It’s easy to think that “bed rest” is a soothing, restorative method, but it’s false. Even after just a few days of being unable to move, our bodies begin to show the effects of our inability to do so. The term “deconditioning” is used to describe the cumulative effect of these negative consequences on the body. This has the potential to have a significant impact on one’s health.
The medical community has come to realize that patients should begin physical therapy as soon as possible following or even during a hospitalization or sickness that mandates bed rest in order to minimize or lessen the negative effects. Here are a few examples:
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Effects on the muscles and bones
It is best for the musculoskeletal system to support the body in an upright position in order to perform optimally against gravity. Weight-bearing muscles of the neck, belly, lower back, buttocks, thighs and calves are particularly crucial for this purpose, and bed rest has a significant negative impact on these muscles.’
Muscles deteriorate and atrophy quickly when they aren’t used (waste away). After a week of complete bed rest, one’s strength can drop by as much as 20-30 percent, and it usually takes longer to regain it than it did to lose it.
Reduced muscle strength and other structural changes to the nerves and muscles affect coordination and balance, which raises the risk of tripping and slipping.
As the bones aren’t doing their usual weight-bearing function, they begin to deteriorate from lack of use and lose density. Leg bones are the most likely to be affected by this condition. Even mild falls might lead to fractures if the bones are too thin.
Joint movement might be restricted as a result of immobility. When people get older, the cartilage in their hips, knees, and shoulders begins to wear away, while the surrounding connective tissue becomes thicker and their muscles shrink. Walking and other routine activities are hampered as a result.
Effects on the heart and blood
Working against gravity puts the cardiovascular system to its optimum use, much like the muscles do. Blood begins to accumulate in the legs after only a few days of bed rest. This might lead to dizziness and falls when standing.
As a result of being confined to a chair, the heart beats faster and the amount of blood it pumps decreases. There is reduced blood volume and less oxygen uptake in the body as a whole. This leads to a decrease in aerobic fitness and an increased risk of exhaustion.
Deep vein thrombosis (DVT) and lung thrombosis (pulmonary embolism) are two of the most common causes of blood clots (pulmonary embolism).
Effects on the lungs and blood
Pneumonia and atelectasis are more likely with prolonged bed rest (collapse of lung tissue).
Due to a lack of movement in the muscles, extra fluid accumulates in the lungs. Blood accumulates in the chest area when you are lying flat, reducing the volume of your lungs. Due to weak abdomen and chest muscles, mucus accumulates in the lungs, making coughing less efficient.
The lungs’ oxygen-to-carbon dioxide exchange is compromised as a result of the shallower breathing.
Effects on the skin
Pressure sores, often known as bed sores, are a type of skin ulcer caused by the increased pressure exerted on areas of the body that are resting on the bed’s surface.
Effects on digestion and excretion
A variety of factors contribute to the frequent ailment of constipation, including a decrease in bowel movement and peristalsis, as well as an inability to completely empty the colon.
Bedridden patients’ appetites are generally restrained, which can lead to malnutrition and dehydration.
A lack of urination is a side effect of long-term bed rest as well. The bladder is more difficult to empty and tends to retain liquids, increasing the risk of infection. Urinary calcium excretion is also increased, which elevates the risk of bladder and kidney stones.
A common side effect of bed rest is incontinence, which can be exacerbated by the accompanying disorientation, confusion, and restricted mobility.
The metabolic and hormonal effects
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The body’s balance of hormones and minerals, as well as the way it processes energy, might be affected by prolonged bed rest.
If you’re sedentary, you’ll have a lower percentage of lean mass to body fat, which means you’ll be more likely to get diabetes because your muscles are less sensitive to insulin.
Effects on the brain
Anxiety, melancholy, irritability, apathy, sleep difficulties, and confusion are some of the mental health and cognitive issues that can arise from bed rest and the stress of sickness.
Short bouts of light exercise can mitigate many of these side effects; even if you simply walk a few steps a day, it counts. You can do some exercises while lying down if you can’t stand up yet. Make sure to contact with your doctor before beginning an exercise and recuperation regimen.
