For much of the last two centuries, one of the very common prescriptions for those who were ill or recovering from injury was plenty of bed rest. The idea behind such treatment was to provide the body with time and energy to allow it heal or recover from sickness. For many different medical conditions and health issues, it was considered a standard part of recovery and generally accepted by patients and the public alike as a necessity while convalescing. Until the 1960's, even the treatment of high blood pressure involved patients spending some time on their backs in bed.
In the past few decades, however, the perceived value of bed rest with patients laying on their back or relaxing comfortably leaning on their bed rest pillow has changed from being a positive to being a negative in many cases. While we will all need some time to rest in bed when knocked down by a flu, cold or infection, research continues to demonstrate that bed rest should be limited where possible to improve overall recovery time and limit other health risks.
To understand these risks that result from excessive bed rest, it is important to first understand the effects that spending long hours in bed can have on the body. In this situation, the old saying "if you don't use it, you lose it" is quite appropriate because spending too many hours inactive in bed leads, among other problems, to loss of muscle mass, loss of body fluids and loss of bone density. The reductions in muscle subsequently result in muscle weakness and the loss of bone density means that bones are more brittle.
In addition to these changes, bed rest also has significant effects on our bodies because it alters the operation of many systems in the body. One specific example is the small increase in lung volume that is seen following 10 to 12 days of bed rest. This change takes place to compensate for decreases in the rate of breathing and oxygen exchange that happen when we are lying down for so long.
Another example results from research out of Boston University where scientists found that only 5 days of bed rest led to a 67% increase in the amount of insulin required because of reduced insulin sensitivity otherwise known as insulin resistance. The same study also found that days spent in bed resulted in high blood pressure
. In a different study of bed rest, this time conducted by Radboud University, researchers found that 8 weeks of bed rest resulted in a 20% increase in the thickness of the walls of specific arteries.
Quite clearly, so much inactivity and time spent resting significantly alters the way our bodies work.
As a consequence of these changes in the body as well as the simple physical effects of being on one's back for so long, health risks will arise from extended bed rest. As an example of such physical effects, unconscious patients in hospitals are regularly turned on their sides and back when possible to prevent the formation of bedsores. Such sores form simply because all of the patients weight is concentrated on specific areas of the body when they are laying immobilized. Over time, this force causes the tissues to break down.
In terms of the risks from the changes in body function, one example is muscle weakness that increases the risk of falling and brittle bones that increase the risk of fractures. A study from Washington University found that in more than 40% of cases, patients who fall will injure themselves and in 1 in 12 falls, the injuries are serious.
In addition to these risks, another set of risks are those to the cardiovascular system. That high blood pressure increases both the risk of strokes and heart attacks is already well known. Only recently, however, researchers from the University of Miami identified that insulin resistance also increases the risks of strokes
. In particular, they found that the 25% of the population with the highest insulin resistance had a 45% higher chance of suffering a stroke than those without such insulin function.
Yet another circulatory system risk arises because of the increased thickness of the arteries. In this case, the consequence is a higher risk of arteriosclerosis in which the arteries become constricted and sometimes blocked leading again to heart attack and stroke risks.
The last known risk to circulatory system health that comes from being immobilized in bed is the same risk experienced when taking extended airplane flights. Deep Vein Thrombosis (DVT) or blood clots formed in the veins can result from lack of motion and such clots can lead to strokes or blockages of blood flow to the lungs called pulmonary embolisms
. Based on research from a number of Italian universities including the University of Perugia the risks for developing such blood clots exists after more than 3 days of bed rest.
Taken together, all of these effects on the circulatory system represent very significant risks for those prescribed bed rest. If that were not enough, all of these changes in the body can also lead to depression which further slows down the healing and recovery process.
Though once a common component of treating numerous health problems, bed rest continues to lose its appeal because of the risks associated with it and the lack of real benefits. Though every one of us will need some legitimate amount of bed rest at some time, we can increasingly expect our health care providers to encourage more active recovery time to use when we are patients.
A future article will look at some of the areas in which medical practice is attempting to reduce the amount of bed rest required by patients during their recovery.
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