Bed rest, I've always believed, is a placebo prescribed by physicians to deal hypochondriacs who want pills and advice, however useless, in exchange for the consultation fee. Science has proved me right. New recovery-room and pain-management practices insist on early mobility to improve circulation and speed healing for almost all diseases and conditions, except acute liver diseases and wasting infections such as tuberculosis.
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The rule of the thumb is that unless you're hospitalised, you're better off on your feet. The most cited study debunking bed rest is the 2001 study in the American Heart Association's journal Circulation that tracked the effect of age on cardiovascular response to exercise over three decades. The results were mind-blowing: the study found that functional losses after just three weeks of total bed rest in young men were roughly equal to the effects of 30 years of ageing. "Most notably, three weeks of bed rest in these same men at 20 years of age (1966) had a more profound impact on physical work capacity than did three decades of ageing," wrote US researchers.
Surgeons now routinely ask their patients to get back on their feet within 24 hours of undergoing an operation, including spine and double-knee replacement surgeries. Patients are usually asked to get up and move around with the help of painkillers and good body mechanics, with rest advised only if the pain gets excruciating.
Mobility boosts the healing process and lowers the chances of surgery-related complications such as blood clots in the legs (deep vein thrombosis), which can occur in diabetics and heart disease patients on prescription blood thinners like aspirin. People undergoing surgery have to stop taking aspirin because it prevents the blood from clotting and raises the risk of bleeding.
Once the mainstay of treating back pain, the role of bed rest is now limited to lying down for a couple of hours if standing or sitting starts causing acute pain. Immobility makes sore backs worse as it lowers blood circulation and impairs the spine’s ability to rehabilitate. Except at night, lying down for a few hours at a stretch for more than a day or two doesn't help to treat moderate back pain at all.
The American College of Obstetricians and Gynecologists (ACOG) recently raised red flags about bed rest recommended for pregnancy-related complications such as active contractions, bleeding, ruptured membranes, and placenta previa, where the placenta obstructs the opening of the cervix. Lying down was believed to help pregnant women by taking the pressure off the cervix, increasing circulation to the womb, decreasing fluid retention and lowering levels of catecholamines hormones — dopamine, norepinephrine, and epinephrine, among others — that trigger preterm contractions.
Still, the ACOG says bed rest "does not appear to improve the rate of preterm birth, and should not be routinely recommended." Instead, it recommends business as usual while avoiding strenuous activity and extreme sport.
Six to seven hours of rest each night is all that the body needs to recover to meet a new day. Too much rest destroys your mind and body in slow and subtle ways, with indolent people more likely to have backaches, hip and muscle pain, headaches, lean muscle loss, bone loss, digestive troubles and depression. Walking involves working against gravity, which naturally tones the body without you even realising it. Astronauts lose more than 1% bone mass each month spent in space just because their bodies don't have to work against gravity. Bed rest also impairs the secretion of gastric juices that aid digestion, sugar-regulating insulin, sodium-regulating aldosterone, growth hormones and the male sex hormone androgen, all of which make you feel a lot worse than the problem that made you seek your bed to begin with.
It hurts people over 40 years harder. Losses in muscle mass, strength, power and functional capacity are higher in older adults who lose lean tissue more rapidly than younger people during prolonged periods of physical inactivity, reported US researchers in the journal, Current Opinion in Clinical Nutrition and Metabolic Care. Apart from having amino acid or protein supplementation to maintain muscle protein synthesis, the only way to lower muscle loss is by getting back on your feet and staying there.
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