L12 - Deconditioning Flashcards
What is deconditioning in the context of ongoing pain?
- Deconditioning is the process by which reduced movement and lack of regular physical activity lead to decreased tissue loading, resulting in tissue deterioration, increased pain, and further physical decline.
- This creates a cycle where inactivity leads to increased threat perception by the brain, protective muscle tone, and altered movement patterns.
What happens when a person stops moving regularly?
When a person stops moving regularly, it leads to decreased loading of tissues. Over time, this causes the tissues to become more deconditioned, which can result in increased pain and other symptoms.
What are the consequences of tissue deconditioning over time?
Deconditioned tissues lead to the brain concluding that the tissues are at higher risk of injury. This increases the brain’s threat perception, resulting in protective mechanisms such as pain, increased muscle tone, and altered movement, further limiting activity.
What is the vicious cycle of deconditioning?
The vicious cycle of deconditioning includes:
- Stopping movement → decreased tissue loading.
- Tissues become more deconditioned.
- The brain perceives tissues as at risk of injury, leading to increased threat perception.
- Increased pain and altered movement, further reducing activity.
How does deconditioning affect older people, particularly after hospitalization?
Older people are at risk of deconditioning syndrome, especially after hospitalization or extended bed rest. This can lead to:
- Reduced muscle strength
- Reduced mobility and risk of falls
- Confusion due to changes in the environment
- Demotivation
- Increased immobility and further health decline.
What are the specific risks associated with deconditioning syndrome in older adults?
Deconditioning syndrome in older adults can cause:
- Increased risk of falls due to muscle weakness
- Increased confusion or disorientation
- Further immobility due to inactivity
- Constipation and incontinence
- Reduced appetite and digestion problems
- Increased risk of swallowing difficulties, potentially leading to pneumonia.
What additional factors worsen deconditioning in older people?
Deconditioning is worsened by factors such as multiple medications, sensory impairments, dementia, and existing illnesses. These factors accelerate physical and cognitive decline.
Describe the chronic and acute decline cycles in deconditioning.
Chronic decline: Muscle weakness, loss of muscle mass, and reduced physical activity lead to ongoing mobility issues.
Acute decline: After events like falls or fractures, extended bed rest or surgery can lead to impaired recovery, further muscle deterioration, and prolonged inactivity, perpetuating the cycle of deconditioning.
What are the potential consequences of prolonged bed rest in elderly patients?
Prolonged bed rest can lead to muscle weakness, decreased physical function, increased risk of falls, fractures, delayed recovery from surgery, and overall health deterioration.
What is the importance of muscle strength in preventing deconditioning?
Maintaining muscle strength is crucial in preventing deconditioning. Strong muscles help preserve mobility, reduce the risk of falls, and improve overall physical function, particularly in elderly individuals.
Which systems are affected by deconditioning, aside from the musculoskeletal system?
In addition to the musculoskeletal system, the cardiovascular system, pulmonary system, and respiratory system are also significantly affected by deconditioning.
What happens to the cardiovascular system with deconditioning?
With deconditioning, the cardiovascular system experiences:
- Reduced stroke volume and cardiac output
- Increased heart rate at rest and during submaximal exertion
- Reduced blood volume, impairing oxygen delivery to muscles and organs
How does deconditioning impact the pulmonary and respiratory systems?
Deconditioning leads to:
- Weaker respiratory muscles, reducing lung capacity
- Increased breathlessness (dyspnea) during exertion
- Impaired gas exchange, leading to lower oxygenation of blood and tissues
How does aerobic exercise benefit the cardiovascular system?
Aerobic exercise improves cardiovascular health by:
- Increasing stroke volume and cardiac output
- Lowering resting and exertion heart rates
- Promoting new capillary growth, improving oxygen and nutrient delivery
What adaptations occur in the respiratory system due to aerobic exercise?
Aerobic exercise strengthens respiratory muscles, enhances lung capacity, and increases the efficiency of gas exchange (oxygen and carbon dioxide). This leads to improved oxygen uptake and reduced breathlessness.
What are the goals of pulmonary rehabilitation for COPD patients?
