The Sequelae of Rest

Elderly Patients Lose Muscle Mass at Three Times the Normal Rate


  • Over the age of 70, bed rest is associated with a major new disability in one-third of cases.

  • Most elderly patients do not engage in the intensive exercise necessary for full recovery after periods of bed rest.

  • Prescribing physical therapy after periods of prolonged rest may protect against geriatric decline.

Bed rest serves as a time-honored recommendation for illness and some injuries, especially for flu and other infections. A normal muscle, at complete rest, in the absence of illness, loses up to 15% of its strength each week.1 During bed rest, the first muscles to become atrophied are the trunk and lower extremity muscles involved in gait and upright posture.2 Illness itself can also cause atrophy of the skeletal muscles, over and above the strength losses caused by rest. Your older patients prove particularly vulnerable to the negative sequela of rest. Among a test sample of healthy subjects age 67 and older, 10 days of bed rest resulted in more lean tissue loss than 28 days of bed rest caused in younger test subjects.3  For patients over the age of 70, bed rest is associated with a major, new disability in one-third of prolonged cases.4 Among elderly patients, when the negative effects of bed rest are not addressed assertively, injury or prolonged difficulties become more likely.  Refer these patients to Back to Action to restore their former ability.

Research has found that during periods of bed rest at home, elderly patients tend to spend more time than needed resting in bed or sitting.4 This stems largely from a lack of confidence and fear of self-injury inspired by the sudden loss of strength and fitness. After the injury has healed or illness has abated, many elderly patients still experience considerable risks associated with their period of rest. Rate of recovery from disuse weakness is slower than the rate of loss. With intensive exercise, the average patient takes 2.5 times longer than the period of rest to regain lost strength.5 Older patients may take even longer because age brings loss of myocellular plasticity which blunts the hypertrophic response.6,7 The fact of the matter is that most elderly patients do not engage in intensive exercise after periods of bed rest and are more likely to quietly decrease their daily activities and self-care. Fall injuries, medication errors, and other problems become more likely during the months following bed rest. Back to Action Physical Therapy can efficiently develop a safe exercise program that will help your older patients maximize their recovery.

The Doctors’ Choice for Physical Therapy

From San Antonio to the southern border of Texas, several hundred doctors refer patients specifically to Back to Action Physical Therapy. Doctors prefer our good outcomes, efficiency of care, fast response to referrals, availability of physical therapists for telephone consults, and mailed case summaries showing real-world results. When you have patients who could benefit from outpatient rehab . . .


Please offer Back to Action to your patients.


  1. Dittmer D, Teasell R. Complications of immobilization and bed rest – Part 1: musculoskeletal and cardiovascular complications. Can Fam Physician. 1993; 39: 1428-1437.
  2. Halar E, Bell K. Rehabilitation’s relationship to inactivity. In: Kottke F, Lehmann J, editors. Krusen’s Handbook of Physical Medicine and Rehabilitation. 4th ed. Philadelphia: WB Saunders Co, 1990: 1113-39.
  3. Kortebein P, Ferrando A, Lombeida J, et al. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007; 297 (16): 1772-1774.
  4. Brown C, Redden D, Flood K, et al. The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society. 2009; 57 (9): 1660-65.
  5. Muller E. Influence of training and inactivity on muscle strength. Arch Phys Med Rehabil. 1970; 51: 449-62.
  6. Slivka D, Faue U, Hollon C, et al. Single muscle fiber adaptations to resistance training in old (>80 year) men: Evidence for limited skeletal muscle plasticity. Am J Physio Regul Integr Comp Physiol. 2008; 295: R273-R280.
  7. Raue U, Slivka D, Minchev K, et al. Improvements in whole muscle and myocellular function are limited with high-intensity resistance training in octogenarian women. J Appl Physiol. 2009; 106: 1611-1617.