Amtmann,, John, EdD

Amtmann,, Kelly, MSN, RN

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Montana Tech LibraryDigital Commons @ Montana TechNursing Faculty Scholarship7-2010Use It or Lose It: Physical Fitness for NursesKelly Amtmann, MSN, RNMontana Tech of the University of MontanaJohn Amtmann, EdDMontana Tech of the University of MontanaFollow this and additional works at: http://digitalcommons.mtech.edu/nursingPart of the Nursing CommonsThis Article is brought to you for free and open access by the Faculty Scholarship at Digital Commons @ Montana Tech. It has been accepted forinclusion in Nursing by an authorized administrator of Digital Commons @ Montana Tech. For more information, please contact ccote@mtech.edu.Recommended CitationAmtmann, K., & Amtmann, J. (2010) Use it or lose it: Physical fitness for nurses. American Nurse Today, 5(7), 45-47.www.AmericanNurseToday.com July 2010 American Nurse Today 45CHRONIC LIFESTYLE-RELATEDDISEASES account for mostdeaths today, with cardiovasculardisease the leading cause of alldeaths. As you know, a seden-tary lifestyle contributes to development of cardiovascu-lar disease. More than a decade ago, experts concludedthat medical science has done all it can for people withchronic lifestyle-related diseases and that additionalhealthcare expenditures wouldn’t bring the financialbenefits that would accrue if Americans improved theirhealth simply by being more physically active.In a literature review we conducted, we found norecent studies on the fitness status of nurses. Currently,we’re performing fitness assessments on future and cur-rent registered nurses (RNs) to establish nurse-specificbaseline health and fitness information. Preliminary re-sults for nursing students are dismal: To date, 25 nurs-ing students have participated in fitness assessments,including a 1.5 mile walk-jog-run used to predict maxi-mal oxygen consumption (VO2max). The rate at which thebody can use oxygen, VO2 maxis a powerful indicator of over-all cardiorespiratory function.The average time the students took for the 1.5-mile runwas just over 18½ minutes, which corresponds to aVO2 max of 29.2 mL/kg/minute. Based on norms pub-lished by the American College of Sports Medicine (AC-SM), this average VO2 max ranks poorly—between the10th and 20th percentiles.Why should nurses improve their fitness?Because you encounter many patients with lifestyle-related disorders, you need to have a basic understand-ing of the role physical fitness plays in prevention andrehabilitation. What’s more, as a nurse you must pro-vide an established standard of care, and sometimes thismeans you need to have at least a minimum level ofphysical fitness. Better overall fitness will improve yourability to effectively per-form the physical tasksyou do every day, suchas assisting and transfer-ring patients, transportingequipment, or simplywalking to your assignedpatients throughout ashift. One study of 146RNs over a 12-hour shiftfound they covered anaverage of 4 to 5 milesper shift.Being a good rolemodel is another reasonto improve your fitness.You can be a more posi-tive influence on patientsif you’re making the life-style choices you’re rec-ommending to them.Important note: Menolder than age 45 andwomen older than age 55should get their physi-Mind/Body/Spirit —Getting fit isn’t just good foryou. It makes you a betterrole model for patients.Use it or lose it:Physical fitness for nursesBy John Amtmann, EdD, and Kelly Amtmann, MSN, RN46 American Nurse Today Volume 5, Number 7 www.AmericanNurseToday.comcian’s approval before beginning a new exercise pro-gram. Younger people should complete the Physical Ac-tivity Readiness Questionnaire (http://uwfitness.uwaterloo.ca/PDF/par-q.pdf) to determine if they need a physi-cian’s approval.Training guidelinesThe ACSM has established guidelines for promotinghealth through physical activity for cardiorespiratory andmusculoskeletal components of fitness. For cardiorespi-ratory fitness, the organization recommends doing activ-ities you can sustain for a prolonged period, such aswalking, jogging, stationary cycling, rope jumping, androwing. Try to engage in these activities 3 to 5 daysweekly for 20 to 60 minutes per session, monitoringyour exercise intensity through heart rate.Heart rate reserve (HRR) is the difference betweenthe maximum heart rate (HRmax) and resting heart rate(RHR). According to ACSM, an exercise intensity rang-ing from 40% to 85% of HRR is necessary to cardiorespi-ratory fitness, depending on fitness levels. If you haven’texercised regularly in more than 6 months, start at thelower end of the range (40% to 60%). If you have beenexercising regularly, you can more comfortably exerciseat the higher end (60% to 85%).A simple way to estimate HRmax is to use this for-mula: 208 – (0.7 × your age). Subtract RHR from the es-timated HRmax; the result is HRR. To determine yourtarget heart rate range, calculate an appropriate percent-age range of your HRR and add it to your RHR.Predicted HRmax = 208 – (0.7 × age)HRR = HRmax – RHRHRR intensity = HRR × 40% to 85%Target heart rate range = HRR intensity + RHRFor an example of this calculation, see Calculatingtarget heart rate range.If you’re deconditioned or in poor physical condi-tion, start at a lower exercise intensity. For many nurseswho haven’t exercised on a regular basis for a fewmonths or longer, 40% to 60% of HRR may be a realisticstarting