The main goals are to:
- Improve exercise tolerance
- Reduce dyspnea (shortness of breath)
- Strengthen respiratory muscles
- Enhance oxygenation and gas exchange efficiency
- Improve quality of life and reduce hospitalizations due to COPD exacerbations
What role does aerobic exercise play in pulmonary rehabilitation?
Aerobic exercise is a key component of pulmonary rehab, helping to:
- Build cardiovascular and respiratory endurance
- Strengthen respiratory muscles
- Improve lung efficiency and reduce breathlessness
Which forms of aerobic exercise are commonly included in pulmonary rehab for COPD?
Common forms include:
- Walking or cycling to improve endurance
- Interval training, where short bursts of high-intensity exercise are followed by rest
- Breathing exercises like diaphragmatic or pursed-lip breathing to enhance lung efficiency and control
What changes do the cardiovascular and respiratory systems need to respond to increased exertional activity?
Increased exertional activity or aerobic exercise requires robust changes in:
- The cardiovascular system to pump more blood
- The respiratory system to efficiently exchange gases (oxygen and carbon dioxide)
- Pulmonary capacity to take in and utilize more oxygen effectively
- Skeletal muscle function to support higher energy demands
How does deconditioning increase dyspnea (breathlessness)?
Deconditioning weakens respiratory muscles and reduces lung efficiency, leading to impaired gas exchange and lower oxygen levels in the body, which increases feelings of breathlessness (dyspnea) even during minimal exertion.
Why is exercise particularly important for individuals with COPD?
For individuals with COPD, exercise helps to:
- Improve lung capacity and reduce breathlessness
- Strengthen respiratory and cardiovascular systems
- Slow down the progression of COPD symptoms
- Enhance the ability to perform daily activities and improve overall quality of life
describe mild deconditioning
This is a change in your ability to do your usual exercise activities, such as running, biking, or swimming.
describe moderate conditioning
This is a change in your ability to do normal everyday activities, such as walking, shopping for groceries, and doing chores.
describe severe deconditioning
In this stage, you may not be able to do minimal activity or usual self-care.
what illnesses can contribute to deconditioning
- Cancer
- Stroke
- Heart Attack
- Fatigue syndromes
- MS
describe injuries that can contribute to deconditioning
- Back Pain
- Fractures
- Acute injuries
- Trauma/RTA,S
describe environmental factors that can contribute to deconditioning
- Residential / Care Home
- ITU
- Prolonged hospital stays
- Employment: Desk work / driving
what are some other factors that can contribute to deconditioning
- Pregnancy
- Elective Surgery
- Mental health problems
How does age or frailty contribute to deconditioning?
With increasing age and frailty, muscle mass and strength naturally decline, making it harder to maintain physical activity levels. This accelerates deconditioning, leading to reduced mobility and increased risk of falls.
What impact do weight disorders (obesity or malnourishment) have on deconditioning?
- Obesity places additional stress on joints and muscles, leading to decreased mobility and an increased risk of deconditioning.
- Malnourishment weakens muscles, reducing strength and endurance, making physical activity more difficult and accelerating deconditioning.
How does poor nutrition affect the risk of deconditioning?
Inadequate nutrition leads to muscle wasting and energy depletion, impairing physical performance and recovery. Without the proper intake of nutrients, muscle strength declines, increasing the risk of deconditioning.
How do comorbidities contribute to deconditioning?
- Comorbidities such as heart disease, diabetes, respiratory conditions (e.g., COPD), and arthritis limit physical activity.
- Chronic illness can cause fatigue, pain, or shortness of breath, which leads to prolonged periods of inactivity and deconditioning.
How does immobility lead to deconditioning?
- Immobility from prolonged bed rest or sedentary behavior causes muscle atrophy and joint stiffness.
- Lack of movement reduces cardiovascular and respiratory capacity, contributing to a rapid decline in overall physical function.
What cognitive factors increase the risk of deconditioning?
Cognitive factors such as:
- Dementia
- Head injury
- Psychological disorders (e.g., anxiety or depression)
- These can impair motivation, awareness, or the ability to perform regular physical activities, leading to inactivity and deconditioning.
What role does delirium play in deconditioning?
Delirium, which causes confusion and disorientation, can lead to inactivity due to decreased mental clarity. Patients may be unable to follow exercise routines or move safely, increasing the risk of deconditioning.