Introduction
While bed rest was once thought of as a helpful measure, its harmful effects are now widely acknowledged. The circulatory, respiratory, and haematological systems were covered in the first two sections in this series on the consequences of bedrest on the body and mind. An examination of how prolonged bed rest affects the gastrointestinal, endocrine, and neurological systems is presented in the final piece of this series.
Effects on the gastrointestinal system
Loss of appetite
Long-term bed rest has been related to a diminished sense of taste and smell as well as a decreased appetite, according to earlier research (Rousseau, 1993; Bortz, 1984). Sedentary males consume much less food than their more active colleagues, according to a new study (Stubbs et al, 2004). Some recent research, however (Debevec et al, 2016) have found minor changes in the experience of hunger during bedrest, which means the link between appetite and immobility remains ambiguous.
Gastric reflux
Food passes through the stomach 66% slower in the recumbent posture than it does in the upright position, making swallowing more difficult (Thomas et al, 2002). The lower oesophageal sphincter may be irritated by the accumulation of gastric fluids. A patient’s chance of developing gastro-oesophageal reflux (Fig. 1) disease increases if they are confined to bed for an extended period of time, as do their symptoms of regurgitation and heartburn (Spellman, 2000). After a meal, prop the individual up with pillows to encourage the stomach juices to accumulate in the bottom area of the stomach, which can help treat GORD.
Peter Lamb is the source.
Constipation
Motility in the gut is diminished in bedbound individuals due to a smaller food intake and a slower rate of peristaltic movement; this is linked to the atrophy of mucosal lining and glandular tissues (Bortz, 1984). Because of the longer transit durations of stool, more water is retained, which causes the stool to harden as it passes through the colon and rectum.
The rectum is filled with faecal matter in the upright posture, and the anal sphincter is pressed by the weight of the stool, causing the need to defecate. As a result, the need to urinate is lessened in the supine posture. Constipation is up to 16 times more prevalent in bedridden individuals than in mobile individuals (Spellman, 2000). Opioid-based medications, such as morphine, can cause constipation in patients because they slow down gastrointestinal motility (Holzer, 2014).
Continual constipation can put a lot of strain on the colon wall, which can lead to diverticulitis. Fig 2: Constipation (inflammation or infection of the diverticula, small bulging pouches that commonly form in the lining of the intestine after the age of 40).
Patients can lower their risk of constipation by eating a diet rich in fiber and drinking enough of fluids. In addition to increasing faecal volume and softening stools, fiber also absorbs excess water in the colon.
Peter Lamb is the source.
Decreased food intake
Patients who are confined to bed may experience gastrointestinal changes and a diminished appetite, which may lead to decreased food intake.
- Consumption of fewer calories;
- Deficiencies in vitamins and minerals.
Bedrest’s adverse effects on the gastrointestinal system might impede healing and recovery from infection, which necessitate an appropriate intake of calories and macro- and micronutrients. Hospitalized patients are at an increased risk of death if they don’t get enough to eat; this has been established as an independent risk factor (Hiesmayr et al, 2009).
Effects on the endocrine system
Increased cortisol secretion
Long-term bed rest can result in a condition called sarcopenia, which is characterized by the loss of muscular mass over time (see part 5). Adrenal glucocorticoid hormone fluctuations exacerbate this problem.
Cortisol, a natural anti-inflammatory that also promotes gluconeogenesis (the creation of glucose derivatives from protein and fat), is released in response to physical damage or famine (VanPutte et al, 2017). Cortisol secretion rises in persons who are bed-bound following an injury or surgery (hypercortisolemia). As a result, the breakdown of skeletal muscle occurs, releasing amino acids into the bloodstream. The catabolic effects of cortisol on skeletal muscles are amplified by prolonged bed rest (Fitts et al, 2007; Ferrando et al, 1999).
