Prolonged bed rest refers to remaining in bed or limiting activity for an extended period of time in order to recover from an illness, injury, or medical procedure. While short periods of bed rest for a few days may be recommended, bed rest extending beyond 2-3 weeks is generally considered prolonged. Prolonged bed rest was once a common medical treatment, but advances in scientific understanding have demonstrated that too much bed rest can often impede rather than promote healing and recovery in many situations. Determining what constitutes prolonged bed rest depends on a person’s underlying medical condition.
When Might Prolonged Bed Rest Be Recommended?
Prolonged bed rest may still be recommended in certain situations, including:
After major surgery
Remaining in bed for an extended period is often prescribed after major surgical procedures like open heart surgery, abdominal surgery, or orthopedic procedures like hip replacement. This allows the body to conserve energy to devote to healing rather than physical activity. Bed rest for 4-6 weeks may be recommended after major surgery.
Late pregnancy complications
Prolonged bed rest in late pregnancy may be prescribed if there are complications like preeclampsia, placental problems, premature labor, or cervical issues. Bed rest reduces strain on the body and aims to delay delivery to term. Bed rest ranging from several days to the remainder of pregnancy may be recommended depending on the severity of complications.
Severe injuries like spinal cord trauma
Major injuries like spinal cord trauma require prolonged non-weight-bearing rest to allow bones, ligaments, and nerves to begin healing. Weeks to months of bed rest may be required after severe spinal or orthopedic injuries to allow adequate time for initial recovery and stability before rehabilitation can begin.
Recovery after illness like mono or pneumonia
Viral illnesses like mononucleosis and bacterial infections like pneumonia often warrant extended bed rest during the acute phase when fatigue, fever, and body aches make even basic activity difficult. Bed rest for 2-4 weeks may be recommended in these situations to control symptoms and complications while the infection resolves.
Medical conditions causing severe fatigue like CFS
Chronic medical conditions characterized by severe fatigue like chronic fatigue syndrome may periodically require prolonged bed rest to manage symptoms. During symptom flares, bed rest for weeks to months may be necessary to reduce activity below patients’ energy thresholds.
How Long is Considered Prolonged Bed Rest?
There is no universal definition for exactly how long bed rest must extend to be considered prolonged. General timeframes that are often cited include:
– More than 1 week
– 10-14 days or longer
– Several weeks
– A month or longer
The following table summarizes some general cutoffs for prolonged bed rest based on underlying medical situation:
| Medical Situation | Duration Considered Prolonged Bed Rest |
|---|---|
| Post-surgical recovery | 2-6 weeks |
| Pregnancy complications | Several weeks to months |
| Major trauma like spinal injury | Weeks to months |
| Severe infections | 2-4 weeks |
| Chronic fatigue conditions | Weeks to months during flares |
Ultimately, doctors determine prolonged bed rest on a case-by-case basis depending on the patient’s condition, expected recovery timeframe, and response to treatment. Two weeks of bed rest may be adequate after one surgery but considered too brief after another procedure requiring longer immobilization.
Potential Risks of Prolonged Bed Rest
While bed rest is sometimes clinically necessary, remaining in bed or sedentary for extended periods carries numerous potential health risks. Understanding these adverse effects can help determine whether prolonged bed rest is truly warranted or potentially excessive for a patient’s situation. Potential risks and complications of prolonged bed rest can include:
Cardiovascular deconditioning
Remaining in bed leads to orthostatic intolerance as the cardiovascular system becomes deconditioned. Prolonged bed rest reduces plasma volume and causes cardiac atrophy, lowering stroke volume. This can result in dizziness or fainting when standing up. Spaceflight studies show cardiovascular deconditioning peaks at 20 days of bed rest.
Muscle atrophy and weakness
Lack of muscle use during prolonged bed rest causes rapid loss of muscle mass and strength. Leg muscles atrophy more rapidly than arm muscles, with studies showing decreases up to 30% after just 1 week. This muscle wasting increases fall risk later on and makes rehabilitation more difficult.
Bone density reduction and calcium loss
Being immobile and non-weight-bearing triggers significant bone density loss, increasing future fracture risk. Spinal bone density can decline by 4% per month of bed rest. Prolonged bed rest also increases bone resorption and urinary calcium wasting.
Increased risk of pressure injuries and blood clots
Remaining in bed raises risks of pressure injuries, skin breakdown, and blood clots due to lack of movement. Pressure injuries can occur after just 3-5 days of prolonged bed rest if preventive measures are inadequate. Without mobilization, risk of venous thromboembolism also increases.
Declines in respiratory and metabolic health
Remaining sedentary slows lung excursion and secretion clearance compared to even routine walking, increasing risks of atelectasis and respiratory infection. Prolonged bed rest also worsens glucose tolerance and insulin resistance, raising diabetes risk.
Mood changes like depression and anxiety
Being isolated in bed with limited social interaction and activities can negatively impact mood and provoke psychological issues like depression, anxiety, and delirium. Prolonged bed rest reduces cognitive stimulation.
Delays returning to normal activity and function
Excessive bed rest results in more severe physical deconditioning that then prolongs recovery time once leaving bed. This creates a vicious cycle making it harder to resume normal functioning. Prolonged bed rest beyond medical need often delays rather than expedites healing.
Alternatives to Prolonged Bed Rest
Given the risks of prolonged bed rest, alternative treatments should be considered whenever feasible. Potential alternatives include:
Allowing occasional short walks around the room or house
This maintains some muscle activation and mobility. Walking even 5-10 minutes 1-2 times daily makes a difference.
Sitting up vs. lying flat
Having the head elevated 30-45 degrees preserves more muscle and bone health compared to supine bed rest.
Isometric exercises in bed
Muscle strengthening activities like presses or leg lifts without joint motion help limit wasting.
Adding passive range of motion exercises
Having a caregiver gently move joints through range of motion prevents contractures.
Using antithrombotic stockings or medications
These aid blood circulation to reduce risks of clots when mobility is low.
Setting up temporary disability equipment
Items like toilet rails, shower chairs, and mobility aids facilitate needed self-care.
Conclusion
There is no universal timeframe that defines prolonged bed rest, but it typically refers to limiting out-of-bed activity for a period exceeding 1-2 weeks. While some medical situations like major surgery, spinal cord injury, or pregnancy complications do require extended bed rest, remaining immobile comes with many adverse health effects. Prolonged bed rest beyond medical necessity can actually impede recovery. Alternatives like occasional walking, sitting upright, range of motion exercises, antithrombotic measures, and self-care aids should be considered whenever feasible to minimize complications. Doctors must weigh the benefits against the risks when recommending prolonged bed rest for a patient’s condition.