How does baseline fitness or activity levels affect deconditioning?
Individuals with low baseline fitness or sedentary lifestyles are at higher risk of deconditioning. Their muscles and cardiovascular system are less resilient, and inactivity can lead to rapid declines in strength and endurance.
How does having a poor support network influence deconditioning risk?
A poor support network may lead to social isolation, lack of encouragement for physical activity, and fewer opportunities for assistance in rehabilitation or exercise, increasing the risk of deconditioning.
How does lower socio-economic status contribute to deconditioning?
People with lower socio-economic status may face barriers such as:
- Limited access to healthcare or fitness resources
- Poor nutrition
- Higher rates of chronic illness
These factors make it harder to maintain an active lifestyle, increasing the risk of deconditioning.
What are key indicators of cardiorespiratory deconditioning?
- Increased shortness of breath on activity
- Increased resting heart rate (HR)
- Increased exertional heart rate
- Increased recovery time post-activity
- Reduced endurance / Increased fatigability
What tools are needed to assess increased shortness of breath during activity?
- Pulse oximeter – to measure oxygen saturation and HR
- Modified Borg Scale – for subjective rating of breathlessness
- Respiratory rate monitoring – count breaths per minute during and after activity
- Treadmill or stationary bike – to test exertion levels during exercise
How would you assess increased resting heart rate in a deconditioned patient?
- Heart rate monitor or pulse oximeter – to measure HR at rest.
- Take pulse manually at the radial artery for accuracy if equipment is unavailable.
- Compare the resting HR to the standard range (60–100 bpm in adults) to determine abnormalities.
What equipment is used to assess increased exertional heart rate?
- Heart rate monitor during physical activity (walking test, treadmill, etc.)
- Exercise stress test to assess HR response to graded exercise
- Stopwatch to time HR response and recovery
- Compare to predicted HR based on age and fitness level.
How can you assess increased recovery period after exertion in deconditioned patients?
- Heart rate monitor or manually track pulse recovery after exercise.
- Stopwatch – measure the time taken for HR to return to baseline after stopping activity.
- Track subjective recovery – patients’ perceived recovery using Borg Recovery Scale.
- Longer than expected recovery times may indicate deconditioning.
What are the musculoskeletal symptoms of deconditioning?
- Reduced range of motion (ROM)
- Reduced muscle strength
- Pain on activity
- Reduced balance
- Reduced endurance / Increased fatigability
How would you assess reduced range of motion (ROM) in deconditioning?
- Goniometer – measures joint angles and ROM.
- Functional tests – such as sit-to-stand test to observe range during activities.
- Visual assessment – observe for limited movement patterns or stiffness during exercises.
What methods are used to assess muscle strength in deconditioned patients?
- Dynamometer – measures grip strength or muscle force.
- Manual muscle testing (MMT) – clinician applies resistance to test muscle strength.
- Functional strength tests – e.g., sit-to-stand, or stair-climbing tests for leg strength.
- Observe for fatigue during repeated activities or resistance exercises.
How is pain on activity assessed in deconditioned individuals?
- Numerical Rating Scale (NRS) or Visual Analog Scale (VAS) – for subjective pain rating.
- Observation – look for signs of discomfort, grimacing, or compensatory movements during activity.
- Patient history – ask about pain patterns during different levels of exertion or movement.
What tools can help assess balance issues in deconditioned patients?
- Berg Balance Scale or Timed Up and Go (TUG) test
- Posturography – if available, for a more advanced assessment of balance and postural control.
- Observation of gait and posture during simple mobility tasks (walking, sitting to standing)
How does reduced functional capacity present in deconditioning?
- Difficulty performing normal exercises – tasks that were previously easy may become challenging.
- Reduced ability for ADLs (Activities of Daily Living) – bathing, dressing, cooking, etc.
- Reduced cognitive function – due to less activity affecting mental clarity.
- Altered perception of functional ability – patients may feel less confident or capable of movement.
How would you assess reduced ability to perform ADLs in a deconditioned individual?
- Barthel Index – measures performance in ADLs like feeding, bathing, and toileting.
- Observation – during functional tasks like dressing, walking, or reaching.
