Imobility Research Paper
The Hazards of Immobility: Effects on Metabolic Equilibrium
Mark Foust
Breckinridge School of Nursing
February 4, 2015
Abstract
Experience and basic wisdom teach us the importance and benefits of exercise and activity and the hazards of inactivity and immobility. However, the myth that bed rest is good for you when ill or recuperating still persists in our world. An abundance of scientific research in the past 50 years demonstrates the specific damage done to each of the body’s organ systems by immobility and inactivity. Immobility of the body leads to devastating deterioration. No body system is immune to the effects. One system affected tremendously is the metabolic system. With prolonged bed rest and immobility, …show more content…
there are changes in the utilization of food leading to increased fat stores and glucose intolerance, increased insulin requirements for carbohydrate metabolism, a reduction in the basal metabolic rate and progressive loss of muscle mass. These metabolic changes are addressed in more detail.
Introduction
Immobility is defined as the inability to mobilize as normal. Reduced physical activity occurs through disease, injury, or following major surgery. Immobility is particularly harmful, especially in the elderly, because it causes muscle wasting and progressive loss of function (Corcoran, 1991). Total immobility produces complications including bedsores, pneumonia, or contractures (Corcoran, 1991). A common complication of partial immobility is oedema (fluid retention), which causes swelling of the legs (Rousseau, 1993). Sluggish blood flow encourages formation of a thrombus (abnormal blood clot) in a leg vein. Regular physical therapy and adequate nursing care are important for any person who is totally immobile. One system in the body that is greatly affected by immobility is the Endocrine system, particularly metabolism. Metabolic complications can include Glucose intolerance, lowered basal metabolic rate, decreased muscle mass, increased total cholesterol levels and decreased low-density lipoprotein levels (Rousseau, 1993).
Article Summary
The effects of immobility on the metabolic processes in the human body include reduced metabolic rate, tissue atrophy and protein catabolism, bone demineralization, changes in nutrient and other substances between the extracellular and intracellular fluids and electrolyte and fluid imbalance (Olson, 1967).
When a person is confinded to bed rest and has increased immobility, the metabolic rate decreases in response to the lower levels of energy required to maintain the body’s homeostasis. Anabolic processes, metabolic pathways that construct molecules from smaller units and require energy for the process, are slowed down and catabolic processes, where large molecules are broken down into smaller parts and then used up in respiration, are sped up in the body (Olson, 1967). The process of protein breakdown leads to protein deficiency and negative nitrogen balance (Olson, 1967). Nitrogen balance expresses the balance between anabolism and catabolism (Olson, 1967). A negative nitrogen balance exists when the excretion of nitrogen from the breakdown of protein exceeds intake (Olson, 1967). This predisposes the patient to problems with wound healing and normal tissue growth, thus resulting in loss of lean body mass and increased percentage of body fat (Olson, 1967). The formation of decubitus ulcers, or pressure ulcers, is also an issue with immobile patients (Olson, 1967). Pressure ulcers are injuries to the skin and underlying tissue resulting from prolonged pressure on the …show more content…
skin, such as prolonged bed rest (Potter, 2013). Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone (Potter, 2103). The kidneys are essential for regulating the volume and composition of bodily fluids- controlling volume, sodium and potassium concentrations, and the pH of bodily fluids (Olson, 1967). Bone also starts to deteriorate as a consequence of reduced muscle tension and loss of weight-bearing stress on the skeleton (Olson, 1967). Immobility can also cause urinary tract stones, a condition known as Urolithiasis (Olson, 1967). They are formed when the urine is supersaturated with salt and minerals such as calcium oxalate, struvite, uric acid and cystine (Olson, 1967).
When hospitalize, a patient should stay up out of bed as long as possible and should be dressed in their “daytime clothing” to help maintain a more natural metabolic rate (Olson, 1967). If the patient is unable to ambulate, sitting in a chair prevents fluid and electrolyte imbalance and prevents BMR and hormone level changes as compared to lying in bed (Olson, 1967).
If a patient must be on bed rest, some nursing measures should be implemented. The head of the patient’s bed should be elevated on a schedule, similar to a turning schedule (Olson. 1967). Light and loose-fitting clothing, like a hospital gown, reduces the loss of fluid and electrolytes through sweating. Increased fluid intake and a diet rich in protein will not only facilitate healing, but also helps with electrolyte imbalance. Range of motion exercises, either active or passive, helps with muscle atrophy and elevated calcium serum levels (Olson, 1967). These interventions decrease many of the problems associated with prolonged bedrest.
