deconditioning
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Introduction
The loss of cardiovascular or physical fitness as a result of inactivity. It is potentially reversible.
Pathology
(organ system involvement)
- muscle
- 10-20% loss of initial strength in 1 week of bedrest
- plateau at 25-40% loss of initial strength
- larger muscle fibers lose strength faster than smaller ones
- generalized mucscle weakness greater in proximal muscles than distal ones
- loose connective tissue begins reorganizing after 1 week increasing risk of fracture
- may take more than twice the period of immobilization to recover strength
- bone
- may start as soon as 30 hours after immobilization
- weight-bearing bones are more affected
- 1% loss of vertebral mineral content/week
- cardiovascular system
- increased resting heart rate
- increased heart rate with submaximal exercise
- decreased resting stroke volume
- resting cardiac output largely unchanged
- atrophy of cardiac muscle
- decrease in VO2 max
- diuresis with bedrest -> hypovolemia
- orthostasis
- increased risk of deep vein thrombosis
- pulmonary
- ventilation perfusion mismatch
- diminished vital capacity
- posterior accumulation of secretions
- impaired ciliary function
- skin
- increased risk of skin breakdown
- pressure ulcers
Management
- rehabilitation
- early mobilization
- strengthening
- range of motion (ROM)
- upright position
- supportive garments
- medications
- prevention
- early mobilization
- no need to wait for discontinuation of vasopressors or resolution of fever[3]
- early mobilization