The Sequelae of Rest

Bed rest serves as a time-honored recommendation for illness and some injuries, especially for flu and other infections. A normal muscle, at complete rest, in the absence of illness, loses up to 15% of its strength each week.1 During bed rest, the first muscles to become atrophied are the trunk and lower extremity muscles involved in gait and upright posture.2 Illness itself can also cause atrophy of the skeletal muscles, over and above the strength losses caused by rest.

Your older patients prove particularly vulnerable to the negative sequela of rest. Among a test sample of healthy subjects age 67 and older, 10 days of bed rest resulted in more lean tissue loss than 28 days of bed rest caused in younger test subjects.3 For patients over the age of 70, bed rest is associated with a major, new disability in onethird of prolonged cases.4

Among elderly patients, when the negative effects of bed rest are not addressed assertively, injury or prolonged difficulties become more likely. Research has found that during periods of bed rest at home, elderly patients tend to spend more time than needed resting in bed or sitting.4

This stems largely from a lack of confidence and fear of self-injury inspired by the sudden loss of strength and fitness. After the injury has healed or illness has abated, many elderly patients still experience considerable risks associated with their period of rest. Rate of recovery from disuse weakness is slower than the rate of loss.

With intensive exercise, the average patient takes 2.5 times longer than the period of rest to regain lost strength.5 Older patients may take even longer because age brings loss of myocellular plasticity which blunts the hypertrophic response.6,7

The fact of the matter is that most elderly patients do not engage in intensive exercise after periods of bed rest and are more likely to quietly decrease their daily activities and self-care. Fall injuries, medication errors, and other problems become more likely during the months following bed rest.

Advanced Physiotherapy can efficiently develop a safe exercise program that will help your older patients maximize their recovery. We offer multidisciplinary care where exercise physiologists and physiotherapist can work together for exercise program design and supervision. We have over 60s exercise classes specialising in improving skeletal mass in elderly patients. 

References

1. Dittmer D, Teasell R. Complications of immobilization and bed rest – Part 1: musculoskeletal and cardiovascular complications. Can Fam Physician. 1993; 39: 1428-1437.

2. Halar E, Bell K. Rehabilitation’s relationship to inactivity. In: Kottke F, Lehmann J, editors. Krusen’s Handbook of Physical Medicine and Rehabilitation. 4th ed. Philadelphia: WB Saunders Co, 1990: 1113-39.

3. Kortebein P, Ferrando A, Lombeida J, et al. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007; 297 (16): 1772-1774.

4. Brown C, Redden D, Flood K, et al. The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society. 2009; 57 (9): 1660-65.

5. Muller E. Influence of training and inactivity on muscle strength. Arch Phys Med Rehabil. 1970; 51: 449-62.

6. Slivka D, Faue U, Hollon C, et al. Single muscle fiber adaptations to resistance training in old (>80 year) men: Evidence for limited skeletal muscle plasticity. Am J Physio Regul Integr Comp Physiol. 2008; 295: R273-R280.

7. Raue U, Slivka D, Minchev K, et al. Improvements in whole muscle and myocellular function are limited with high-intensity resistance training in octogenarian women. J Appl Physiol. 2009; 106: 1611-1617.