Do you know what deconditioning, or prolonged immobilization, does to your body?
“Anyone who lives a sedentary life and does not exercise, even if he eats good foods and takes care of himself according to proper medical principles-all his days will be painful ones and his strength shall wane.”
-Maimonides, Treatise of Hygiene (1199)
What Is Deconditioning?
Our bodies are meant to move. This was recognized even in 1199 when Maimonides gave his Treatise of Hygiene. Our body’s structure and function are improved with regular use. Exercise, in particular, maintains and improves organ physiology and promotes functional interaction between organ systems. Deprived of this stimulus, the body will undergo many degenerative changes in a process called deconditioning which limits and impairs all organ systems and their normal interactions.
Since early days, physicians from ancient Greece and China used different forms of exercise to treat or prevent illness. In the mid-1800’s, medicine began the practice of recommending long periods of bed rest and immobilization for a variety of disorders. The same situation often arises in modern medicine, even though exercise is viewed as a positive mode of treatment while bed rest is a negative. Even as many antiquated beliefs about rest have been refuted, physicians still make it a popular order.
“While prolonged bed rest can cause emotional and financial hardships, it doesn’t have the side effects that drugs do. So doctors have believed that at least bed rest does no harm…”
–U.S. News & World Report, 1994
Similar to the body’s ability to be trained to become better conditioned and more fit, it can also be trained to deteriorate. Prolonged rest, or immobilization, results in a cascade of negative interrelated effects on body systems.
Causes of Deconditioning
- Immobilization
- Paralysis/ neuromusculoskeletal disorder
- Weightlessness
- Sedentary lifestyle
- Medically Prescribed Rest
- Neglect
- Pain
The negative effects of deconditioning play an enormous toll on the overall health and the economy at large. There are over 200, 000 deaths in U.S. annually related to sedentary lifestyle. In fact, only about 25% of U.S. adults do not engage in even leisure time physical activity, let alone regular exercise. Only about 15% of adults perform recommended amount of exercise, which is about 150 minutes/week. The chart below illustrates how quickly the body can become deconditioned. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
In fact, deconditioning is very analogous to a rapid aging process. In normal aging, we will see about 1% bone loss per year, whereas we’ll see 1% bone loss PER WEEK with acute deconditioning. We’ll see a 10% decline in our exercise capacity (VO2max) each decade of aging, while we’ll see 10% per week with deconditioning.
Deconditioning affects every organ system in interrelated ways.
Our muscles lose strength, size and endurance with deconditioning. We can experience a decrease in cross sectional area by 25-30% in 1mo. Ligaments and tendons lose 1/3 of strength after only 8wks of immobilization and take several months to recover.
The heart is another important muscle that is affected by deconditioning. Similar to skeletal muscles, the cardiac musculature undergoes atrophy as well as a decrease in cardiac size, strength and endurance after prolonged deconditioning. Long-term inactivity has been shown to be comparable to high blood pressure, tobacco use, and high cholesterol as risk factor for coronary artery disease.
Not only is the heart affected, so is the fluid it pumps. When we are deconditioned, our bodies loose fluid through increased urination and edema. This makes the blood thicker and harder to pump. It also increases risks for blood clots, kidney stones and loss of important minerals crucial to bone health.
We will also see joint degeneration. Joints receive their nutrition by the regular loading and unloading in order to draw synovial fluid into and out of the cartilage. This process ceases with immobilization and leads to deterioration. The bones also become more brittle by increased resorption. This can begin in as little as 30hrs after immobilization.
This cascade of events will also lead to increased body fat, constipation, altered lung capacity, hormonal imbalances, sleep disturbances and altered mood among several other physiologic problems.
We can combat this downward spiral by using our bodies more, hopefully with a regular exercise routine. Physicians can diagnose disorders and treat painful conditions that limit the capacity to exercise. Physical therapists can address musculoskeletal imbalances and problematic movement patterns in order to facilitate movement and exercise. PT’s and athletic trainers can help people develop proper exercise routines which include direction on the type, frequency, amount, duration, intensity and velocity required in different exercises. People may need exercise testing prior to safely beginning a new exercise regimen and the medical team can be utilized to help direct this.
Once a person begins an exercise routine, they embark on the only natural method that can offset wasting conditions such as aging, injury, disease. Some diseases, such as osteoporosis, may be completely reversed with exercise. We also note improved sense of well-being, better sleep and improved immune health. At CHARM, we have physicians who can diagnose and treat musculoskeletal and neurologic injuries that limit or prevent the ability to exercise. We also have excellent physical therapists who work one on one with patients to help guide them through safe movement patterns and return to function.
Board-Certified Physical Medicine & Rehabilitation by ABPMR and AOBPMR
Fellowship-Trained and Board-Certified in Pain and Musculoskeletal Medicine