When it comes to increasing cortisol levels during bedrest, it’s not obvious whether it’s due to bedrest alone; some studies show a steady increase in cortisol production, while others show minimal change in cortisol levels (Trudel et al, 2009). Current research suggests that sarcopenia caused by prolonged bed rest is mostly the result of muscular atrophy from lack of usage and an increased susceptibility to cortisol impacts. Muscle function and strength can be maintained in bedbound patients by supplementing their diets with a mixture of essential amino acids and carbohydrates (sucrose) (Fitts et al, 2007).
Metabolic changes
The metabolic rate decreases with time as a result of inactivity and immobility (Withers et al, 1998). After only 10 hours of inactivity, the basal metabolic rate begins to decrease, and after 10-24 hours, it has decreased by roughly 6.9%. (Rousseau, 1993). Even if one remains sedentary, the body’s lean muscle mass continues to shrink.
Thyroid hormones, which control metabolic rate, have shown no change during bed rest in previous investigations. The hormones triiodothyronine (T3) and tetraiodothyronine (T4), often known as thyroxine, remain stable in the bloodstream (Balsam and Leppo, 1975). Even after eight weeks of bedrest (Belav et al., 2012), plasma T concentrations dropped, suggesting that the lower energy expenditure may be to blame.
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Patients who are confined to bed tend to keep a constant weight despite a decreased metabolic rate. The reduced lean muscle mass and lower calorie consumption are likely to counteract any weight gain caused by a decreased basal metabolic rate (Rousseau, 1993). Unfortunately, as the amount of lean muscle mass declines, fat storage in the adipose tissues increases (Krebs et al, 1990).
Glucose intolerance and insulin resistance
Insulin resistance, reduced glucose tolerance, and, in certain cases, the onset of type 2 diabetes, have all been related to a sedentary or inactive lifestyle (Blanc et al, 2000). Long durations of bedrest impair the body’s ability to control blood glucose, leading to the development of glucose intolerance, which increases in direct proportion to the amount of time spent in bed (Rousseau, 1993; Takayama et al, 1974).
Skeletal muscle insulin receptor expression rises along with physical exercise. Insulin receptors are highly expressed in those who are physically active and do so on a regular basis. Carbohydrate-rich meals raise their blood glucose levels, which then cause insulin to be released. Insulin binds to the many receptors in skeletal muscles, causing the muscles to rapidly absorb glucose, resulting in a return to normal blood glucose levels.
On the other hand, inactive lifestyles and diets that restrict caloric intake are linked to decreased insulin receptor expression in the muscles (Rousseau, 1993). When a person is confined to bed, the muscles’ sensitivity to insulin is decreased, thus a high-carbohydrate meal will result in poorer muscle glucose uptake and a higher blood sugar level.
Insulin resistance, the hallmark of type 2 diabetes, steadily worsens as a result of extended bed rest and inactivity. Patients who have been in bed for 10 days have been shown to have considerably elevated fasting blood-glucose levels (Coker et al, 2014).
Because of the pancreatic islets’ increased insulin production in response to insulin resistance (Blanc et al, 2000), a condition known to promote fat storage and be a contributing factor to obesity (Blanc et al, 2000). (Erion and Corkey, 2017). Hyperinsulinaemia, insulin resistance, and changes in blood lipids and fat deposition appear to be connected.
Triglyceride and low-density lipoprotein cholesterol levels rise when people are confined to a chair or bed for long periods of time, but the exact mechanisms by which this occurs remain a mystery (Coker et al, 2014). Increased rates of atherosclerotic occlusion in individuals who are bed-bound could be attributed to alterations in blood-lipid profiles. Non-alcoholic fatty liver disease, which itself appears to be connected to decreasing physical activity, may be accompanied by an increase in hepatic fat accumulation (Bergouignan et al, 2011).
As the number of insulin receptors in skeletal muscle rises, insulin has a greater effect on glucose tolerance and insulin resistance, which can be relieved by mild exercise. Nurses should try to urge patients who are restricted to bed to engage in physical activity. Reduced glucose intolerance is linked to increased muscle activity, therefore even light exercises performed in bed are advantageous. Even in young, healthy adults, it normally takes 5-14 days to reverse reduced glucose tolerance caused by bed rest (Heer et al, 2014).
