Authors: Jörg Blech
By now, the fourth stage of the decline is reached: confinement to only one spot. Patients resign themselves to the dim prospect of spending every minute in the same spot, with the exception of using the bathroom, for which they need assistance.
This physical decline is usually associated with a cognitive one. At the beginning of their immobile existences, these ailing individuals tend to watch television, but that becomes too boring after a while. Reading often becomes impossible because they lack the muscle strength to hold books. Visitors are rare, creating a condition of mental vacuity. “The immobile patients are caught in an eventless world and subsequently they lose their sense for time. Months and years dwindled, being fixed to one place all the time made the concept of time meaningless,” observes Zegelin.
Eventually, the patients slide into the fifth and last phase: they are permanently bedridden. They depend on diapers, and they will never again use their legs.
One would like to believe that physicians take measures to avoid such dramatic declines. However, according to Zegelin’s survey, it was both well-intentioned advice, as well as medically motivated arrangements, that contributed to these unfortunate circumstances. In the interviews, many of the residents reported being admonished by doctors and nurses to take it easy and to rest their bodies: “If you have another fall, it’s all over for you!”
Furthermore, the transfer into a special nursing bed added to the patients’ physical immobilization. These beds are often fenced with bars and, because of very thick mattresses, are grotesquely high. When Zegelin asked the residents of the retirement home, “Since when were you actually confined to bed?” too often she heard a revealing answer: “Since they put me in this special bed.”
WASTING AWAY IN OUTER SPACE
Scientists first became aware of the importance for patients to keep moving due to an accidental finding from the Second World War, when beds in sick bays and nurses were scarce. Acting from necessity, doctors released the injured and the sick earlier than usual—often resulting in better healing successes and fewer complications. After the war, this approach lived on in U.S. military hospitals, and medical personnel were taught that the consequences of bed rest are often worse than the original injury.
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The next hint came from space research. When the United States decided to send astronauts to the moon, it became crucial to understand how zero-gravity conditions would affect a human body confined for many days to a tiny space capsule. Thus, in 1966, the National Aeronautics and Space Administration (NASA) initiated a remarkable endeavor that became known as the Dallas Bed Rest and Training Study.
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In a Dallas hospital, five young and healthy men were ordered to stay in bed for three weeks. Like the unfortunate patients in Dr. Silas Weir Mitchell’s ward, these human guinea pigs were not allowed to move their bodies at all. To avoid weight gain, they were kept on a low-calorie diet. They were allowed to take one shower the whole time and were pushed to the bathroom in a wheelchair. After 21 days, the five men were examined—and it turned out they were physical wrecks. Their ability to consume oxygen was reduced by 28 percent, and when two of the subjects were asked to run on a treadmill, they fainted.
WHILE THE BODY RESTS
We don’t fully understand the effects of immobilization on the body, but the findings doctors have gathered in the past 50 years show a broad physical decline. As soon as we spend too much time under the covers, almost every part of the body starts to waste away.
Connective Tissue and Joints
The flexible parts of the body—like joints, tendons, ligaments, muscles, and skin—ordinarily move often, allowing them to function properly. When the freedom of these movements is constrained, these parts shrink. This reaction, known as contracture, can be seen within eight hours of rest: After a night of sleep, some joints and muscles are stiff. While stretching intuitively in the morning, we reverse this early symptom of rest.
Bones
Our bones might appear stable, solid, and hard, but bone tissue is a dynamic structure constantly changing itself. After each stimulus from outside—if we carry a weight or perform push-ups—bone tissue is added, reorganized, or broken down. But as soon as a person takes to bed, bones start to lose calcium, which shows up through increased levels of calcium in the urine after only a few days of bed rest. Scientists have measured this loss and found that 1.54 grams of calcium are excreted per week. This flushing, in turn, increases the risk of kidney stones and of calcification in tissues. This loss of calcium affects the stability of bones. An underused skeleton can soon become crumbly and fragile. People confined to bed for three weeks double their risk of breaking a hip.
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Skin
Resting in bed curtails blood flow in the skin tissues. In those areas where the skin does not cover soft tissue but spans directly across a bone, it gets highly compressed. This compression restricts the blood flow in the skin tissue, which is incrementally dissolved, dies off, and turns into a festering sore prone to inflammation.
Muscle
A given muscle is only as strong as it needs to be and is highly adapted to its usual tasks. Thus, given nothing to do, a muscle will start wasting away, losing roughly one-eighth of its strength during one week of physical inactivity. Such atrophy also occurs when we have to carry an arm or leg in a cast; after the plaster is removed, it is amazing to see how stiff and short the unused muscles have become. The voluntary disuse of our body has a similar effect. When a muscle exerts less than 20 percent of its maximum strength, it starts to shrink. In the case of absolute bed rest, the body loses eight grams of protein every day. The back pain that often appears after a few days of bed rest is actually triggered by the fact that stomach muscles, as well as the muscles lining the backbone, are wasting away. Thus the medical tradition of prescribing bed rest to heal back pain seems downright absurd.
Urinary Passages
The renal pelvis drains because of gravity. If a person is lying in a horizontal position all the time, the accumulating urine cannot properly run off, and the fluid is retained in parts of the kidney, in the calyxes. This in turn poses a risk of developing kidney stones and infections.
Lungs
Another problem for people who remain immobile for long periods is that mucus starts to accumulate in certain areas of the lungs, leading to a condition called local atelectasis. As a result, air cannot move properly through the affected areas and, subsequently, the number of deep breaths a person can take decreases. Even people initially in good health before becoming bedridden risk developing atelectasis and lung infections.