Research
One of the major complications of prolonged bedrest is a progressive loss of muscle mass, known as sarcopaenia (Rousseau, 1993). This condition is made even worse by changes in the adrenal glucocorticoid hormones. Glucocorticoid hormones, specifically cortisol, are involved in glucose metabolism (Rousseau, 1993). Cortisol stimulates several processes that collectively serve to increase and maintain normal concentrations of glucose in blood (Potter, 2013). After physical injury, cortisol is released, which acts as an anti-inflammatory and promotes the generation of glucose derivatives from proteins and fat (Corcoran, 1991). This is known as gluconeogenesis. This is one of the main mechanisms used by the body to maintain blood glucose levels helping to avoid low blood glucose levels (hypoglycemia). When patients are confined to bedrest, cortisol secretion increases, which promotes skeletal muscle breakdown and the release of amino acids into the blood (Corcoran, 1991). Prolonged bedrest also sensitizes skeletal muscles to the catabolic effects (breaking down molecules into smaller units to release energy) of cortisol increasing the rate of muscle atrophy (Rousseau, 1993).
Research supports that inactivity and immobility lead to a progressive drop in the basal metabolic rate (BMR) (Rousseau, 1993). BMR is the amount of energy expressed in calories that a person needs to keep the body functioning at rest (Potter, 2103). Some of those processes include breathing, blood circulation, controlling body temperature, cell growth, brain and nerve function, and contraction of muscles. BMR also affects the rate that a person burns calories and ultimately whether a person maintains, gains, or loses weight. Research shows that the basal metabolic rate begins to fall after as little as 10 hours of immobility (Rousseau, 1993). After 10-24 hours of immobility, there is a 6.9% drop in metabolism which will persist regardless of the length of immobility (Rousseau, 1993). These drops in metabolism are most likely related to reduced muscle activity. The metabolic rate continues to fall in patients who remain immobile, reflecting the progressive decline in lean muscle mass caused by disuse (Rousseau, 1993). Interestingly, a reduced metabolism does not usually lead to weight gain with patients confined to bed (Rousseau, 1993). They usually maintain a fairly stable body weight. The reduced BMR is often offset by the patient’s reduced lean muscle mass and consumption of fewer calories due to poor appetite (Rousseau, 1993).
Immobility, even leading a sedentary lifestyle, has been linked to insulin resistance, impaired glucose tolerance and the development of type 2 diabetes (Rousseau, 1993).
The body’s ability to regulate blood glucose is adversely affected by long periods of immobility. Studies show a progressive development of glucose intolerance that correlates directly to the length of time that patients remain in bed (Rousseau, 1993). The number of insulin receptors expressed in skeletal muscles increases in proportion to physical activity (Rousseau, 1993). When a person leads an active lifestyle and exercising regularly, expression of insulin receptors remains high. When active people eat a meal rich in carbohydrates, their blood glucose levels rise, triggering insulin release. Insulin binds to the abundant receptors within the skeletal muscles, promoting rapid glucose uptake, returning the blood glucose level to within the normal range (Rousseau, 1993). Immobility and reduced food intake are associated with a reduction in the expression of insulin receptors in the skeletal muscles (Rousseau, 1993). When patients confined to bed eat carbohydrate-rich meals, the sensitivity of the skeletal muscles to the effects of insulin is much lower, resulting in lower glucose uptake and a higher blood glucose concentration (Rousseau, 1993). The reduced sensitivity of skeletal muscles to the effects of insulin typically results in overproduction and secretion of insulin, leading to hyperinsulinaemia
(Rousseau, 1993).
Studies show patients subjected to prolonged periods of bedrest have increased total cholesterol levels and decreased low-density lipoprotein levels (Brown, 2007). Low-density lipoproteins (LDL) are complex particles composed of multiple proteins which transport all fat molecules (lipids) around the body within the water outside cells (Black, 2008). LDL are sometimes referred to as bad cholesterol because they transport their content of fat molecules into artery walls, attract macrophages (a type of white blood cell that ingests foreign material) and cause atherosclerosis (Black, 2008). Atherosclerosis is a disease in which plaque builds up inside the arteries (Black, 2008). Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows the arteries, which limits the flow of oxygen-rich blood to the organs and other parts of your body.
Authoritative or Not?
