CHAPTER 44 / Activity and Exercise 1113

Benefits of ExerciseIn general, regular exercise is essential for maintaining mentaland physical health.

Musculoskeletal SystemThe size, shape, tone, and strength of muscles (including theheart muscle) are maintained with mild exercise and increasedwith strenuous exercise. With strenuous exercise, muscles hy-pertrophy (enlarge), and the efficiency of muscular contractionincreases. Hypertrophy is commonly seen in the arm muscles ofa tennis player, the leg muscles of a skater, and the arm and handmuscles of a carpenter.

CULTURALLY COMPETENT CARE Therapeutic Movement Modalities from Eastern Cultures

Therapeutic movement modalities from eastern cultures are finding aplace in evidence-based health care. In particular, hatha yoga, qigong,and t’ai chi are receiving wide attention for improving strength and bal-ance as well as treating a wide variety of health problems. Hatha yoga,developed in ancient Hindu culture, is a series of physical exercises,breath control, and meditation that tone and strengthen the whole per-son—body, mind, and spirit (Figure 44-32 ■). The beauty of yoga is thatit can be fully practiced by those who must use a wheelchair or remainin bed.

Qigong is a Chinese discipline that involves breathing and gentlemovements of mostly arms and torso. The regular practice of qigongis intended to generate as well as conserve energy to maintain healthor treat illness.

T’ai chi was derived from qigong and combines physical fitness,meditation, and self-defense. Although developed as a martial art, it ispracticed today mostly for health promotion (Micozzi, 2006). In China,it is common to see people of all ages, including older adults, practicingthese movement disciplines outdoors in public parks (Figure 44-33 ■).

In several studies investigating immune effects of qigong practice,levels of white blood cells, monocytes, and lymphocytes increasedsignificantly after training. In an investigation with hypertension clients,both systolic and diastolic blood pressure, norepinephrine,metanephrine, and epinephrine levels were significantly reduced inthe group given qigong training versus those in the control group. Inthis same study, ventilatory functions were also improved in the qigong group. In a randomized study it was found that older adults prac-ticing t’ai chi had an increase in varicella zoster virus cell-mediated im-munity and thus, decreased risk for the virus (Freeman, 2004). Aquasi-experimental, randomized controlled study of 54 persons withhypertension revealed significant decreases in both systolic and dias-tolic blood pressure, self-reported stress, heart rate, and body mass in-dex after 8 weeks of yoga practice (McCaffrey et al. 2005).

Nurses can independently recommend that clients who are ableto do so consider initiating these movement modalities. Through ap-propriate referrals to group classes in the community as well as theuse of videotapes in homes and long-term care facilities, clients cantake charge of their own health in ways that are empowering, holistic,and free of negative side effects. Nurses should assess each individ-ual for readiness, safety issues, balance, and ability to engage in anyphysical activity.

Figure 44-32 ■ Woman in a yoga stretch.Figure 44-33 ■ Men and women practicing t’ai chi outdoors inLeshan, China.

Joints lack a discrete blood supply. It is through activity thatjoints receive nourishment. Exercise increases joint flexibility,stability, and range of motion. A growing number of random-ized, controlled clinical trials have shown that exercise inter-ventions significantly reduce weakness, frailty, depression, andthe risk and incidence of falling in elderly people (Burke &Laramie, 2004).

Bone density and strength is maintained through weightbearing. The stress of weight-bearing and high-impact move-ment maintains a balance between osteoblasts (bone-buildingcells) and osteoclasts (bone-resorption and breakdown cells).Examples of non-weight-bearing exercise include swimmingand bicycling. In its 2005 report entitled “Move It or Lose It,”

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