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deconditioning
The loss of cardiovascular or physical fitness as a result of inactivity. It is potentially reversible.
Pathology: (organ system involvement)
1) muscle
a) 10-20% loss of initial strength in 1 week of bedrest
b) plateau at 25-40% loss of initial strength
c) larger muscle fibers lose strength faster than smaller ones
- generalized mucscle weakness greater in proximal muscles than distal ones
d) loose connective tissue begins reorganizing after 1 week increasing risk of fracture
e) may take more than twice the period of immobilization to recover strength
2) bone
a) may start as soon as 30 hours after immobilization
b) weight-bearing bones are more affected
c) 1% loss of vertebral mineral content/week
3) cardiovascular system
a) increased resting heart rate
b) increased heart rate with submaximal exercise
c) decreased resting stroke volume
d) resting cardiac output largely unchanged
e) atrophy of cardiac muscle
f) decrease in VO2 max
g) diuresis with bedrest -> hypovolemia
h) orthostasis
i) increased risk of deep vein thrombosis
4) pulmonary
a) ventilation perfusion mismatch
b) diminished vital capacity
c) posterior accumulation of secretions
d) impaired ciliary function
5) skin
a) increased risk of skin breakdown
b) pressure ulcers
Management:
1) rehabilitation
a) early mobilization
b) strengthening
c) range of motion (ROM)
d) upright position
e) supportive garments
f) medications
2) prevention
- early mobilization
- no need to wait for discontinuation of vasopressors or resolution of fever [3]
Related
physical conditioning (training)
rehabilitation
General
sign/symptom
References
- nlmpubs.nlm.nih.gov/hstat/ahcpr/
- Genova A. UCLA Intensive Course in Geriatric Medicine & Board
Review, Marina Del Ray, CA, Sept 12-15, 2001
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015