Effects of Prolonged Bed Rest on Health
Prolonged bed rest or laying flat for most of the day is harmful to overall health and should be avoided unless medically necessary, as it leads to multiple documented deleterious effects including muscle atrophy, thromboembolic disease, and insulin resistance. 1
Physical Consequences of Prolonged Bed Rest
Musculoskeletal System
- Significant muscle strength loss (approximately 25% loss of plantar flexor muscle strength over just 5 weeks) 1
- Diffuse muscle atrophy that contributes to physical frailty and sarcopenia 2
- Increased risk of joint contractures that limit mobility 1
- Reduced bone density, potentially leading to osteoporosis with extended periods of inactivity 3
Cardiovascular System
- Decreased volume of blood plasma and reduced cardiac output 1
- Increased resting heart rate (approximately 0.5 bpm for each day of bed rest) 1
- Development of orthostatic intolerance (inability to maintain blood pressure when changing positions) 1
- Increased risk of deep venous thromboembolism 1
Metabolic Effects
- Development of insulin resistance 1
- Diuresis with significant losses of sodium and potassium 1
- Negative impact on glucose tolerance 1
- Potential weight gain and adverse effects on body composition 1
Respiratory System
Immune System
- Depressed immune function, increasing susceptibility to infections 1
Population-Specific Considerations
Post-Stroke Patients
- Early mobilization (within 24 hours after stroke) has been shown to result in earlier walking and improved functional recovery 1
- Minimizing bed rest is critical during acute and inpatient rehabilitation for stroke patients 1
Cancer Patients
- If disease or treatment necessitates periods of bed rest, physical therapy during bed rest is advisable to maintain strength and range of motion 1
- Exercise during cancer treatment is not only safe and feasible but can enhance physical and functional well-being and improve quality of life 1
Liver Disease Patients
- For patients with ascites, prolonged bed rest cannot be recommended as there is insufficient evidence that it is beneficial in treatment 1
Alternatives to Prolonged Bed Rest
For Healthy Individuals
- Aim for at least 150 minutes per week of moderate-intensity physical activity 4
- Even half of this volume (75 minutes per week) can lead to marked health benefits 5
- Incorporate resistance exercises for major muscle groups 2-3 days per week 4
- Include flexibility exercises and neuromotor exercise involving balance, agility, and coordination 4
For Those with Limited Mobility
- Early mobilization should be encouraged as soon as medically possible 1
- Simple activities like intermittent sitting or standing (orthostatic or gravitational stress) can prevent much of the deterioration in exercise tolerance 1
- Active breaks throughout the day can improve cardiovascular and metabolic health 1
- "Exercise snacks" (short bursts of exercise multiple times throughout the day) can be beneficial for those with limited time or predominantly sedentary work 1
Practical Recommendations
- Move more and sit less - even small amounts of physical activity provide health benefits 5
- If bed rest is medically necessary, physical therapy should be incorporated to maintain strength and range of motion 1
- For those recovering from illness or surgery, gradually increase activity as tolerated rather than remaining in bed 1
- Avoid prolonged sedentary behaviors, as they increase risk of morbidity and mortality from cardiovascular and metabolic causes 1
Key Takeaway
The evidence is clear that prolonged bed rest has numerous detrimental effects on multiple body systems. Unless specifically indicated for medical reasons, laying flat for most of the day should be avoided, and efforts should be made to incorporate regular movement and physical activity into daily routines to maintain health and prevent the complications associated with prolonged immobility.