An acquired mode of behavior that is characterized by waking hour activities that require low energy expenditure

Average daily physical activity is less than recommended for age and gender

Chooses a daily routine lacking physical exercise

Does not exercise during leisure time

Expresses preference for low physical activity

Performs majority of tasks in a reclining posture

Performs majority of tasks in a sitting posture

Physical deconditioning

NANDA-I approved*

Pathophysiologic

Related to:

Decreased endurance secondary to obesity

Pain

Impaired Physical Mobility

Situational (Personal, Environment)

Conflict between cultural beliefs and health practices*

Decreased Activity Tolerance *

Difficulty adapting areas for physical activity*

Exceeds screen time recommendations for age*

Inadequate interest in physical activity*

Inadequate knowledge of consequences of sedentarism*

Inadequate knowledge of health benefits associated with physical activity*

Inadequate motivation for physical activity*

Inadequate resources for physical activity*

Inadequate role models*

Inadequate social support*

Inadequate time management skills*

Inadequate training for physical exercise*

Low self-efficacy*

Low self-esteem*

Negative affect toward physical activity*

Parenting practices that inhibit child's physical activity*

Perceived physical disability*

Perceived safety risk*

Adolescents

Individuals aged ≥ 60 years

Individuals living in urban areas

Individuals living with a partner

Individuals with high educational level

Individuals with high socioeconomic status

Individuals with significant time constraints

Married individuals

Women

AUTHOR'S NOTE

This is the first nursing diagnosis submitted by a nurse from another country and accepted by NANDA. Congratulations to J. Adolf Guirao-Goris of Valencia, Spain (*2004).

The individual will verbalize intent to or engage in increased physical activity, as evidenced by the following indicators:

• Sets a goal for weekly exercise.
• Identifies a desired activity or exercise.

Level 1 Fundamental Focused Assessment (all settings)

Subjective

Review routine activities

Cleaning, walking a pet, yard work

Work-related activity level

Planned exercise (walking, biking, exercise machine, yoga) frequency; solo? group?

Reports fatigue, shortness of breath with increased activity

Level 2 Extended Focused (nonacute, community)

Emphasize new guidelines report that one can have health benefits from any amount of physical activity. Examples of everyday opportunities to increase physical activity, such as:

• Park further from stores, get off public transportation earlier than regular stop, and walk. Walk down steps. Divide a project into parts such as gardening and weeding a small area and then resting to reduce fatigue, increase motivation, and participation.
• Try to have an "activity buddy" to increase motivation.
• Advise that gym membership is not the only method to exercise.

R:Physical Activity Guidelines for Americans (2018) reports that individuals can benefit from small amounts of moderate-to-vigorous physical activity throughout the day that counts toward meeting the guidelines. The second edition removes this requirement to encourage Americans to move more frequently throughout the day as they work toward meeting the guidelines.

Discuss Benefits of Exercise

• Improves cognitive functioning and well-being
• Improves body posture and balance
• Preserves lean muscle mass
• Improves self-esteem
• Provides fun, recreation, diversion
• Increases caloric expenditure
• Increases restful sleep
• Reduces caloric absorption
• Increases metabolic rate
• Suppresses appetite
• Reduces depression, stress
• Increases oxygen uptake
• Maintains weight loss
• Increases resistance to age-related physiologic changes

R:New evidence shows that physical activity hasimmediate health benefits. For example, physical activity can reduce anxiety and blood pressure and improve quality of sleep and insulin sensitivity.

Review the current long-term age-related health benefits of physical activity (those in bold type are new findings) (U.S. Department of Health and Human Services, 2018):

• Improved cognition, bone health, fitness, and heart health. It can also reduce the risk of depression.
• Helps prevent 8 types of cancer (bladder,* breast, colon, endometrium,* esophagus,* kidney,* stomach,* and lung*); reduces the risk of dementia* (including Alzheimer's disease*),
• Reduces all-cause mortality from heart disease, stroke, high blood pressure, type 2 diabetes, and depression; and improves bone health, physical function, and quality of life, can decrease pain for those with osteoarthritis,
• Reduces disease progression for hypertension and type 2 diabetes,
• Reduces symptoms of anxiety and depression, improves cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson's disease
• Also lowers the risk of falls and injuries from falls.
• For pregnant women, physical activity reduces the risk of postpartum depression.
• For all age groups, physical activity reduces the risk of excessive weight gain and helps people maintain a healthy weight.

R:Mandolesi et al. (2018) reports that much evidence shows that physical exercise (PE) is a strong gene modulator that induces structural and functional changes in the brain, determining enormous benefit on both cognitive functioning and well-being.

Harvey et al. (2018) found that regular leisure-time exercise of any intensity provides protection against future depression, but not anxiety. Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.

