• strengthens cardiac muscle
• increases cardiac output
• decreases resting heart rate
• improves venous return 

• maintains and improves muscle tone and strength
• increaes joint flexibility and range of motion
• maintains bone density (through weight bearing)

• improves elveolar ventilation
• decreases breath effort 
• improves diaphragmatic excursion
• O2 intake increased during strenuous exercise 

• improves eppetite
• increases GI tract tone, improving digestion and elimination 

• elevates basal metabolic rate
• reduces triglycerides & cholesterol levels
• increases use of glucose
• increases production of body heat
• burns excess calories 

• promotes effective excretion of wastes 
• helps prevent urine stasis in the bladder

• improves stress tolerance
• produces a sense of well being
• reduces depression 
• improves body image
• enhances quality of sleep 
• increases energy level 

• osteoporosis- bone demineralization with calcium loss
• decrease in muscle size 
• contractures 
• joint deformity 
• stiffness and joint pain 
• frozen joints

• diminished cardiac reserve
• rapid heart rate 
• reduced diastolic pressure 
• reduced coronary blood flow- may produce tachycardia and angina 
• orthostatic (postural) hypotension 
• peripheral venous vasodilation and stasis
• dependent edema 
• thrombus formation 

• decreased lung expansion and vital capacity
• pooling of respiratory secretions 
• inability to cough up secretions
• decreased depth of breathing 
• atelectasis (complete or partial collapse of a lung)
• pneumonia 

• decreased metabolic rate
• increased protein breakdown 
• negative nitrogen balance
• anorexia
• negative calcium balance 

• urinary stasis 
• urinary retention and occasionally urinary incontinence 
• urinary infection 
• renal calculi 

• constipation from decreased peristalsis and weakness of abdominal and perineal muscles 

• reduced skin turgor and skin breakdown 

• low self esteem 
• frustration
• emotional reactins (apathy, withdrawl, anger, aggression....)
• impaired ability to make decisions and solve problems
• anxiety

• Have you noticed any pain in your joints or muscles?
• do you have any weakness or twitching? 
• have you had any recent falls?
• are you able to care for yourself?
• do you exercise or participate in sports?
• do you use any assistive devices? 

• maintain while sitting and standing
• scoliosis, kyphosis

• balance
• ask the patient to sit or stand with eyes closed 
• swaying to one side indicates inability to maintain balance 

• range of motion
• evaluate each joint as it's put through its full range of motion
• note any limitation
• compare the right and left sides for symmetry
• observe any nonverbal signs of discomfort

• measure hand strength by having the client squeeze your wrists 
• measure foot strength by having the client pus the ball of the foot against your hand
• have the client move arms and legs against your resistance
• Then, grade the response 

grading scale for muscle strength 

• 0 - no detectable muscle contraction 
• 1 - barely detectable contraction 
• 2- complete range of motion or active body part movement with gravity eliminated 
• 3 - complete range of motion or active movement against gravity
• 4 - complete range of motion or active movement against gravity and some resistance 
• 5 - complete range of motion or active movement against gravity and full resistance 

• positioning 
• turning schedule
• ambulation
• transferring from one surface to another

• pain
• early stage: pain may dissappear after rest away from work 
• intermediate stage: body part aches and feels weak soon after starting work and lasts until well after finished work
• advanced stage: body part aches and feels weak even at rest; sleep is affected; light tasks are difficult on days off 

• Slippery or wet surfaces
• uneven floor surfaces 
• obstruction on floor surfaces
• physical obstructions
• space too small or difficult to access entrance way width too small 
• poor arrangement of furnishing
• uneven work surfaces 
• poor bathing area design
• poor design of chairs