Susceptible to experiencing insufficient endurance to complete required or desired daily activities

• Depressive symptoms
• Fear of pain
• Imbalance between oxygen supply/demand
• Impaired physical mobility
• Inadequate muscle mass
• Inexperience with an activity
• Malnutrition
• Muscle weakness
• Pain
• Prolonged inactivity
• Sedentary behaviors
• Unaddressed vitamin D deficiency

• Neoplasms
• Neurodegenerative diseases
• Respiration disorders
• Traumatic brain injuries

• History of present illness
• Past experience with immobility or prescribed bed rest
• Pain
• Environmental factors, including safety hazards
• History of chronic illnesses (cardiopulmonary, cardiovascular, musculoskeletal, and neuromuscular)
• Sensory deficits, including hearing, vision, and tactile
• Psychosocial status, including cognitive and mental status, mood, affect, behavior, family support, and coping style
• Economic status
• Medication history, including use of prescription and over-the-counter medications
• Cardiovascular status, including blood pressure, heart rate, and rhythm at rest and with activity, complete blood count, skin temperature and color, edema, and chest pain or discomfort
• Respiratory status, pulse oximetry, auscultation of breath sounds, pain or discomfort associated with respiration, and rate, rhythm, depth, and pattern of respirations at rest and with activity
• Neurologic status, including level of consciousness; orientation; and mental, sensory, and motor status
• Musculoskeletal status, including range of motion (ROM), muscle size, strength, and tone, and functional mobility as follows:
  • 0 = completely independent
  • 1 = requires use of equipment or device
  • 2 = requires help, supervision, or teaching from another person
  • 3 = requires help from another person and equipment or device
  • 4 = dependent; doesn't participate in activity

• Patient will maintain muscle strength and joint ROM.
• Patient will carry out isometric exercise regimen.
• Patient will communicate understanding of the rationale for maintaining activity level.
• Patient will avoid risk factors that may lead to activity intolerance.
• Patient will perform self-care activities to tolerance level.
• Patient will seek help in performing activities of daily living (ADLs), as needed.
• Patient will demonstrate willingness to perform activities needed to follow prescribed care plan.
• Patient will verbalize acceptance of decreased activity level.
• Patient will experience less discomfort when ambulating, transferring, or performing other activities.
• Patient's blood pressure, pulse, and respiratory rate will remain within prescribed range during periods of activity (specify).