Cardiovascular System
Like every other muscle in the body, the heart shrinks as soon as it lacks sufficient work. The Dallas Bed Rest and Training
Study
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revealed that after three weeks of rest, the heart’s stroke volume decreases by 25 percent, and the size of the heart shrinks by 11 percent. In addition, the risk of suffering an embolism rises, as the blood cannot circulate as usual. A thrombus can emerge and can cause a sudden death by blocking a vessel.
Sex and Reproduction
Physical inactivity decreases the production of the male hormone testosterone and dampens the libido. Also, fewer sperm are produced in the testes.
Digestion
When a person lacks movement, the peristalsis usually needed to move the food through the guts slows down. This can lead to digestive problems and constipation.
Psychological Effects of Immobility
At one point, NASA also kept young male test subjects in bed for as much as five weeks, which caused a whole range of mental and sensory problems. These brave men developed sleeping disorders, anxiety, and hostility to the people around them. In addition, there were hints that the physical passivity impaired their senses. Their capability to hear, see, and taste diminished.
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Another long-term psychological effect is commonplace in hospitals. As soon as people are admitted, many of them abandon their autonomy and slip into the role of the passive patient. Whenever a doctor or nurse appears, patients act in a servile way and readily abide to every procedure. Other people now control many aspects of their life: what they eat, when they sleep, and when visitors are allowed. The lack of intellectual stimulation leads to a dull state of mind. A stay in a clinic can thus mark a sharp decline in cognitive abilities. Nursing scientists aptly call it “the downswing of the IQ in the hospital.”
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Consequently, after being released from a hospital, a surprisingly high number of people must struggle to go back to their normal lives. As the American physician Paul Corcoran concluded: “Small wonder that many patients have trouble resuming independent management and decision making after prolonged bed rest.”
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Pain and Rest: A Vicious Circle
Patients being treated because of neurological injuries suffer more often from chronic pain when they—or their affected body part—are immobilized following the treatment. Less well-understood disorders like fibromyalgia and fibrositis also appear connected with the level of physical activity a person maintains. Attacks of pain tend to start during periods without exercise, when the body is in a depleting mode called “deconditioning.”
Often a person experiencing pain gets caught in a vicious cycle, cautions Annette Becker: “As soon as the patients feel the pain they start to take it easy. In the beginning, the rest admittedly leads on to some pain relief, but in the long run it gives rise to deconditioning—which, in turn, makes the pain worse. This increase of pain adds to the urge to take it easy. Eventually, the rest becomes the reason for being sick and the sickness becomes the reason for the rest—the pain is likely to become chronic.”
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PREMATURE AGING
The decline a person suffers in the course of a bed rest of several weeks is, in effect, occurring right now in wide sections of the larger population, albeit distributed across many years in the lives of people. In middle age, around their 40th birthday, many people adopt a passive and sedentary way of life. They never walk their children to school and always use a car for simple errands. The more they sit, the faster their bodily composition changes. While muscles shrink, fat cells get bigger.
In 1988, the physician Irwin Rosenberg of Tufts University in Boston came up with a name for an eerie phenomenon: “sarcopenia” (from the Greek words
sarx
, meaning “flesh,” and
penia
, or “deficiency”). People suffering from sarcopenia usually walk extremely slowly and have a reduced bone density. They have a weak grip, are prone to falls, and are often unable to control urination and defecation. Their condition is, in a word, tragic. As Rosenberg states: “The more [the potential sarcopenia victims] sit around, fail to exert themselves, and are waited upon by others, the greater the amount of their body’s muscle mass that is replaced by fat. This insidious weakening of body structure and gradual loss of functional capacity then becomes a good excuse for continuing the pattern of immobility.”
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But those affected may think it perfectly normal that they hardly have any physical strength. This, they may declare, is nothing but a natural symptom of old age.
This attitude could not be more dangerous. Such a decline of fitness and bodily control is caused by the fact that muscles haven’t been used properly in years. Gradually, the physiological changes mimic the rapid degeneration caused by complete bed rest. In both instances the body’s ability to process oxygen, its aerobic capacity, dwindles. While the stroke capacity of the heart decreases, blood pressure increases. The concentration of red blood cells decreases, but that of cholesterol increases. The ability of blood to coagulate, thus healing wounds, is hampered. Sarcopenia and complete bed rest shape the body and the metabolism in strikingly similar ways: The proportion of fat grows at the cost of the muscular system. Calcium is flushed away, and the outer substance of the bones thins. The capability to utilize blood sugar is impaired, and the average body temperature drops. The level of male sex hormones drops, the production of sperm slows down, and the libido—the desire to have sex—is also impaired.
With both long-term physical inactivity and short-term bed rest, fewer neurotransmitters like dopamine and serotonin are active in the brain. The sense of hearing fades, as well as the ability to sleep. The sense of taste is slowly desensitized. Memory becomes worse.
For most people, all these changes arrive over the course of years. For the most part, however, this decline is not caused by the phenomenon of aging but simply by the permanent disuse of the body in the course of those years.
Every sedentary person can demonstrate that this is true because these multiple symptoms of degradation and decomposition will be reversed as soon as a person gets in motion again. That is the good news of this sobering chapter: Even degenerating cells, organs, and tissues can recover. If they are stimulated to move, they will renew themselves, and will do so at every age of a person’s life.
Unemployed Bodies, New Diseases
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N 1961, PHYSICIANS HANS KRAUS AT NEW YORK UNIVERSITY AND Wilhelm Raab at the University of Vermont College of Medicine wrote of an alarming trend:
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