Are we deconditioning ourselves?
In hospitals we use the term “deconditioned” for the physiological changes that happen to the body causing physical, cognitive and psychological decline after a period of bed-rest or inactivity.
A person aged 65 years and over can spend between 71-83% of their time in hospital lying down! (1,2,3).
Look at what happens with just days of bed-rest:
1 week of bed-rest leads to marked reduction in muscle mass (4,5) and lowers insulin-sensitivity (4).
10 days of bed-rest leads to reduction in strength and power in the legs as well as aerobic capacity (6).
21 days of bed-rest leads to an increase in CRP levels, an inflammatory marker (7).
27 days of bed-rest can lead to bone mineral loss (8).
60 days of bed-rest results in a decrease in lean body mass and an increase in resting heart rate (9).
While muscle loss and bed sores are unfortunately well-known and visible consequences of extended bed-rest that we often see in healthcare settings, prolonged bed-rest actually affects every body system. Here are just a few:
joint contractures
muscle weakness (skeletal and cardiac)
changes in heart muscle (10,11)
increased pro-inflammatory state (12,7)
reduced respiratory function (13)
reduction in red blood cells so less oxygen circulating
formation of blood clots (14)
insulin resistance (15,16)
constipation
loss of balance + coordination (17)
changes in volume of grey matter in brain related to performance, movement, learning, memory and coordination (18)
reduced levels of circulating neurotransmitters (dopamine, noradrenaline, serotonin) might explain depressed mood (19)
sensory deprivation
anxiety and “learned helplessness” (20)
urinary stones, retention and infections (21)
reduction in bone mineral density, increasing fracture risk (22,23,24)
compromised skin integrity (25)
The list above reminds us just how dynamic our tissues are. Bones need some impact to continually reform, our lymph fluid needs help moving waste and nutrients around our body, our muscles need mechanical load and resistance to generate force. We are constantly in interaction with our surroundings.
According to Ayurveda, muscle is the organ of longevity so to maintain it is vital. We can see in the list above, that nearly all the body systems rely on muscles (skeletal, cardiac, smooth) or the movement that they allow, to function well. It is muscle that creates the peristaltic movement of our gut lining, muscles that pump our heart, muscles that are the main deposit site for glucose, muscles that expand and contract our lungs, muscles that take us outdoors and to new places for our senses to experience, giving us independence.
According to Ayurveda, muscle is the organ of longevity
The mind map below summarises all the physiological changes that occur in the body with prolonged bed-rest.
Of course people in hospital have usually experienced an injury or surgery so there are the added physiological demands that will have a knock-on effect. But, incorporating early movement and therapies during hospital stays have shown to improve people’s recovery and speed up their hospital discharge.
Healthcare professionals have learnt the importance of early mobilisation with hospital patients instead of the traditional, long bed-rest that used to be prescribed decades before. This is because the circumstances we are observing in hospital are extreme. But, beyond the hospital walls, has convenience slowly started deconditioning us in everyday life too?
Modern life is defined by convenience and comfort so it is easy to live a sedentary lifestyle. But, this kind of living can decondition us. Sure, there are perks to some conveniences if they afford us more time to spend elsewhere, if we are housebound due to long-term conditions, have disabilities or an illness. But, have some made it easier for us to just be lazy too?
Modern life is defined by convenience and comfort
Just think of all the services that now deliver to our doorstep. Instead of cooking a meal from scratch, we can easily get a takeaway. Instead of going out and meeting friends in real life, we can just stay home and meet them over a video call. Instead of taking the stairs (if we are able to), we can just choose the lift. We can replace these scenarios with plenty of other things – binge-watching Netflix shows back-to-back; driving to the corner shop that’s within walking distance; working from home at the computer for hours without a break, the list can go on. The point is, if we stop using and stretching our body and mind, we start to notice loss in function. Now, you may be thinking “this nurse is taking things out of proportion”, but it is not that far-fetched. We are already seeing the complications of sedentary lifestyles in Primary Care – diagnoses of chronic conditions such as type 2 diabetes and hypertension in younger people and even kidney stone formation in people who stay seated working from home for hours at a time. This is avoidable.