This article was written in April of 1967. At the time, I believe the article was an example of authoritative writing. The article was relevant and an excellent resource because it was written for The American Journal of Nursing, which is a peer reviewed nursing journal. In a peer review, one or more people with similar competence and expertise as the writer evaluate the work. The article’s audience was probably aimed at nurses and those in the health care field who had interest on the topic of immobility and the effects on the different systems in the body for the benefit of their patients. The article was written by Edith V. Olson and for each section of the article dealing with the different systems, she had an expert on that system to discuss the effects of immobility as it relates to that system. For her article, she used the leverage of authority of other experts and used it as sources for her content. The article was written with simplicity. The information presented was at a high level, but was also easily presented and explained to the audience. The article was also written with good grammar. I didn’t find any typos or grammatical errors, so that helped me to believe the author’s credibility. When I find grammatical errors in someone’s writing, I tend to think of the author as careless and, for me, it destroys their credibility. For the year the article was written, I do think it was an authoritative piece. It was well written with an abundance of information from experts in their fields. I would not use the article today as a reference, just because of the fact that it is out dated- almost 50 years old.
Conclusion
Bed rest sounds like a gentle, healing process for the body, but that term is deceptive. Our bodies need to move and multiple problems in the different systems of the body quickly start to set in even after only a couple of days of immobility. These negative effects have a serious impact on a patient’s health. One system affected greatly is on the metabolism and hormonal system. Prolonged bed rest presents numerous complex changes on the metabolic processes in the body and in how the body processes energy.
References
Black, J. (2008). Microbiology: Principles and explorations (7th ed.). Hoboken, NJ: J. Wiley & Sons.
Brown C. J., Redden D. T., Flood K. L., Allman R. A. (2009). The under-recognized epidemic of low mobility during hospitalization. Journal of American Geriatrics Society, 57(9), 1660- 1665.
Brown C. J., Williams B. R., Woodby L. L., Davis L. L., Allman R. M. (2007). Barriers to mobility during hospitalization from the perspective of nurses and physicians. Journal of Hospital Medicine, 2(5), 305-313.
Corcoran PJ., Use it or lose it: the hazards of bed rest and inactivity. (1991).Western Journal of Medicine,154, 536-538.
Inoue M., Tanaka H., Moriwake T., Oka M., Sekiguchi C., Seino Y. (2000). Altered biochemical markers in humans during 120 days of bed rest. Journal of Clinical Endocrinology and Metabolism, 26(3), 281-286.
Potter, P., & Perry, A. (2013). Fundamentals of nursing (8th ed.). St. Louis, Mo.: Mosby Elsevier.
Rousseau, P., (1993). Immobility in the aged. Archives of Family Medicine. 1993 Feb; 2(2):169-77.
Mark Foust
Breckinridge School of Nursing
February 4, 2015
Abstract
Experience and basic wisdom teach us the importance and benefits of exercise and activity and the hazards of inactivity and immobility. However, the myth that bed rest is good for you when ill or recuperating still persists in our world. An abundance of scientific research in the past 50 years demonstrates the specific damage done to each of the body’s organ systems by immobility and inactivity. Immobility of the body leads to devastating deterioration. No body system is immune to the effects. One system affected tremendously is the metabolic system. With prolonged bed rest and immobility, …show more content…
there are changes in the utilization of food leading to increased fat stores and glucose intolerance, increased insulin requirements for carbohydrate metabolism, a reduction in the basal metabolic rate and progressive loss of muscle mass. These metabolic changes are addressed in more detail.
Introduction
Immobility is defined as the inability to mobilize as normal. Reduced physical activity occurs through disease, injury, or following major surgery. Immobility is particularly harmful, especially in the elderly, because it causes muscle wasting and progressive loss of function (Corcoran, 1991). Total immobility produces complications including bedsores, pneumonia, or contractures (Corcoran, 1991). A common complication of partial immobility is oedema (fluid retention), which causes swelling of the legs (Rousseau, 1993). Sluggish blood flow encourages formation of a thrombus (abnormal blood clot) in a leg vein. Regular physical therapy and adequate nursing care are important for any person who is totally immobile. One system in the body that is greatly affected by immobility is the Endocrine system, particularly metabolism. Metabolic complications can include Glucose intolerance, lowered basal metabolic rate, decreased muscle mass, increased total cholesterol levels and decreased low-density lipoprotein levels (Rousseau, 1993).
Article Summary
The effects of immobility on the metabolic processes in the human body include reduced metabolic rate, tissue atrophy and protein catabolism, bone demineralization, changes in nutrient and other substances between the extracellular and intracellular fluids and electrolyte and fluid imbalance (Olson, 1967).