- Patient-reported outcome measures (PROMs) – ask the patient about their perceived difficulty with daily tasks.
What is the normal range for Respiratory Rate (RR) in adults?
Normal respiratory rate for adults: 12–16 breaths per minute (bpm).
You can measure it by counting the number of breaths (inhalation + exhalation) over one minute.
How do you measure Respiratory Rate (RR) accurately?
- Use a timer or stopwatch.
- Observe the patient’s chest rise and fall (one complete breath).
- Count the number of breaths in 60 seconds.
- Ensure the patient is at rest and not talking during measurement.
What is the normal Resting Heart Rate (RHR) range for adults?
Normal Resting Heart Rate (RHR) for adults: 60–100 beats per minute (bpm).
How do you measure Radial Heart Rate (RHR)?
- Place your index and middle fingers on the radial artery (thumb side of the wrist).
- Apply gentle pressure until you feel the pulse.
- Count the number of beats for 60 seconds.
- Ensure the person is seated and relaxed for at least 5 minutes before measurement.
What is the purpose of the 6-Minute Walk Test?
- The 6-Minute Walk Test (6MWT) assesses the functional capacity and endurance of a patient by measuring the distance walked in 6 minutes.
- It’s commonly used in cardiorespiratory rehabilitation to evaluate improvement.
How do you perform the 6-Minute Walk Test (6MWT)?
- Mark a straight course of 30 meters (100 feet).
- Instruct the patient to walk back and forth along the course for 6 minutes.
- Monitor heart rate, oxygen saturation, and symptoms like fatigue or breathlessness.
- Measure the total distance walked in meters.
- Resting periods are allowed but included in the total time.
What is the 10-Meter Walk Test used for?
The 10-Meter Walk Test (10MWT) assesses gait speed over a short distance. It’s used to measure walking ability, functional mobility, and fall risk, particularly in deconditioned or elderly patients.
How do you conduct the 10-Meter Walk Test?
- Mark a 10-meter straight path.
- Instruct the patient to walk at their normal pace.
- Start timing as soon as the patient begins walking and stop when they cross the finish line.
- Calculate the average walking speed in meters per second (m/s).
- Repeat the test at a fast walking pace for a secondary measure.
What does the Physiological Cost Index (PCI) measure?
The Physiological Cost Index (PCI) is used to estimate the energy cost of walking, based on the relationship between heart rate and oxygen consumption (VO2).
It evaluates how much energy a person uses during walking, considering:
- Resting heart rate (RHR)
- Working heart rate during the test
- Walking speed (from a 10-meter walk test).
How is the Physiological Cost Index (PCI) calculated?
PCI = (Working HR – Resting HR) / Walking speed (m/s)
- Measure resting heart rate (RHR).
- Have the patient walk at a comfortable pace (e.g., during the 10-Meter Walk Test).
- Measure heart rate during the activity (working heart rate).
- Use the formula to assess the energy expenditure for walking.
How do you assess recovery heart rate post-exertion?
- Measure heart rate immediately after exercise using a heart rate monitor or by taking the radial pulse.
- Continue to measure HR at 1-minute intervals post-exercise until it returns to resting levels.
- Longer recovery times can indicate cardiorespiratory deconditioning.
Why is measuring recovery time after exertion important in deconditioning?
- The time it takes for the heart rate to return to resting levels after exercise provides insight into cardiovascular fitness.
- Prolonged recovery time can be a sign of deconditioning or poor cardiovascular health, indicating reduced efficiency of the heart and lungs.
Which neurological conditions commonly experience fatigue?
Fatigue is common in conditions such as:
- Multiple Sclerosis (MS)
- Traumatic Brain Injury (TBI)
- Stroke
- Parkinson’s Disease (PD)
Fatigue often limits patient participation in daily activities and therapy.
What is the difference between fatigue and fatigability in neurological conditions?
- Fatigue: A subjective feeling of tiredness or lack of energy.
- Fatigability: The rate at which muscles become fatigued during physical activity.
- Central fatigue involves dysfunction in the brain and spinal cord, while peripheral fatigue involves dysfunction in the muscles or nerves.
What structural brain changes can cause neurological fatigue?