intensity.If you find it difficult to monitor your heart rate duringexercise, you can use the rate of perceived exertion (RPE)scale as an adjunct to monitor exercise intensity. TheCenters for Disease Control and Prevention has an articlethat explains how to use the RPE. Visit www.cdc.gov/nccdphp/dnpa/physical/measuring/perceived_exertion.htm.The goal of exercise is to expose the body to anoverload stimulus in a safe manner. With appropriaterest and recovery, the body will improve in strength,endurance, or efficiency in the activity that caused thestimulus. As your fitness improves, you can increaseyour exercise intensity to improve your cardiorespirato-ry function even further. For a 50-year-old nurse, in-creasing the intensity to 60% to 70% of HRR wouldchange the target heart rate range to 131 to 141beats/minute, assuming RHR remained unchanged.Get into it graduallyYour exercise should progress at a gradual pace. Asyour fitness improves, the same level of exercise inten-sity may no longer be adequate to increase your heartrate to within the target range. This means your body isadapting to exercise training through improved car-diorespiratory fitness—and that’s the goal. The improve-ment will be more pronounced in individuals who startat lower fitness levels.To allow for continued improvements, update yourexercise program by gently increasing your exercise in-tensity, duration, or both. When you’ve achieved youroptimal fitness level, switch to a maintenance program.To keep your exercise program fresh and enjoyable,add variety. In addition, try to include weight training atleast 2 days per week. Weight training helps maintainlean body mass and resting metabolic rate; it also pro-motes bone mineral density, which is essential to over-all health.Interval trainingIf you have been exercising regularly for at least 4months and would like to increase the intensity of aer-obic training, you might benefit from interval training.Interval training combines higher-intensity work seg-ments with lower-intensity active recovery/rest seg-ments. For example, interval training with a 2:1 ratiomay involve 1 minute of more intense exercise fol-lowed by 30 seconds at a slower pace.Developing an interval training program to suit yourneeds allows you to be creative with the program. Thehigher-intensity segment increases metabolic demands,which means you’re expending more energy (kilocalo-ries) during and after the training session. (See Warm-ing up and cooling down.)While it’s crucial not to perform too much activityCalculating target heart rate rangeNurse Susan Kean, age 50, is starting an exercise programfor the first time in many years (with her physician’s clear-ance). Her resting heart rate (RHR) is 73 beats/minute. Here’show she calculates her target heart rate range.HRmax (maximum heart rate): 208 – (0.7 × 50 [her age]) = 173HRR (heart rate reserve): 173 – 73 (her RHR) = 100Heart rate intensity: 100 × 0.4 + 73 = 113Susan’s target heart rate range: 100 × 0.6 + 73 = 133 beats/minutewww.AmericanNurseToday.com July 2010 American Nurse Today 47too soon, it’s good to gradually increase your exerciseintensity, duration, or both to improve physical fitness.You can implement interval training by using an aerobicactivity, such as cycling, stair stepping, swimming, orrope jumping.Aim for overload, not reversibilityAccording to the principle of overload, when demands aremade on body systems that these systems aren’t used to,instead of becoming weaker, the systems getstronger—given appropriate nutrition and re-covery time. That’s the objective of cardiores-piratory training.Conversely, the principle of reversibilitystates that physiologic gains are lost when theload against which a system works is reduced.This is better known as “Use it or lose it.”Best of luck in your pursuit of cardiorespira-tory fitness. If you have questions or commentson this article, contact author Kelly Amtmannat kamtmann@mtech.edu or author John Amt-mann at jamtmann@mtech.edu. Selected referencesAmerican College of Sports Medicine. ACSM’s Guidelinesfor Exercise Testing and Prescription. 7th ed. Philadelphia,PA: Lippincott Williams & Wilkins; 2006.Gibbons L, Stoedefalke K. Exercise is medicine. In Blake B. The Fit-ness Handbook. Urbana, IL: Sagamore Publishing; 1995.Tanaka H, Monahan K, Seals D. Age-predicted maximal heart rate re-visited. J Am Coll Cardiol. 2001;37:153-156.Welton J, Decker M, Adam J, Zone-Smith L. How far do nurses walk?MedSurg Nurs. 2006;15(4):213-216.John Amtmann is a professor of Applied Health Science at Montana Tech of TheUniversity of Montana. Kelly Amtmann is an assistant professor of nursing atMontana Tech of The University of Montana.Warming up and cooling downTo prevent injury, always warm up before you exercise and cool downafterward. The warm-up increases your body’s temperature and pre-pares it for the more intense training to follow. For an effective warm-up, do the same activity you’ll perform during the session to follow—but at a lower intensity. For instance, if walking is your chosen activity,warm up by walking at a slower pace for 5 to 10 minutes.The cool-down eases your body into a resting state by loweringexercise intensity for 5 to 10 minutes. This allows your heart rate toapproach resting levels. 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Use It or Lose It: Physical Fitness for Nurses

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