When a person is confinded to bed rest and has increased immobility, the metabolic rate decreases in response to the lower levels of energy required to maintain the body’s homeostasis. Anabolic processes, metabolic pathways that construct molecules from smaller units and require energy for the process, are slowed down and catabolic processes, where large molecules are broken down into smaller parts and then used up in respiration, are sped up in the body (Olson, 1967). The process of protein breakdown leads to protein deficiency and negative nitrogen balance (Olson, 1967). Nitrogen balance expresses the balance between anabolism and catabolism (Olson, 1967). A negative nitrogen balance exists when the excretion of nitrogen from the breakdown of protein exceeds intake (Olson, 1967). This predisposes the patient to problems with wound healing and normal tissue growth, thus resulting in loss of lean body mass and increased percentage of body fat (Olson, 1967). The formation of decubitus ulcers, or pressure ulcers, is also an issue with immobile patients (Olson, 1967). Pressure ulcers are injuries to the skin and underlying tissue resulting from prolonged pressure on the …show more content…
skin, such as prolonged bed rest (Potter, 2013). Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone (Potter, 2103). The kidneys are essential for regulating the volume and composition of bodily fluids- controlling volume, sodium and potassium concentrations, and the pH of bodily fluids (Olson, 1967). Bone also starts to deteriorate as a consequence of reduced muscle tension and loss of weight-bearing stress on the skeleton (Olson, 1967). Immobility can also cause urinary tract stones, a condition known as Urolithiasis (Olson, 1967). They are formed when the urine is supersaturated with salt and minerals such as calcium oxalate, struvite, uric acid and cystine (Olson, 1967).
When hospitalize, a patient should stay up out of bed as long as possible and should be dressed in their “daytime clothing” to help maintain a more natural metabolic rate (Olson, 1967). If the patient is unable to ambulate, sitting in a chair prevents fluid and electrolyte imbalance and prevents BMR and hormone level changes as compared to lying in bed (Olson, 1967).
If a patient must be on bed rest, some nursing measures should be implemented. The head of the patient’s bed should be elevated on a schedule, similar to a turning schedule (Olson. 1967). Light and loose-fitting clothing, like a hospital gown, reduces the loss of fluid and electrolytes through sweating. Increased fluid intake and a diet rich in protein will not only facilitate healing, but also helps with electrolyte imbalance. Range of motion exercises, either active or passive, helps with muscle atrophy and elevated calcium serum levels (Olson, 1967). These interventions decrease many of the problems associated with prolonged bedrest.
Research
One of the major complications of prolonged bedrest is a progressive loss of muscle mass, known as sarcopaenia (Rousseau, 1993). This condition is made even worse by changes in the adrenal glucocorticoid hormones. Glucocorticoid hormones, specifically cortisol, are involved in glucose metabolism (Rousseau, 1993). Cortisol stimulates several processes that collectively serve to increase and maintain normal concentrations of glucose in blood (Potter, 2013). After physical injury, cortisol is released, which acts as an anti-inflammatory and promotes the generation of glucose derivatives from proteins and fat (Corcoran, 1991). This is known as gluconeogenesis. This is one of the main mechanisms used by the body to maintain blood glucose levels helping to avoid low blood glucose levels (hypoglycemia). When patients are confined to bedrest, cortisol secretion increases, which promotes skeletal muscle breakdown and the release of amino acids into the blood (Corcoran, 1991). Prolonged bedrest also sensitizes skeletal muscles to the catabolic effects (breaking down molecules into smaller units to release energy) of cortisol increasing the rate of muscle atrophy (Rousseau, 1993).
Research supports that inactivity and immobility lead to a progressive drop in the basal metabolic rate (BMR) (Rousseau, 1993). BMR is the amount of energy expressed in calories that a person needs to keep the body functioning at rest (Potter, 2103). Some of those processes include breathing, blood circulation, controlling body temperature, cell growth, brain and nerve function, and contraction of muscles. BMR also affects the rate that a person burns calories and ultimately whether a person maintains, gains, or loses weight. Research shows that the basal metabolic rate begins to fall after as little as 10 hours of immobility (Rousseau, 1993). After 10-24 hours of immobility, there is a 6.9% drop in metabolism which will persist regardless of the length of immobility (Rousseau, 1993). These drops in metabolism are most likely related to reduced muscle activity. The metabolic rate continues to fall in patients who remain immobile, reflecting the progressive decline in lean muscle mass caused by disuse (Rousseau, 1993). Interestingly, a reduced metabolism does not usually lead to weight gain with patients confined to bed (Rousseau, 1993). They usually maintain a fairly stable body weight. The reduced BMR is often offset by the patient’s reduced lean muscle mass and consumption of fewer calories due to poor appetite (Rousseau, 1993).
Immobility, even leading a sedentary lifestyle, has been linked to insulin resistance, impaired glucose tolerance and the development of type 2 diabetes (Rousseau, 1993).
