Why Most Seniors Should Rehab After Bed Rest

As we age, we lose conditioning faster during periods of rest, and we regain that conditioning more slowly with rehabilitation. Below, we show a few ways this presents serious risk for seniors. Older people experiencing ten days or more of bed rest should receive a disability assessment shortly after. Where increased disability is detected, a professionally designed and supervised rehabilitation program can put seniors on the path for the most rapid return to normal ability.

How Bed Rest Affects People in General

• Trunk and leg muscles atrophy first during bed rest.¹
• For a group of young, healthy, male volunteers, five days of bed rest resulted in an 8% decline in knee extensor strength.²
• 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.^3,4 Decreased insulin sensitivity refers to how the body’s cells will respond to insulin less efficiently and manage blood glucose less effectively.
• In a group of healthy, male volunteers, two weeks of reduced activity (1,350 steps daily) led to a 7% decrease in maximal oxygen consumption.⁵ Maximal oxygen consumption  (or VO² max) refers to the maximum amount of oxygen a person can use during intense exercise. Many authorities consider this indicator to be the best measure of cardiovascular fitness and aerobic endurance. It links directly to mortality rates.³ 

How Bed Rest Affects People Age 60+

Faster deconditioning. Slower response to rehabilitation.

• Among a group of healthy research participants age 67+, 10 days of bed rest caused more muscle loss than 28 days of bed rest caused in younger test subjects.^6,7 Seniors at rest lose lean tissue at nearly three times the rate of younger people.
• The loss of maximum oxygen consumption capacity was twice as bad among patients over the age of 59.⁸
• For patients age 75+, two days or more of hospitalisation is associated with increased disability in about 10% of cases.⁷
• While two weeks of rehabilitation restored insulin sensitivity among young patients, it did not among patients around age 70.⁹

Physiotherapy Following Bed Rest

Most seniors do not fully recover from bed rest in a timely fashion. Rather, they adapt to their newly lowered level of fitness. This is not necessary; nor is it good for patients. Intensive exercise can improve the odds of full recovery, speed recovery, and prevent future injuries that would only compound the problems. Keep in mind that recovery from disuse weakness happens slower than the rate of loss. With intensive exercise, patients of all ages require 2.5 weeks of rehab per week of bed rest.^10,11 This may be even longer for seniors. A healthcare professional such as a physiotherapist or exercise physiologist can help seniors develop the most efficient rehabilitation plan.

References

1. 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.
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 lo-comotion replacement training. European Journal of Applied Physiology. 2015 Apr;115(4):727-38.
3. 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.
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. 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.
11. Muller E. Influence of training and inactivity on muscle strength. Arch Phys Med Rehabil. 1970; 51: 449-62.