Deconditioning

Deconditioning
SpecialtyPhysical medicine and rehabilitation
SymptomsFatigue, weakness, muscle atrophy, joint stiffness, pressure ulcers/wounds, loss of appetite, constipation, depression, disorientation
Risk factorsOld age, disability, prolonged hospitalization, chronic disease
PreventionMobility exercises
TreatmentPhysical therapy, occupational therapy

Deconditioning is the adaptation of an organism to a less demanding environment, or, alternatively, the decrease of physiological adaptation to normal conditions. Deconditioning can result from decreased physical activity, prescribed bed rest, orthopedic casting, paralysis, and disability that can accompany aging.[1][2] A particular interest in the study of deconditioning is in aerospace medicine, to diagnose, fight, and prevent adverse effects of the conditions of space flight.

Deconditioning due to lack of gravity or non-standard gravity action (e.g., during bed rest) results in abnormal distribution of body fluids.[3]

Deconditioning as a syndrome has historically been associated with a number of medical disorders, including chronic fatigue syndrome,[4] though whether it plays any role in the latter is highly controversial.[5][6]

Signs and symptoms

Patients affected by deconditioning can have almost all systems of their body negatively impacted.[7] Fatigue is a manifestation of a decline in function in both the cardiovascular and pulmonary system. Effects of deconditioning on the heart include: decreased cardiac output, increased heart rate, orthostatic hypotension, and an inability to exert oneself.[7] On the other hand, effects on the lungs include: increased pneumonia risk, decreased oxygenation of organs, and shortness of breath.[7]

Deconditioning can impact the musculoskeletal system through muscle loss, weakness, increased bone fragility, and joint stiffness.[7] These symptoms may increase the risk of fall and decrease the pain threshold that patients may have.[8] One source states that muscles become significantly deconditioned at approximately 1 week of being immobile with 37.3% of patients being classified as sarcopenic.[9] More specifically, it is found there is a 1.5% decrease in leg strength each day a patient is immobile, which equates to a 10% loss in total strength after a week of immobility.[10] Other symptoms that deconditioned patients are at increased risk for are: constipation, urinary incontinence, increased blood viscosity, and skin ulcers/wounds (due to prolonged pressure from bedrest).[7]

One body system that is commonly overlooked in patients with deconditioning is the psychological impact it can bring.[11] Some psychiatric symptoms that deconditioned patients may experience are depression, anxiety, confusion, disorientation, and delirium.[7][8] Specifically, patients with delirium are likely to increase their stay in the hospital by 2 times than without, 2 times more likely to fall, and 3 times more likely to result in early death.[8]

Complications

Complications stemming from the changes due to hospital-associated deconditioning include aspiration pneumonia, hospital-acquired pneumonia, pneumothorax (collapsed lung), blood clots, urinary tract infections, falls, and fragility fractures.[7][8]

Causes

Factors that put a patient at risk for deconditioning include prolonged bed rest, old age, prior frailty, sarcopenia (muscles that are dysfunctional or reduced in size), chronic malnutrition, and prior cognitive issues.[11]

Treatment

Once a patient has been deconditioned, it typically takes double the amount of time they have been deconditioned in order to recover their prior condition.[12]

Prognosis

30% of elderly patients are able to regain the same level of function they were at prior to their deconditioned state after 1 year.[8]

Epidemiology

30-41% of older adults are affected by hospital-associated deconditioning following an acute hospital admission.[8] Deconditioning has been observed to be the cause of delaying hospital discharges in 47% of older patients.[8] Independent elderly adults are 4 times more likely to develop significant functional decline after a hospital stay.[8]

See also

References

  1. ^ McGraw-Hill Encyclopedia of Science and Technology
  2. ^ Lenz, Thomas L. (2007). Lifestyle Modifications in Pharmacotherapy. Baltimore: Lippincott Williams & Wilkins. p. 298. ISBN 978-0-7817-7651-6.
  3. ^ Woods, Susan L.; Erika Sivarajan Froelicher; Sandra Adams Motzer (2004). Cardiac Nursing. Philadelphia: Lippincott Williams & Wilkins. p. 921. ISBN 0-7817-4718-X. Retrieved 2013-04-07.
  4. ^ De Lorenzo, F.; Xiao, H.; Mukherjee, M.; Harcup, J.; Suleiman, S.; Kadziola, Z.; Kakkar, V. V. (July 1998). "Chronic fatigue syndrome: physical and cardiovascular deconditioning". QJM: Monthly Journal of the Association of Physicians. 91 (7): 475–481. doi:10.1093/qjmed/91.7.475. ISSN 1460-2725. PMID 9797930.
  5. ^ Bazelmans, E.; Bleijenberg, G.; Van Der Meer, J. W.; Folgering, H. (January 2001). "Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity". Psychological Medicine. 31 (1): 107–114. doi:10.1017/s0033291799003189. ISSN 0033-2917. PMID 11200949.
  6. ^ Wilshire, Carolyn E.; Kindlon, Tom; Courtney, Robert; Matthees, Alem; Tuller, David; Geraghty, Keith; Levin, Bruce (2018-03-22). "Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT". BMC Psychology. 6 (1): 6. doi:10.1186/s40359-018-0218-3. ISSN 2050-7283. PMC 5863477. PMID 29562932.
  7. ^ a b c d e f g "Physical Deconditioning". www.sralab.org. Retrieved 2026-03-16.
  8. ^ a b c d e f g h Arun, Bhagya; Lewis, Siobhan H. M. (2026-03-01). "Frailty and deconditioning on the acute take". Clinical Medicine. 26 (2) 100548. doi:10.1016/j.clinme.2025.100548. ISSN 1470-2118.
  9. ^ "Deconditioning syndrome: Symptoms and treatment". www.medicalnewstoday.com. 2024-12-03. Retrieved 2026-03-17.
  10. ^ Hoenig, Helen M.; Rubenstein, Laurence Z. (February 1991). "Hospital‐Associated Deconditioning and Dysfunction". Journal of the American Geriatrics Society. 39 (2): 220–222. doi:10.1111/j.1532-5415.1991.tb01632.x. ISSN 0002-8614.
  11. ^ a b Chen, Yaohua; Almirall-Sánchez, Arianna; Mockler, David; Adrion, Emily; Domínguez-Vivero, Clara; Romero-Ortuño, Román (March 2022). "Hospital-associated deconditioning: Not only physical, but also cognitive". International Journal of Geriatric Psychiatry. 37 (3). doi:10.1002/gps.5687. ISSN 1099-1166. PMC 9303382. PMID 35142397.
  12. ^ "Deconditioning syndrome: Symptoms and treatment". www.medicalnewstoday.com. 2024-12-03. Retrieved 2026-03-17.


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