pushing up from a chair
• lifting weights

• running
• aerobic exercise
• jogging on treadmill

• should be done to point of resistance and not beyond
• stop if patient experiences pain
• perform in order
• do each exercise 5 times, at least twice a day

• anyone over 35 with sedentary lifestyle should consult with dr before starting a program
• 5-10 minutes warmup/cool down with stretching
• wear appropriate clothes
• drink adequate fluids
• wait 1.5 to 2.5 hrs after meal to exercise
• stop: pain, pressure in chest, dizziness, fainting, or light headiness

Nursing Responsiblities (Mobility)

• counsel clients to adopt and maintain regular physical activity
• tell them they can still benefit from engaging in amounts of exercise less than recommended
• correct misconceptions
• as a nurse you should not supervise or plan a program for them *only advise*
• AHA has excellent pamphlets on exercise programs

• the ability to move about freely
• can be partial or complete
• the greater extent and duration of immobility= greater consequences

Reason for Immobilty

• severe pain
• impairment of musculoskeletal or nervous system
• generalized weakness
• psychosocial problem (depression)
• infectious process

• reduces the need of the body cells for oxygen
• directs energy toward healing process
• reduces pain
• prevent labor or miscarriage

1. presence of pain?
2. change in mobility or balance?
3. presence of fatigue, sob, chest pain with movement?
4. history of falls?
5. adl's?

• decrease metabolic rate
• anorexia
• calcium resorption, increase calcium in the circulation and can lead to osteroporis and kidney stones
• negative nitrogen balance- causes weight loss, decreased muscle mass, weakness

• decrease in quality and quantity of sensory input
• client has an increase awareness of limitations imposed by immobility
• can lead to behavioral, social, and emotional, and intelluctual changes

• boredom
• depression
• impaired coping
• feeling of helplessness/hopelessness
• changes in sleep/wake cycle

• Pulmonary ventilation- inflow and outflow of air between the atmosphere and the alveoli
• Diffusion- oxygen and co2 between the alveoli and pulmonary capillaries
• Transport- oxygen and carbon dioxide via the blood to and from the cells

• bed presses against chest and decreases chest movement
• abdominal organ pushes against the diaphragm
• recombent person rarely sighs
• muscle atrophy affects respiratory muscles
• decrease chest expiration means more shallow respirations with reduced vital capacity

• blood and mucus pools in dependent areas of the lungs which are less effectively ventilated
• mucus and secretions are more viscous
• coughing mechanism is impaired due to weakened muscles, inability to inhale maximally and decrease ciliary movement-therfore cannot expectorate mucus

• may be due to lack of stimulation of the marrow to produce red blood cells because of immobility
• due to poor nutrition because of anorexia

• elevated temp (slightly)
• increase pulse and respirations
• dyspnea
• cyanosis if severe
• adventitious breath sounds/ absent breath sounds
• xray is done to confirm diagnosis- *white on xray*

• cough
• fever
• pain with breathing (pleuritic pain)
• leukocytosis(increased wbc)
• yellowish sputum, may be greenish
• patchy infiltrate on chest x ray

• slight cough
• fatigue
• rapid respirations

Treatment of Hypostatic Pneumonia

• antibiotics
• more aggressive preventive measures

• reduced force of cardiac contraction and cardiac output- due to reduction in cardiac muscle mass
• resting heart rate increases 0.5 beats each day of immobilization
• supine position makes the heart work harder
• may experience tachycardia, and angina with minimal exertion.

Orthostatic hypotension

• drop in blood pressure 20 or more systolic, 10 or more diastolic- when changing from a sitting, lying, or standing position.
• blood pools in lower extremities due to decrease efficiency of orthostatic neurovascular reflexes
• dizziness, lightheadedness, syncope- due to decreased cerebral perfusion

• used more often when person is immobilized- person uses arms and upper body more
• constipation occurs more often from immobility

Increased incidence of Thrombus formation

• thrombus- clot attached ot a vein
• thrombophlebitis- clot attached to an inflamed vein
• DVT- thrombus in deep veins (lower extremity)
• embolus- dislodged venous thrombus

• venous stasis
• blood hypercoagulability
• endothelial damage (hardening of the artery)

• unilateral edema
• redness, warmth and tenderness around clot
• increased temp -related to inflammation
• if superficial may be firm, palpable, cordlike vein

• sudden onset of unexplained dyspnea, tachypnea, tachycardia
• cough
• chest pain
• hemoptysis
• crackes, fever
• decreased oxygen saturation

late signs

• sudden change in mental status
• massive emboli- cyanosis, shock, pallor,severe dyspnea, crushing chest pain, cardiac arrest

• muscle atrophy- decrease in muscle mass caused by decreased muscle fiber contraction (20% loss after one wk of bed rest)
• disuse osteoporosis- decrease in bone density, results from lack of weight bearing exercise, decrease muscular activity, complex endocrine and metabolic disturbances( starts the 2nd or 3rd day of immobilization)
• contractures- deformity of the joint (fibrosis, ankylosis,foot drop, permanet shortening of a flexor muscle)

• urinary stasis- stagnation of urine in kidney or bladder
• bladder looses muscle tone making it difficult to empty
• lying position impedes emptying from bladder and kidney
• can lead to renal calculi and uti

• stasis of urine
• increased alkalinity of urine
• indwelling catheter- increases risk for uti

• increase calcium in urine
• urinary stasis
• decreased volume in urine
• increased incidence of uti's
• increased alkalinity of urine
• 70% of kidney stones due to immobility are composed of calcium oxalate

• pain in back and flank area
• nausea, vomiting, sweating, pallor
• anxiousness, restlessness
• hematuria

• Hydronephrosis- back flow of urine into the kidney
• Pyelonephritis- infection of kidney itself

• constipation
• fecal impaction
• lack of exercise
• muscle weakness
• decreased fluid intake
• inability to assume normal position for defacation, lack of privacy
• inability to maintain personal habits