Review the assessment of their exercise levels. Explore with individual: How can they increase their activity levels? Assist to Identify Realistic Exercise Program. Consider:

R:The individual is responsible for choosing a healthy pattern of living. The nurse is responsible for explaining the choices:

• Physical limitations (e.g., range of motion, balance, chronic diseases that affect oxygenation)
• Personal preferences (walking, stationary bicycle, road bicycle)
• Lifestyle (best time to exercise)
• Community resources (e.g., safe places to exercise)

If involved in aerobic exercise, explain how to monitor pulse before, during, and after exercise to assist them to achieve target heart rate and not to exceed maximum advisable heart rate for age.

Advise to stop exercising if they experience chest pain, shortness of breath, or lightheadedness.

R:These sign/symptoms can indicate an underlying condition, such as coronary artery disease, stroke, high blood pressure, or other heart or lung problems. Advise to seek medical advice.

Explain a regular exercise program should:

• Be enjoyable
• Use a minimum of 400 calories in each session
• Sustain a heart rate of approximately 120 to 150 bpm unless advised otherwise from health professional
• Involve rhythmic, alternating contracting and relaxing of muscles
• Be integrated into the lifestyle of 4 to 5 days/week for at least 30 to 60 minutes
• Include activities that improve endurance, strength, balance, and flexibility

R:Most people tend to focus on one activity or type of exercise and think they are doing enough. Each type is different, though. Doing them all will give you more benefits. Mixing it up also helps to reduce boredom and cut your risk of injury. Any increase in activity also increases energy output and caloric deficits (National Institute on Aging, 2018).

Discuss Aspects of Starting the Exercise Program

R:Vigorous exercise sessions should include a warm-up phase (10 minutes at a slow pace), endurance exercise, and a cooldown phase (5 to 10 minutes of a slow pace and stretching).

• Start slow and easy; obtain clearance from a physician, nurse practitioner, or physician assistant.
• Read, consult experts, and talk with friends/coworkers who exercise.
• Plan a daily walking program:
  • Start at 5 to 10 blocks for 0.5 to 1 mile/day; increase 1 block or 0.1 mile/week.
  • Gradually increase rate and length of walk; remember to progress slowly.
  • Avoid straining or pushing too hard and becoming overly fatigued.
  • Stop immediately if any of the following occur:
    • Lightness or pain in the chest
    • Dizziness, lightheadedness
    • Severe breathlessness
    • Loss of muscle control
    • Nausea
• If pulse is 120 bpm at 4 minutes or 100 bpm at 10 minutes after stopping exercise, or if shortness of breath occurs 10 minutes after exercise, slow down either the rate or the distance of walking for 1 week to point before signs appeared and then start to add 1 block/0.1 mile each week.
• Remember, increase only the rate or the distance of walking at one time.
• Establish a regular time for exercise, with the goal of 3 to 5 times/week for 15 to 45 minutes and a heart rate of 80% of stress test or gross calculation (170 bpm for 20 to 29 years of age). Decrease 10 bpm for each additional decade (e.g., 160 bpm for 30 to 39 years of age, 150 bpm for 40 to 49 years of age).
• Encourage significant others to engage in walking program.
• Add supplemental activity (e.g., parking far from destination, gardening, using stairs, spending weekends at activities that require walking).

R:The safest activities for the unconditioned obese person are walking, water aerobics, and swimming.

Older Adults Interventions

CARP'S CUES

Fuzhong et al. (2016) reported falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through evidence-based, exercise-focused fall interventions. Every year, 1 in 3 community-dwelling adults aged 65 and older falls (Ibid).

Differentiating between age-related changes and risk factors that affect the functioning of older people is important. Risk factors, such as inadequate nutrition, fluid intake, exercise, and socialization, can have more influence on functioning than can most age-related changes (Miller, 2019).

Level 2 Extended Interventions (postacute, community)

Explain the benefits of activity/exercise of 150 minutes a week. Explain that every 10 minutes counts. Refer to box below on the benefits of regular physical activity and exercise for older adults.

R:"Focusing on age, problems, and deficits alone limits the exploration of individual strengths, thereby compounding the risk for vulnerability to diminished health and well-being" (McMahon & Fleury, 2012). Some individuals may not be able to walk unassisted, but they still can increase their metabolic rate in a chair with arm and leg exercises.

• Perform ankle-strengthening exercises daily (*Liu & Latham, 2009; Donath et al., 2016):
  • Stand behind a straight chair, with feet slightly apart.
  • Slowly raise both heels until body weight is on the balls of the feet; hold for a count of 3 (e.g., 1 Mississippi, 2 Mississippi, 3 Mississippi).
  • Do 5 to 10 repetitions; increase repetitions as strength increases.
• Walk at least 2 or 3 times a week.
  • Use ankle exercises as a warm-up before walking.
  • Begin walking with someone at side, if needed, for 10 minutes.
  • Increase time and speed according to capabilities.

R:Ankle strengthening and a walking program can improve balance, increase ankle strength, improve walking speed, decrease falls and fear of falling (Donath et al., 2016).