Clinical physiology of bed rest

Maintenance of optimal health in humans requires the proper balance between exercise, rest, and sleep as well as time in the upright position. About one-third of a lifetime is spent sleeping; and it is no coincidence that sleeping is performed in the horizontal position, the position in which gravitational influence on the body is minimal. Although enforced bed rest is necessary for the treatment of some ailments, in some cases it has probably been used unwisely. In addition to the lower hydrostatic pressure with the normally dependent regions of the cardiovascular system, body fuid compartments during bed rest in the horizontal body position, and virtual elimination of compression on the long bones of the skeletal system during bed rest (hypogravia), there is often reduction in energy metabolism due to the relative confinement (hypodynamia) and alteration of ambulatory circadian variations in metabolism, body temperature, and many hormonal systems. If patients are also moved to unfamiliar surroundings, they probably experience some feelings of anxiety and some sociopsychological problems. Adaptive physiological responses during bed rest are normal for that environment. They are attempts by the body to reduce unnecessary energy expenditure, to optimize its function, and to enhance its survival potential. Many of the deconditioning responses begin within the first day or two of bed rest; these early responses have prompted physicians to insist upon early resumption of the upright posture and ambulation of bedridden patients.