Edmund M. Kosmahl, PT, EdD

BEDREST

• Rapidly causes generalized deconditioning in healthy individuals
• Injury, illness, or surgery compound the effects of bedrest
• Highly associated with morbidity in older population

• Increased resting heart rate
• Increased elevation of heart rate with exercise
• Decreased cardiac output
• Orthostatic Hypotension
• Increased Diuresis
• Deep vein thrombosis

• Accumulation of pulmonary interstitial fluid in dependent lobes
• Decreases in all lung volumes
• 2% vital capacity
• 7% total lung capacity
• 30% functional residual capacity

• Decreased size (cross-sectional area) - primarily in fast twitch fibers
• Decreased maximal tension
• Occurs within 8 - 10 days
• 35% decrease by 5 weeks

• Calcium and phosphorus excretion increases rapidly
• Underlying osteoporosis is more common in post-menopausal white women

• Food travels through stomach 66% slower
• Reduced bowel motility

• Muscles develop insulin resistance
• smaller decreases in blood glucose in response to exogenous insulin
• 3 days - 20% less
• 14 days - 50% less
• Decrease glucocorticosteroids
• Destabilized thyroid hormone rhythms

• 12 of 36 nursing home patients who took to bed died within 3 months, and 17 died within 6 months
• Almost all who survived 6 months regained ambulatory ability

(Clark LP, Dion DM, Barker WH: Taking to bed. Rapid functional decline in an independently mobile older population living in an intermediate-care facility. J Am Geriatr Soc 1990 Sep;38(9):967-72.)

• Clark LP, Dion DM, Barker WH: Taking to bed. Rapid functional decline in an independently mobile older population living in an intermediate-care facility. J Am Geriatr Soc 1990 Sep;38(9):967-72.

• Downey RJ: Physiology of Bed Rest, in Downey JA et al eds The Physiological Basis of Rehabilitation Medicine 2 ed, Boston, Butterworth-Heinemann, 1994.

• Goodman CC, Boissonnault WG: Pathology: Implications for the Physical Therapist, Philadelphia, WB Saunders, 1998.