Why do I get weaker in hospital?
There are two things that will cause this.
The first is what caused the admission originally. Every person is affected differently by their illness journey - and there is a very big difference between a minor infection, and a long stay in intensive care. On face value, we all understand this to a degree and we all understand that it takes time to get over even small illnesses sometimes. The factor that often isn’t accounted for when people think of how much either they, or their loved ones, have deteriorated while they are in hospital is something known as ‘hospital acquired deconditioning’.
What is hospital acquired deconditioning?
We have all heard the phrase ‘if you don’t use it, you lose it’.
This is partly what is happening when you are in hospital, and is especially problematic in people who are older (75 plus) or who have multiple health conditions, especially neurological conditions like Parkinson’s. In hospital, it isn’t uncommon for people remain in bed for a prolonged period of time.
This inactivity has a severe impact:
Bed rest for a week is associated with a loss of muscle mass of approximately 3% per week, or up to 15% if someone is critically ill or in intensive care.
Bed rest in older healthy adults leads to a 11-12% reduction in strength of knee extension (a key movement in standing, and walking)
Not only are there physical impacts, but there are cognitive ones as well - older people especially are prone to cognitive decline after a period of hospitalisation (regardless of what they went in with).
It can lead to issues with blood pressure control - such as getting dizzy when you stand up.
Anonymous case study:
A patient that I met earlier in my career was in hospital for around nine months. During that time, they were focused on trying to get out of bed and move when they felt well enough too, or when staff were present to support them.
Their smart watch tracked an average of 90 steps per day for 9 months. That is approximately 24000 steps that he took in 9 months. Studies show that the average person takes between 4000-18000 steps per day, meaning that despite this person’s attempts to stay active while an inpatient they were only able to achieve 2% of the “normal” activity.
This is something that I see repeated across a large number of patients that we see: low step counts and long periods of time in bed then make thriving (or even managing) at home much more difficult on discharge.
What is the process of recovery, and where does physiotherapy fit in?
Everyone is different, however the gold standard of recovery always involves a period of medical and social stability. This means having proper support in place to manage care needs, and making sure medical needs are addressed promptly.
Physiotherapy can help with the following:
Getting well setup at home (proper equipment, care if needed, providing education to you or family members).
Supporting to increase baseline levels of activity (walking around the house more, doing more tasks around the house)
Structured exercise plan to start regaining some of the muscle strength lost (this can also include support to help complete this plan, especially when exercise might not be familiar to you!)
Return to activities outside the house (sports, gardening, etc.)
Support with the psychological factors that come with a loss in independence - it’s normal to feel frustrated, and having someone to talk to about that can make a big difference!
How long does recovery take?
Everyone is different, and rehab and recovery can look very different for each person.
A general rule is that for every day in hospital, it takes 3-5 days to recover. This generally means that for a 2 week hospital stay, it would take between 6-10 weeks to begin to return to normal. However, it depends on both the severity of the illness and prior level of ability prior to that admission. For some people, a 2 week hospital stay can be life changing, and they will never recover to their previous level of independence.
It is important during the rehab phase to have a comprehensive assessment done early, as deconditioning can happen after hospital. This tends to happen where people are moving less because of their hospital journey, and then deconditioning becomes a vicious cycle. Rehab does not need to mean an exercise programme - but it does mean needing to be out of bed (even if hoisted) for some periods of the day, a good starting point is 3-5 hours (i.e between carer calls).
Summary
Usually, people manage very well when they are discharged from hospital. However, for some people the impact of the admission on their lives is substantial. Physiotherapy is a key component of the process of return to function after hospital, and the sooner that it can be started the better the overall outcome is likely to be.