Terms such as “disuse atrophy” or “disuse syndrome” really bring home that the risks of inactivity to our health are just too high. Our body works best when it is mobile, so let’s keep it moving!
References:
1. Brown et al. (2009) The unrecognised epidemic of low mobility during hospitalisation of older adults. Journal of American Geriatrics Society, 57(9)
2. Callen et al. (2004) Frequency of hallway ambulation by hospitalised older adults on medical units of an academic hospital, 25(4)
3. Pedersen et al. (2012) Twenty-four-hour mobility during acute hospitalisation in older medical patients. The Journal of Gerontology: Series A, 68(3)
4. Dirks et al (2016) One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes, 65(10)
5. Ferrando et al. (2015) Magnetic Resonance imaging quantitation of change sin muscle volume during 7 days of strict bed rest. Aviation, space and environmental medicine, 66(10)
6. Kortebein et al. (2008) Functional impact of 10 days of bed rest in healthy older adults. The Journal of Gerontology: Series A: Biological Sciences and Medical Sciences, 63(10)
7. Zwart et al. (2009) Effects of 21 days of bed rest, with or without artificial gravity, on nutritional status of humans. Journal of Applied Physiology, 107(1)
8. Krolner and Toft (1979) Vertebral bone loss: an unheeded side effect of therapeutic bed rest. Clinical Science, 64(5)
9. Kramer et al. (2017) High-intensity jump training is tolerated during 60 days of bed rest and is very effective in preserving leg power and lean body mass: An overview of the Cologne RSL Study. PloS One, 12(1)
10. Dorfman et al. (2007) Cardiac atrophy in women following bed rest. Journal of Applied Physiology, 103
11. Perhonen et al. (2001) Cardiac atrophy after bed rest and spaceflight. Journal of Applied Physiology, 91(2)
12. Chouker et al. (2001) Simulated microgravity, psychic stress, and immune cells in men: observations during 120-day 6 degrees HDT. Journal of Applied Physiology, 90(5)
13. Manning et al. (1999) Effects of side lying on function in older individuals. Physical Therapy, 79(5)
14. Weill-Engerer et al. (2004) Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study. Journal of American Geriatric Society, 52(8)
15. Hamburg et al. (2007) Physical activity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Atherosclerosis, thrombosis and vascular biology, 27
16. Kakehi et al. (2023) Physical activity induces insulin resistance in plantaris muscle through protein tyrosine phosphotase 1B activation in mice. Frontiers in Physiology, 14
17. Saumer et al. (2020) The effect of bed rest on balance control in healthy adults: A systematic scoping review. Journal of Musculoskeletal and Neuronal Interactions, 20(1)
18. Li et al. (2015) Effect of simulated microgravity on human brain grey matter and white matter – evidence from MRI. PloS One, 10(8)
19. Basso et al. (2017) The effects of acute exercise on mood, cognition, neurophysiology and neurochemical pathways: A review. Brain Plasticity, 2(2)
20. Cocoran (1991) Use it or lose it – The hazards of bed rest and inactivity. Rehabilitation Medicine – Adding Life to Years, 154
21. Hwang et al. (1988) Effect of prolonged bedrest on the propensity for renal stone formation. The Journal of Clinical Endocrinology & Metabolism, 66(1)
22. Kramer et al. (2017) How to prevent the detrimental effects of two months of bed-rest on muscle, bone and cardiovascular system: an RCT. Scientific Reports, 7
23. Rawal et al. (2015) A pilot study of change in fracture risk in patients with acute respiratory distress syndrome. Critical Care, 19(1)
24. Takata & Yasui (2001) Disuse osteoporosis. The Journal of Medical Investigation, 48
25. Agrawal & Chauhan (2012) Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery