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Appreciating the Effects of Bed Rest on Older Patients

Bed rest serves as a time-honored recommendation for both injury and illness. However, the drawbacks of bed rest include a somewhat surprising list of consequences: decreased heart volume, increased insulin resistance, skeletal muscle atrophy, muscle denervation, triggering of neurodegenerative processes, and decreased oxygen uptake capacity.1

Among older patients, these consequences appear more rapidly and rehabilitate more slowly.

Bed Rest and Patients of All Ages

Here are examples of how bed rest can affect any adult. For a group of young, healthy, male volunteers, five days of bed rest resulted in an 8% decline in knee extensor strength.2 During bed rest, trunk muscles and lower extremity muscles involved in gait and upright posture atrophy first.3 Illness itself can also cause atrophy of the skeletal muscles, over and above the strength losses caused by rest.

Additionally, seven to ten days of bed rest for healthy volunteers resulted in a 10-34% decrease in whole-body insulin sensitivity, and a 47% to 75% decrease in the forearm and leg.1,4 There is evidence that this decrease in insulin sensitivity stems directly from changes in skeletal muscles. What’s more, in a group of healthy, male volunteers, two weeks of reduced activity (1,350 steps daily) resulted in a 7% decrease in maximal oxygen uptake.5

Bed Rest and Older Patients Your older patients prove particularly vulnerable to the negative consequences of rest. For instance, older patients lose muscle mass at roughly three times the rate of younger patients. 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.6,7 The loss of maximum oxygen intake capacity was twice as pronounced among patients age 60+.8 For patients over the age of 75, two days or more of hospitalisation is associated with increased disability in one out of ten cases.7

Older patients also rehabilitate more slowly. Where two weeks of rehabilitation restored insulin sensitivity among young patients, it did not among patients around age 70.9 Among senior patients, when the negative effects of bed rest are not addressed assertively, injury, prolonged difficulties, and institutionalisation become more likely. Refer to Advanced Physiotherapy and Exercise Physiology to help these patients restore their former ability.

Recovery from Bed Rest Research has found that during periods of bed rest at home, senior patients tend to spend more time than needed resting in bed or sitting.10 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 older 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 or high-volume exercise, young patients take 2.5 times longer than the period of rest to regain lost strength.11 One study found that, at the gene expression level, reversing the downregulation of various pathways caused by nine days of bed rest required four weeks of retraining.12 That was among young men. The fact of the matter is that most older patients do not engage in intensive or high-volume exercise after periods of bed rest and are more likely to quietly decrease their daily activities and self-care.

The result is increased risk of fall injuries, disability, and mortality.1 Exercise physiologists can develop a safe exercise program that will help older patients maximise their recovery. 


1. Narici M, De Vito G, Franchi M, Paoli A, Moro T, Marcolin G, Grassi B, Baldassarre G, Zuccarelli L, Biolo G, Di Girolamo FG. Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science. 2020 May 12:1-22.

2. Mulder E, Clément G, Linnarsson D, Paloski WH, Wuyts FP, Zange J, Frings-Meuthen P, Johannes B, Shushakov V, Grunewald M, Maassen N. Musculoskeletal effects of 5 days of bed rest with and without locomotion replacement training. European Journal of Applied Physiology. 2015 Apr;115(4):727-38.

3. Narici M, Monti E, Franchi M, Sarto F, Reggiani C, Toniolo L, Pisot R. Biomarkers of muscle atrophy and of neuromuscular maladaptation during 10-day bed rest. European Journal of Translational Myology. 2020;30(1):23-4.

4. Sonne MP, Alibegovic AC, Højbjerre L, Vaag A, Stallknecht B, Dela F. Effect of 10 days of bedrest on metabolic and vascular insulin action: a study in individuals at risk for type 2 diabetes. Journal of Applied Physiology. 2010 Apr;108(4):830-7.

5. Slentz CA, Houmard JA, Kraus WE. Modest exercise prevents the progressive disease associated with physical inactivity. Exercise and Sport Sciences Reviews. 2007 Jan 1;35(1):18- 23.

6. Karinkanta S, Pirrtola M, Sievanen H, et al. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol. 2010; 6: 396-407.

7. Sourdet S, Lafont C, Rolland Y, Nourhashemi F, Andrieu S, Vellas B. Preventable iatrogenic disability in elderly patients during hospitalization. Journal of the American Medical Directors Association. 2015 Aug 1;16(8):674-81.

8. Pišot R, Marusic U, Biolo G, Mazzucco S, Lazzer S, Grassi B, Reggiani C, Toniolo L, Di Prampero PE, Passaro A, Narici M. Greater loss in muscle mass and function but smaller metabolic alterations in older compared with younger men following 2 wk of bed rest and recovery. Journal of Applied Physiology. 2016 Apr 15;120(8):922-9.

9. McGlory C, von Allmen MT, Stokes T, Morton RW, Hector AJ, Lago BA, Raphenya AR, Smith BK, McArthur AG, Steinberg GR, Baker SK. Failed recovery of glycemic control and myofibrillar protein synthesis with 2 wk of physical inactivity in overweight, prediabetic older adults. The Journals of Gerontology: Series A. 2018 Jul 9;73(8):1070-7.

10. Brown C, Redden D, Flood K, Allman R. The unrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatric Society. 2009; 57 (9): 1660-1665.

11. Alibegovic AC, Sonne MP, Højbjerre L, Bork-Jensen J, Jacobsen S, Nilsson E, Færch K, Hiscock N, Mortensen B, Friedrichsen M, Stallknecht B. Insulin resistance induced by physical inactivity is associated with multiple transcriptional changes in skeletal muscle in young men. American Journal of Physiology-Endocrinology and Metabolism. 2010 Nov;299 (5):E752-63.

12. Xiao R, Miller J, Zafirau W, et al. Impact of home health care on health care resource utilization following hospital discharge: a cohort study. The American Journal of Medicine. 2018; 131 (4): 395-407

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