restriction of a patient's activities, either partially or completely. A person on
strict bed rest must remain in bed at all times. Many patients are placed on
bed rest with bathroom privileges and are permitted to ambulate to a toilet in the bathroom. Bed rest may be prescribed to maintain a pregnancy. It is associated with many
hazards of immobility and may be a greater stressor to the patient than a less restrictive activity prescription would be.
The cardiovascular, pulmonary, gastrointestinal, and musculoskeletal systems all suffer from inactivity and the recumbent position. Cardiac output and capacity, depth of respiration, and peristalsis decrease, while the risk of orthostatic hypotension, thromboembolism, and pulmonary disorders increases. Muscle tone, strength, and endurance decrease. Losses of muscle strength as much as 10 to 15 per cent have been demonstrated after only one week of bed rest. Over extended periods of immobility, collagen components of soft tissues begin to rearrange, resulting in joint capsule tightening and muscle contracture and atrophy. Osteoporotic changes with loss of bone density result from lack of weight bearing and reduction of muscular forces on the bones.
Measures to offset the deleterious effects of immobility are indicated for those confined to bed rest, specifically bed mobility and exercise. Such activities and exercises condition not only the musculoskeletal system, but also other body systems stressed by bed rest. Daily range of motion exercises prevent stiffness in muscles and joints and provide sensory and proprioceptive stimulation. Conditioning exercises enhance cardiac, pulmonary, and gastrointestinal function. Instruction and assistance with an appropriate exercise program can do much to promote the well-being of a patient immobilized by bed rest.