Renin-angiotensin-aldosterone cascade
The long-term management of blood pressure relies heavily on the renin-angiotensin-aldosterone cascade (VanPutte et al, 2017). Renin, an enzyme that catalyzes the conversion of the plasma protein angiotensinogen into angiotensin I, is released by the kidneys when blood pressure drops; this is quickly converted into angiotensin II by angiotensin-converting enzymes in the lungs. High blood pressure is caused by the strong vasoconstrictor, angiotensin II, which also increases sodium reabsorption in the kidneys and hence raises blood pressure, blood volume, and blood sodium levels.
Plasma volume decreases dramatically in bedridden patients, primarily because of increased urine production (see part 1). The renin-angiotensin-aldosterone cascade is activated as a result of this decrease in blood volume and salt loss during diuresis (see part 2), which raises plasma renin activity and aldosterone levels (Annat et al, 1986; Gharib et al, 1985). To maintain blood volume and arterial pressure, this causes the kidneys to reabsorb more sodium.”
Effects on the nervous system
Blunting of baroreceptor response
Few studies have examined the effects of prolonged bedrest on the neurological system. Impairment of baroreceptor responses, a major contributor to orthostatic hypotension (see part 1), has been studied extensively in research that have examined immobility’s impact on the autonomic nervous system Sensorimotor dysfunction, most typically shown as postural instability and an unsteady sensation of balance, is linked to prolonged bed rest (Yuan et al, 2018). Reduced muscular mass and strength also contribute to an increased risk of falls (see parts 1 and 5).
Changes in brain tissue
MRI studies have shown that extended bedrest affects brain tissue structure, with reductions of grey matter in the temporal and frontal lobes thought to be connected to impaired synaptogenesis (synapse creation), as well as deleterious consequences on movement, coordination, and cognitive ability (Li et al, 2015). However, there is currently a lack of study in that area.
Neurochemistry
When it comes to bedrest and brain biochemistry, there is a lack of information. When a person is inactive, the levels of key neurotransmitters such as dopamine, noradrenaline, and serotonin drop (Corcoran, 1991). Reduced serotonin levels during immobility may be connected to a patient’s depression, cognitive decline, and loss of appetite, as serotonin is recognized to play a critical role in these areas.
Sensory deprivation and learnt helpnessness
Due to a lack of social connection outside of their immediate surroundings, patients in the hospital are more likely to experience a decline in environmental and psychosocial stimulation. Restriction or deprivation of some senses (Hayes, 2000) can alter behavior.
It is frequently linked to:
- Restlessness;
- a rise in hostility;
- Insomnia;
- a lower threshold for discomfort (Fletcher, 2005; Rousseau, 1993).
The brain receives information from both the outside and the inside of the body. The individual’s attention is continually divided between information from the outside world and information from within. When the surrounding environment is relatively ‘silent,’ the body’s signals receive more attention.
Uncertainty and unpredictability are common side effects of bed rest, and these might exacerbate existing anxiety. Depression is often accompanied by feelings of powerlessness or hopelessness (Walker et al, 2012). Changes in neurochemistry, such as the drop in serotonin levels described above, enhance this effect of bed rest on mental state.
This “learnt helplessness” (Corcoran, 1991) is sometimes perpetuated by well-intentioned support from personnel, which can lead patients to become increasingly reliant on their caretakers. According to Seligman’s (1975) theory of learned helplessness, people initially react with anger and irritation towards the stressor.
Patients’ experiences and views will differ, and nurses must be aware of this when working with them. When two patients are placed on the same bed rest regimen for the same amount of time, their reactions can diverge dramatically. While anxiety and depression are typical and reversible responses to stressful situations, they can also have major crippling effects if experienced intensively or for a long period of time. This is something to keep in mind.
promoting social engagement, exercise, and mobility as early as possible will help relieve some of the side effects of prolonged bed rest-induced sensory deprivation (Rousseau, 1993). Long-term and medium-stay patients in the hospital may benefit from learning about the physical and psychological repercussions of prolonged bed rest.
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