One day makes a big difference!! 









Beginning 1*

Skeletal Muscle 

atrophy begins 1*

Pressure area develop 

Plasma volume begins to develop 2*

Orthostatic hypotension begins to develop 2*

Hypoxemia 2*

Insulin resistance ^


Altered triglyceride levels 4*

Increase CA+ in urine 1* 

To-Do List

Get Milk

Pick Up kids

Mobilize Patients 

Sarcopenia (loss of muscle strength) 1-3% per day 1,2*

Dorsal atelectasis begins

Thoracic fluid volume ^ 5* 

Loss of calcium in urine and increased risk of renal calculi

40% chance of becoming incontinent if >65 years 6*

Peristalsis/impaction <

8-10% loss of plasma volume 1*

Cardiac workload ^ 1*

HR (rest) 1*

Stroke volume < 1*

Cardiac output <1*

Lower pain threshold 

Anxiety and fear

Depressed central nervous system responses

Risk of gastric aspiration and endotoxemia ^

Micrrovascular dysfunction 1*

> 1% bone mineralization lost per week 6*

Visible weakness in 25-30% MV patients 

10% decrease in Muscle strength 1*

Bone degradation continues as long as bed rest occurs

Risk of ventilator acquired pneumonia increases every day

Risk of long term disabling weakness continues every day 

Risk for falls and delirium increases every day

1. DeJonghe B, Sharshar T, Lefaucher JP et al. Paresis acquired in the ICU. A Prospective Multi-Center Study. JAMA 2002; 288(22): 2859-2867

2. King L. Developing a Progressive Mobility Activity Protocol. Orthopedic Nursing 2012; (Sept/Oct) 31(5): 253-262

3. Casey C. The Study of Activity. An Integrative Review. Journal of Gerentological Nursing, 2013; 39(8).

4. Greenleaf JE. Physiology of prolonged Bedrest. NASA Technical Memorandum, 101010.1988

5. Pavy-Le Traon A,  Heer M, Narici MV, Rittweger J, Vernikos J. From Space to Earth: advances in human physiology from 20 years of bed rest studies (1986-2006). Eur J Appl Physiol 2007; 101(2): 143-194

6. Ray K, Boderham A, Paramasivam E. Pulmonary Atelectasis in Anesthesia and Critical Care. Continuing Education in Anaesthesia, Critical Care & Pain j 2014; 14(5): 236-245

7. Hamburg NM, McMackin CJ, Huang AL, Sherouda SM, et al. Physical Inactivity Rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler. Thromb. Vasc. Biol. 2007; 27:2650-2656

8. Peddie MC, Bone JL, Rehrer NJ, Skeaff CM, Gray AR, & Perry TL. Breaking Prolonged sitting reduces postprandial glycemia I healthy normal-weight adults: a randomized crossover trial. Am J ClinNutr 2013; 98:358-66


10. Stuempfle KJ, & Drury DG. The Physiological Consequences of Bed rest. JEPOnline 2007; 10(3):32-41

11. Vollman K. Progressive Mobility in the Critically Ill. Critical Care Nurse, 2010; 30(2): S3-S4.

12. Winkelman C. Bed Rest In Health and Critical Illness. A Body Systems Approach. AACN Advanced Critical Care 20(3):254-266.

13. Knight J, et al. Effects of bedrest 1. Cardiovascular, respiratory, & hematological systems. Nursing Times 2009; 105(21).

14. Nigam Y, Knight J, & Jones A. The physiological effects of bed rest and immobility part 3- the musculoskeletal system, skin, and Immunity. Nursing Times 2009; 105(23):18-22

15. Shearer WT,  Ochs HD, et al. Immune responses in adult female volunteers during the bed-rest model of spaceflight: Antibodies and cytokines. J Allergy Clin Immunol 2009; 123(4): 900–905

16. Anastasopoulos et al. Is plasma calcium concentration implicated in the development of critical illness polyneuropathy and myopathy? Critical Care 2011, 15:R247

17. Puthucheary ZA, Rawal J, McPhail M, Connolly B, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013; 310(15)1591–1600. doi:10.1001/jama.2013.278481

18. Kortebein P, Ferrado A, Lombieda J, Wolfe R, & Evans J. Effect of 10 days of bedrest on skeletal muscle in healthy older adults. Journal of the American Medical Association, 2007. 297(16): 1772-1774. doi:10.1001/jama.297.16.1772-b.