Suggested NOC Outcomes

• Assess patient's level of functioning using the functional mobility scale to determine patient's capabilities.
• Monitor the patient's medication regimen regularly to identify drugs that may cause gait, posture, or ambulatory problems.
• Explain rationale for maintaining or improving activity level. Discuss factors that increase risk of activity intolerance. Education helps patient avoid activity intolerance.
• Encourage patient to become involved in planning care and making decisions related to treatment. Participation in planning enhances patient compliance and self-esteem.
• Help the patient identify activities that are personally meaningful and develop a realistic plan to incorporate meaningful activities into the daily routine to heighten satisfaction with energy expenditure.
• Establish realistic goals for improving the patient's activity level, taking into account the patient's physical limitations and energy level to help improve the patient's quality of life. Keep in mind that in some older patients with chronic conditions, even minimal improvements in activity level are noteworthy.
• Encourage the patient to take part in exercise and social activities as tolerated to increase stamina and decrease social isolation.
• Establish progressive goals to increase ambulation, for example:Older patients may tire easily; therefore, the activity level should be increased gradually.
  • Ambulate 20 ft (6.1 m) three times/day for 1 week
  • Ambulate 40 ft (12.2 m) three times/day for 1 week
  • Ambulate 60 ft (18.3 m) three times/day for 1 week
• Demonstrate the use of assistive devices, such as a cane or walker, shopping cart on wheels, or trapeze, to teach methods of conserving energy and maintaining independence.
• Position patient to maintain proper body alignment. Use assistive devices as needed to maintain joint function and prevent musculoskeletal deformities.
• Turn and position patient at least every 2 hours. Establish turning schedule for the dependent patient. Post at bedside and monitor frequency. Turning helps prevent skin breakdown by relieving pressure and reduces the risk of atelectasis and pneumonia.
• Assess patient's physiologic response to increased activity (blood pressure, respirations, heart rate, and rhythm). Monitoring vital signs helps assess tolerance for increased exertion and activity.
• Communicate patient's level of functioning to all staff. Communication among staff members ensures continuity of care and enables patient to preserve identified level of independence.
• Unless contraindicated, perform ROM exercises every 2 to 4 hours. Progress from passive to active, according to patient tolerance. ROM exercises prevent joint contractures and muscular atrophy.
• Perform periodic health assessments and monitor for complaints of weakness or fatigue to assess whether acute illness or exacerbation of chronic condition is causing activity intolerance.
• Teach patient how to perform isometric exercises to maintain and improve muscle tone and joint mobility.
• Teach patient symptoms of overexertion, such as dizziness, chest pain, and dyspnea, to help patient take responsibility for monitoring activity level.
• Encourage patient to carry out ADLs. Provide emotional support and offer positive feedback when patient displays initiative. Offering emotional support enhances patient's self-esteem and motivation.
• Assist patient in carrying out self-care activities, turning, and transfer. Increase patient's participation in self-care, as tolerated, to foster independence and improve mobility.
• Modify the environment to maximize independent activity. For example, place the bed on the first floor of the home with easy access to the bathroom, and instruct the patient to obtain and use energy-saving devices, such as an elevated toilet seat, trapeze bar on the bed, and a chair with arms and a seat that raises the patient to standing position, to promote independence.
• Teach patient, family members, or other caregiver methods to maximize patient's participation in self-care. Informed caregivers can encourage patient to become more independent.
• Coordinate the activities of the interdisciplinary team when developing an activity regimen for the patient. For example, the physician can prescribe treatment for the medical condition, a physical therapist can design an exercise program, a dietitian can devise a nutrition plan, and a social worker can locate community resources, such as Meals on Wheels or home health care services. All of these measures address the patient's physical and psychosocial needs.
• Refer the patient to a home health care agency for follow-up care. Encourage the patient to interview and select home health care personnel to foster the patient's sense of independence.

Suggested NIC Interventions

• Functional mobility scale indicates that muscle strength and joint ROM remain stable.
• Patient demonstrates isometric exercises.
• Patient explains rationale for maintaining activity level.
• Patient states at least five risk factors for activity intolerance.
• Patient performs self-care activities in preparation for discharge.
• Patient doesn't exhibit evidence of cardiovascular or respiratory complications during or after activity.

• Patient's expressions of motivation to maintain maximum activity level within restrictions imposed by illness
• Activities performed by patient
• Teaching instructions provided to patient and family member or other caregivers
• Patient's physiologic response to increased activity
• Evaluations for expected outcomes

• Brunjes, D., Kennel, P., & Christian Schulze, P. (2017). Exercise capacity, physical activity, and morbidity. Heart Failure Reviews, 22(2), 133-139.
• Elbehairy, A. F., Ciavaglia, C. E., Webb, K. A., Guenette, J. A., Jensen, D., Mourad, S. M., … O'Donnell, D. E. (2015). Pulmonary gas exchange abnormalities in mild chronic obstructive pulmonary disease. Implications for dyspnea and exercise intolerance. American Journal of Respiratory and Critical Care Medicine, 191(12), 1384-1394.
• Fox, M. T., Sidani, S., Brooks, D., & McCague, H. (2018). Perceived acceptability and preferences for low-intensity early activity interventions of older hospitalized medical patients exposed to bed rest: A cross sectional study. BMC Geriatrics, 18, 53.
• Liu, S., Marcinek, D., Liu, S. Z., & Marcinek, D. J. (2017). Skeletal muscle bioenergetics in aging and heart failure. Heart Failure Reviews, 22(2), 167-178.