Are we deconditioning ourselves?

WellbeingAyurveda

15 Feb

Written By Kirit S

In hospitals we use the term “deconditioned” for the physiological changes that happen to the body causing physical, cognitive and psychological decline after a period of bed-rest or inactivity.

A person aged 65 years and over can spend between 71-83% of their time in hospital lying down! (1,2,3).

Look at what happens with just days of bed-rest:

1 week of bed-rest leads to marked reduction in muscle mass (4,5) and lowers insulin-sensitivity (4).
10 days of bed-rest leads to reduction in strength and power in the legs as well as aerobic capacity (6).
21 days of bed-rest leads to an increase in CRP levels, an inflammatory marker (7).
27 days of bed-rest can lead to bone mineral loss (8).
60 days of bed-rest results in a decrease in lean body mass and an increase in resting heart rate (9).

How Inactivity Impacts Every System

While muscle loss and bed sores are unfortunately well-known and visible consequences of extended bed-rest that we often see in healthcare settings, prolonged bed-rest actually affects every body system. Here are just a few:

joint contractures

muscle weakness (skeletal and cardiac)
changes in heart muscle (10,11)
increased pro-inflammatory state (12,7)
reduced respiratory function (13)
reduction in red blood cells so less oxygen circulating
formation of blood clots (14)
insulin resistance (15,16)
constipation
loss of balance + coordination (17)
changes in volume of grey matter in brain related to performance, movement, learning, memory and coordination (18)
reduced levels of circulating neurotransmitters (dopamine, noradrenaline, serotonin) might explain depressed mood (19)
sensory deprivation
anxiety and “learned helplessness” (20)
urinary stones, retention and infections (21)
reduction in bone mineral density, increasing fracture risk (22,23,24)
compromised skin integrity (25)

The list above reminds us just how dynamic our tissues are. Bones need some impact to continually reform, our lymph fluid needs help moving waste and nutrients around our body, our muscles need mechanical load and resistance to generate force. We are constantly in interaction with our surroundings.

According to Ayurveda, muscle is the organ of longevity so to maintain it is vital. We can see in the list above, that nearly all the body systems rely on muscles (skeletal, cardiac, smooth) or the movement that they allow, to function well. It is muscle that creates the peristaltic movement of our gut lining, muscles that pump our heart, muscles that are the main deposit site for glucose, muscles that expand and contract our lungs, muscles that take us outdoors and to new places for our senses to experience, giving us independence.

The mind map below summarises all the physiological changes that occur in the body with prolonged bed-rest.

Movement is Medicine

Of course people in hospital have usually experienced an injury or surgery so there are the added physiological demands that will have a knock-on effect. But, incorporating early movement and therapies during hospital stays have shown to improve people’s recovery and speed up their hospital discharge.

Healthcare professionals have learnt the importance of early mobilisation with hospital patients instead of the traditional, long bed-rest that used to be prescribed decades before. This is because the circumstances we are observing in hospital are extreme. But, beyond the hospital walls, has convenience slowly started deconditioning us in everyday life too?

Modern Living Encourages Inactivity

Modern life is defined by convenience and comfort so it is easy to live a sedentary lifestyle. But, this kind of living can decondition us. Sure, there are perks to some conveniences if they afford us more time to spend elsewhere, if we are housebound due to long-term conditions, have disabilities or an illness. But, have some made it easier for us to just be lazy too?

Just think of all the services that now deliver to our doorstep. Instead of cooking a meal from scratch, we can easily get a takeaway. Instead of going out and meeting friends in real life, we can just stay home and meet them over a video call. Instead of taking the stairs (if we are able to), we can just choose the lift. We can replace these scenarios with plenty of other things – binge-watching Netflix shows back-to-back; driving to the corner shop that’s within walking distance; working from home at the computer for hours without a break, the list can go on. The point is, if we stop using and stretching our body and mind, we start to notice loss in function. Now, you may be thinking “this nurse is taking things out of proportion”, but it is not that far-fetched. We are already seeing the complications of sedentary lifestyles in Primary Care – diagnoses of chronic conditions such as type 2 diabetes and hypertension in younger people and even kidney stone formation in people who stay seated working from home for hours at a time. This is avoidable.

Terms such as “disuse atrophy” or “disuse syndrome” really bring home that the risks of inactivity to our health are just too high. Our body works best when it is mobile, so let’s keep it moving!