Possible structural changes linked to neurological fatigue include:
- Changes in the frontal lobe
- Parietotemporal alterations
- Disruption in cortico-subcortical pathways
These areas are involved in attention, motivation, and motor function, contributing to fatigue.
What neurochemical changes are associated with neurological fatigue?
- HPA axis dysregulation (hypothalamic-pituitary-adrenal axis)
- Altered levels of serotonin, which affects mood and fatigue.
- These changes can contribute to both physical and mental fatigue.
What has meta-analysis shown regarding physical activity and neurological fatigue
A meta-analysis in 2020 showed that physical activity can reduce fatigue in patients with neurological conditions such as MS, stroke, and Parkinson’s Disease. It highlights the benefit of incorporating exercise into rehabilitation programs.
What types of physical interventions are useful in managing neurological fatigue?
Interventions that have shown to help include:
- Endurance training
- Strength training
- Aerobic exercises
However, more research is needed on their effectiveness in other neurological conditions.
What functional assessments can be used for neurological fatigue?
- timed Get Up & Go Test (TGUG): Measures mobility, balance, and risk of falls.
- Berg Balance Test: Assesses static and dynamic balance.
- Dynamic Gait Index: Evaluates gait stability during walking under varying conditions.
- Ashworth Scale: Measures muscle tone to assess spasticity.
What are some effective interventions for neurological rehabilitation?
- Pulmonary rehab classes: For improving lung function.
- Cardiac rehab classes: For heart health and stamina.
- Exercise circuits: For general strength and mobility.
- Balance classes: To prevent falls.
- Strengthening programs: For weak muscles.
- Use of games/VR: To improve motivation and engagement.
How can technology like VR headsets be used in neurological rehabilitation?
VR headsets or apps (e.g., Mindmotion) allow patients to perform repetitive exercises with increasing intensity. This technology helps:
- Enhance motivation and engagement
- Promote effective rehabilitation
- Enable self-monitoring through tracking adherence and progress.
What is the WHO definition of physical activity?
- The World Health Organization (WHO) defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure.
- This includes activities such as walking, running, and even household chores.
What are the ACSM guidelines for physical activity in adults aged 18–65 years?
- Moderate-intensity aerobic activity: At least 30 minutes, 5 days per week.
- Vigorous-intensity aerobic activity: At least 20 minutes, 3 days per week.
- Strength training: At least 2 days per week for muscle strength and endurance.
What are the CDC guidelines for physical activity in adults aged 65+?
At least 150 minutes per week of moderate-intensity activity (e.g., brisk walking), or 75 minutes per week of vigorous-intensity activity (e.g., jogging).
Strength exercises: At least 2 days per week.
Balance exercises: Such as standing on one foot, 3 days a week.
How does exercise benefit adults with chronic health conditions or disabilities?
Exercise provides numerous benefits such as:
- Supporting daily living activities and independence.
- Improving mental health and reducing depression and anxiety.
- Lowering the risk of early death, heart disease, type 2 diabetes, and some cancers.
- Improving cardiovascular and muscle fitness.
- Reducing pain in conditions like osteoarthritis.
What are the long-term cardiac adaptations to aerobic exercise?
Long-term adaptations include:
- Decreased resting and exertional heart rate
- Increased heart muscle strength
- Increased cardiac output (CO), leading to higher VO2 max
- Reduced arterial stiffness, reducing cardiovascular disease risk.
What are the benefits of Pulmonary Rehabilitation for COPD patients?
Pulmonary rehab improves:
- Exercise capacity
- Dyspnoea (shortness of breath)
- Psychological well-being
- Physical strength
NICE guidelines recommend that all COPD patients be offered pulmonary rehab.
What happens to the respiratory system during exercise?
During exercise:
- Respiratory rate increases to meet higher oxygen demand.
- More efficient respiratory muscles (intercostals, abdominals, diaphragm) reduce the strain on the cardiovascular system.
- Trained muscles have increased capillary density, improving oxygen exchange.
What does the BTS recommend for pulmonary rehab programs?
The British Thoracic Society (BTS) recommends pulmonary rehab programs lasting 6–12 weeks. Generalized exercises are recommended for groups, but the intensity should be tailored to individual patients.
