1112 UNIT X / Promoting Physiologic Health
exercise, both heart rate and cardiac output quicken to
increaseblood flow to all parts of the body.
Isometric (static or setting) exercises are those in which
thereis muscle contraction without moving the joint (muscle
lengthdoes not change). These exercises involve exerting
pressureagainst a solid object and are useful for strengthening
abdomi-nal, gluteal, and quadriceps muscles used in ambulation;
formaintaining strength in immobilized muscles in casts or
traction;and for endurance training. An example of isometric bed
exer-cise would be squeezing a towel or pillow between the
kneeswhile at the same time tightening the muscles in the fronts of
thethighs by pressing the knees backwards (see Figure 44-31 ■),
andholding for several seconds. These are often called “quad
sets.”Isometric exercises produce a mild increase in heart rate and
car-diac output, but no appreciable increase in blood flow to
otherparts of the body.
Isokinetic (resistive) exercises involve muscle contraction
ortension against resistance; thus, they can be either isotonic
orisometric. During isokinetic exercises, the person moves
(iso-tonic) or tenses (isometric) against resistance. Special
machinesor devices provide the resistance to the movement. These
exer-cises are used in physical conditioning and are often done
to
build up certain muscle groups; for example, the pectorals(chest
muscles) may be increased in size and strength by liftingweights.
An increase in blood pressure and blood flow to mus-cles occurs
with resistance training (Burke & Laramie, 2004).
Aerobic exercise is activity during which the amount of oxy-gen
taken in the body is greater than that used to perform the
ac-tivity. Aerobic exercises use large muscle groups that
moverepetitively. Aerobic exercises improve cardiovascular
condi-tioning and physical fitness. Assessment of physical fitness
isdiscussed in Chapter 16. The accompanying Client Teach-ing
feature describes frequency, duration, and types of
activityrecommended for healthy adults.
Intensity of exercise can be measured in three ways:
1. Target heart rate. The goal is to work up to and sustain
atarget heart rate during exercise, based on the person’s age.To
determine target heart rate, first calculate the person’smaximum
heart rate by subtracting his or her current agein years from 220.
Then obtain the target heart rate by tak-ing 60% to 85% of the
maximum. Because heart rates varyamong individuals, the tests that
follow are replacing thismeasure.
2. Talk test. This test is easier to implement and keeps
mostpeople at 60% of maximum heart rate or more. When exer-cising,
the person should experience labored breathing, yetstill be able to
carry on a conversation.
3. Borg scale of perceived exertion (Borg, 1998). This
scalemeasures “how difficult” the exercise feels to the person
interms of heart and lung exertion. The scale progresses from1 to
20 with the following markers: 7 � very, very light; 9 � very
light; 11 � fairly light; 13 � somewhat hard; 15 � hard; 17 � very
hard; and 19 � very, very hard.
“Very, very hard” corresponds closely to 100% of max-imum heart
rate. “Very light” is close to 40%. Most peopleneed to strive for
the “somewhat hard” level (13/20), whichcorresponds to 75% of
maximum heart rate.
Anaerobic exercise involves activity in which the musclescannot
draw out enough oxygen from the bloodstream, andanaerobic pathways
are used to provide additional energy for ashort time. This type of
exercise is used in endurance trainingfor athletes such as weight
lifting and sprinting.
Figure 44-31 ■ Example of an isometric exercise for the knees
andlegs. The client sits or lies on a flat surface with the legs
straight out.Using a rolled towel between the knees, the person
pushes the kneestogether and tightens the muscles in the front of
the thighs by forcingthe knees downward and holding for 10
seconds.(Patrick Watson)
CLIENT TEACHING Guidelines and Minimal Requirements for Physical
Activity
FREQUENCY AND DURATION
■ Aerobic: Cumulative 30 minutes or more daily (can be
dividedthroughout the day) of “moderate intensity” movement as
mea-sured by talk test and perceived exertion scale.
■ Stretching: Should be added onto that minimum requirement
sothat all parts of the body are stretched each day.
■ Strength training: should be added onto these minimum
require-ments so that all muscle groups are addressed at least
three timesa week, with a day of rest after training.
TYPE OF EXERCISE
■ Aerobic: Elliptical exercisers, walking, biking, gardening,
dancing,and swimming are recommended for all persons, including
begin-
ners and older adults. Activities that are more strenuous
includejogging, running, Spinning®, power yoga, bouncing, boxing,
andjumping rope.
■ Stretching: Yoga, Pilates, qi gong, and many other flexibility
pro-grams are effective.
■ Strength training: Resistance can be provided with
weights,bands, balls, apparatus, and body weight.
SAFETY
■ Stress the importance of balance and prevention of falls,
proper cloth-ing to ensure thermal safety, checking equipment for
proper function,wearing a helmet and other protective gear, using
reflective devicesat night, and carrying identification and
emergency information.
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