Normal activity patterns

The activity-exercise health pattern deals with behaviors related to exercise, activity, leisure, and recreation. Nurses must consider the wide range of behaviors within this pattern that fall under the general term activity. Activity is anything that requires the expenditure of energy. Some activities require only a small expenditure of energy, whereas others require a great deal of energy.

Basic body functions such as breathing, temperature control, and metabolism expend the least amount of energy. Sitting, resting, watching television, reading, and playing cards or bingo are sedentary activities that require little energy. Activities of daily living (ADL) such as dressing, grooming, eating, bathing, and toileting require a greater expenditure of energy. Cooking, cleaning, driving, and shopping require still more effort and expend more energy. Walking can be a mild or vigorous activity, depending on the pace. Running, swimming, dancing, aerobics, and other forms of active exercise require the greatest energy expenditure. Although the amount and type of exercise an individual performs change over the life span, exercise and activity remain an essential part of life. Persons who were not physically active as young adults are not likely to become physically active as they age. A healthy pattern of activity and exercise should be established early in life to ensure that these behaviors become habitual and are carried into old age.

Exercise helps people look and feel better. Physical activity is necessary to maintain normal joint mobility and muscle tone. When people do not participate in regular activity, all body systems suffer. Preventing mobility problems is easier than trying to overcome the problems when they develop. Older individuals should be encouraged to be as active and independent as possible. Because existing medical conditions may restrict activity, nurses should be aware of any problems that may affect the individual’s ability to participate in activities. Older adults should be assisted to do as much as is permitted.

Many aging individuals remain physically active. Today, it is common to see individuals in their sixties, seventies, and eighties leading active, self-sufficient lives. Aging no longer implies that a person must sit forever in a rocking chair or recliner and vegetate. All one has to do is visit a park or shopping mall early in the morning, where many older adults can be seen walking for their health. Access to golf courses is more difficult because of the amazing number of senior citizens playing 18 holes. Activity is good for people of all ages. Aging may change the type and amount of participation, but more and more people are realizing that active participation in a variety of activities is the best way to maintain high-level function.

Physical activity requires a complex interaction of physiologic processes, primarily those of the neurologic, musculoskeletal, cardiovascular, and respiratory systems. Anything that interferes with the coordination of these systems can alter the ability to participate in physical activity.

Of major importance is the function of the nervous system, which is the primary coordinating system of the body. The brain controls the involuntary activities of the body, including metabolism, respiration, and temperature control. Areas of the brain control the high-level processes of perception and cognition. Before any voluntary activity occurs, individuals must be able to recognize that a need for action exists. Once the need is recognized, the individual must have the desire, as well as the ability, to perform that action. The brain is also the motor control center of the body, and it communicates with the somatic peripheral nervous system. Any physiologic age- or disease-related change that alters the function of the brain’s motor centers or that interferes with the transmission of impulses from the brain to the musculoskeletal system can interfere with activity.

The musculoskeletal system must then be able to respond to these messages from the brain. Normal and pathologic changes in muscles or bones can interfere with normal activity. Even if the nervous and the musculoskeletal systems are intact, problems in the cardiovascular and respiratory systems can lead to alterations in activity. Muscles, including the heart muscle, require an adequate supply of oxygen and nutrients to function properly. Anything that interferes with the oxygen supply to tissues affects a person’s ability to perform activity.

Activity and aging

With advancing age, most people experience some changes in the ability to perform or tolerate activity, and this ability varies widely among older adults. In general, the more active a person has been, the more active he or she remains with aging.

The first change noticed by most aging persons is a decrease in the rate or speed of activity. Things that could be done quickly in the past now take longer. Many older individuals complain that it takes them much longer to dress, shop, or do other simple activities than it used to. Normal aging does not interfere with the transmission of nerve impulses, but it does slow the speed of nerve transmission.

A loss of muscle mass can interfere with activities that require muscular strength. Activities such as moving furniture, lifting bags of groceries, shoveling snow, and vacuuming may be increasingly difficult.

Loss of cushioning cartilage can result in arthritic joint pain, which inhibits motion and makes a person less likely to exercise. Ligaments and tendons become more stiff, contributing to decreased joint flexibility. This can result in problems with performing ADL. Reaching for objects on shelves, dressing, bending to put on shoes, and even washing the feet or back may be difficult.

Agility, the ability to move quickly and smoothly, decreases with age. This may cause difficulty when older adults try to climb ladders or avoid hazards while walking. Dexterity, the ability to perform fine manipulative skills, is also likely to decrease with age. Gross motor skills remain intact longer than do fine motor skills. However, skills that were perfected when younger, such as playing a musical instrument or sewing, may be maintained at a high level if the skills are used regularly.

Decreased stamina is typically seen with aging. This is most often a result of a decrease in oxygen supply to body tissues. Decreased oxygen exchange may be caused by a loss of elasticity in the lungs and a smaller chest cavity. The decreased availability of oxygen may lead to frequent pauses during activity or a slower pace when performing activities.

Coordination of multiple activities is likely to decrease with aging. Activities that require simultaneous perception of many stimuli and quick physical response (such as driving) are often affected. Older individuals with impaired vision and hearing, decreased strength, slow reaction time, and decreased coordination may not be able to safely perform this type of complex activity.

Because these changes appear gradually, most older individuals learn to compensate for or cope with them. Many strategies such as pacing activities, finding alternative methods of performing activities, and simplifying activities demonstrate the capacity of older adults to adapt and adjust.

Nursing Process for Impaired Physical Mobility

Most older adults experience some changes in their ability to perform physical activities. These changes may result from the normal changes of aging or from some pathologic changes.