The body’s ability to regulate blood glucose is adversely affected by long periods of immobility. Studies show a progressive development of glucose intolerance that correlates directly to the length of time that patients remain in bed (Rousseau, 1993). The number of insulin receptors expressed in skeletal muscles increases in proportion to physical activity (Rousseau, 1993). When a person leads an active lifestyle and exercising regularly, expression of insulin receptors remains high. When active people eat a meal rich in carbohydrates, their blood glucose levels rise, triggering insulin release. Insulin binds to the abundant receptors within the skeletal muscles, promoting rapid glucose uptake, returning the blood glucose level to within the normal range (Rousseau, 1993). Immobility and reduced food intake are associated with a reduction in the expression of insulin receptors in the skeletal muscles (Rousseau, 1993). When patients confined to bed eat carbohydrate-rich meals, the sensitivity of the skeletal muscles to the effects of insulin is much lower, resulting in lower glucose uptake and a higher blood glucose concentration (Rousseau, 1993). The reduced sensitivity of skeletal muscles to the effects of insulin typically results in overproduction and secretion of insulin, leading to hyperinsulinaemia
(Rousseau, 1993).
Studies show patients subjected to prolonged periods of bedrest have increased total cholesterol levels and decreased low-density lipoprotein levels (Brown, 2007). Low-density lipoproteins (LDL) are complex particles composed of multiple proteins which transport all fat molecules (lipids) around the body within the water outside cells (Black, 2008). LDL are sometimes referred to as bad cholesterol because they transport their content of fat molecules into artery walls, attract macrophages (a type of white blood cell that ingests foreign material) and cause atherosclerosis (Black, 2008). Atherosclerosis is a disease in which plaque builds up inside the arteries (Black, 2008). Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows the arteries, which limits the flow of oxygen-rich blood to the organs and other parts of your body.
Authoritative or Not?
This article was written in April of 1967. At the time, I believe the article was an example of authoritative writing. The article was relevant and an excellent resource because it was written for The American Journal of Nursing, which is a peer reviewed nursing journal. In a peer review, one or more people with similar competence and expertise as the writer evaluate the work. The article’s audience was probably aimed at nurses and those in the health care field who had interest on the topic of immobility and the effects on the different systems in the body for the benefit of their patients. The article was written by Edith V. Olson and for each section of the article dealing with the different systems, she had an expert on that system to discuss the effects of immobility as it relates to that system. For her article, she used the leverage of authority of other experts and used it as sources for her content. The article was written with simplicity. The information presented was at a high level, but was also easily presented and explained to the audience. The article was also written with good grammar. I didn’t find any typos or grammatical errors, so that helped me to believe the author’s credibility. When I find grammatical errors in someone’s writing, I tend to think of the author as careless and, for me, it destroys their credibility. For the year the article was written, I do think it was an authoritative piece. It was well written with an abundance of information from experts in their fields. I would not use the article today as a reference, just because of the fact that it is out dated- almost 50 years old.
Conclusion
Bed rest sounds like a gentle, healing process for the body, but that term is deceptive. Our bodies need to move and multiple problems in the different systems of the body quickly start to set in even after only a couple of days of immobility. These negative effects have a serious impact on a patient’s health. One system affected greatly is on the metabolism and hormonal system. Prolonged bed rest presents numerous complex changes on the metabolic processes in the body and in how the body processes energy.
References
Black, J. (2008). Microbiology: Principles and explorations (7th ed.). Hoboken, NJ: J. Wiley & Sons.
Brown C. J., Redden D. T., Flood K. L., Allman R. A. (2009). The under-recognized epidemic of low mobility during hospitalization. Journal of American Geriatrics Society, 57(9), 1660- 1665.
Brown C. J., Williams B. R., Woodby L. L., Davis L. L., Allman R. M. (2007). Barriers to mobility during hospitalization from the perspective of nurses and physicians. Journal of Hospital Medicine, 2(5), 305-313.
Corcoran PJ., Use it or lose it: the hazards of bed rest and inactivity. (1991).Western Journal of Medicine,154, 536-538.
Inoue M., Tanaka H., Moriwake T., Oka M., Sekiguchi C., Seino Y. (2000). Altered biochemical markers in humans during 120 days of bed rest. Journal of Clinical Endocrinology and Metabolism, 26(3), 281-286.
Potter, P., & Perry, A. (2013). Fundamentals of nursing (8th ed.). St. Louis, Mo.: Mosby Elsevier.
Rousseau, P., (1993). Immobility in the aged. Archives of Family Medicine. 1993 Feb; 2(2):169-77.