Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of DebrecenIdentification number: TÁMOP-4.1.2-08/1/A-2009-0011

PHYSICAL ACTIVITY, IMMOBILIZATION

Erika Pétervári and Márta BalaskóMolecular and Clinical Basics of Gerontology – Lecture 5

Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of DebrecenIdentification number: TÁMOP-4.1.2-08/1/A-2009-0011

TÁMOP-4.1.2-08/1/A-2009-0011

Outline

• The beneficial effects of physical exercise

• Inactivity• Immobilization syndrome – chronic

bedrest• Pressure ulcers and other

consequences

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Exercise

• Helps to maintain (reach) a healthy BMI• Improves body composition, increases BMR• Trained muscles burn fat• Active muscles take glucose without insulin

(GLUT4)• Increases the rate of HDL, improves

cholesterol profile• Improves thermal adaptation

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• Adrenalin induces vasodilatation in active muscles

• Increases Peak-Bone –Mass, helps prevent osteoporosis

• Reduces stress levels• Helps prevent depression and dementia

(neural growth factor, decreased amyloid production)

• Decreases the incidence of certain types of cancer (colon, breast, uterus, esophagus, prostate) via maintenance of normal BMI and insulin sensitivity – decreased levels of insulin, estrogen levels and binding.

Exercise

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• Muscle hypertrophy may be elicited by relatively intensive training even in the elderly(12 weeks – 3 times a week +10%)

Exercise

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Inactivity

0 Regular intensive physical exercise, good level of fitness

1 Sedentary lifestyle, only recreational sport

2 Sedentary lifestyle, without recreational sport

3 Moderate immobilization in sitting or horizontal position

4 Total immobilization (paralysis)

5 Tilting

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• MET: metabolic unit1 MET: 3.6 mlO2/kg/min

3 MET: brisk walking• A school child has a 7 MET PE lesson 3 times

a week for 10 months – 3 × 7 × 10/12 = 17.5 MET/week

• Inactivity increase BMI(difference between most and least active 30% 2.1 in Caucasians, 2.9 in Afro-americans)

• Maximal activity decreases with age:from 28-40 → 4-30 MET/week(3-22 MET/week in Afro-americans)

Inactivity

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Immobilization – chronic bed rest

• Short term – beneficial; Long-term – harmful • Inactivity and somnolence is part of the

“sickness-behavior”, besides fever, anorexia, depressed water intake, apathy, lethargy, impaired grooming, enhanced sensitivity to pain…

• XIXth century: AMI – 6-week bedrest, femur fracture - 6-month bedrest

• Today: a minimum of 12-48 hours of bedrest after AMI

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Causes• Loss of both lower limbs• Spinal injuries (transection)• Amyotrophic lateral sclerosis• Late stages of Parkinson’s disease• Neuropathies/encephalopathies• Paralysis due to stroke• Coma• Extreme weakness, painful joints, severe COPD, heart

failure• Elderly (depression, isolation, fear from falling,

dementia, tranquillizers, sleeping pills, antihypertensive drugs, diuretics, orthostatic hypotension)

Immobilization – chronic bed rest

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Consequences• Adaptation of the circulation (short term – long term)• Pressure ulcers• Depressed ventilation, risk for hypostatic pneumonia• Increased risk for deep venous thrombosis,

pulmonary embolism• Muscle atrophy, contractures, constipation• Osteoporosis• Changes in metabolism, heat adaptation• Depressed immunity failure• Psychological changes

Immobilization – chronic bed rest

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Earth gravityNormal condition

Zero gravityAcute exposure

Zero gravityChronic exposure

Earth gravityUpon return

Central venouspool

Immobilization – chronic bed rest

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Pressure Ulcers

• DefinitionAny lesion caused by unrelieved pressure resulting in damage of underlying tissue (AHCPR, 1994).

• Can occur anywhere on body

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Pressure Ulcer Etiology• Pressure exerted by bony prominences

on the body that stop capillary flow to the tissues.

• Deprives tissues of oxygen and nutrients causing cell death.

• Pressure greater than 32mmHg exerted by bony prominences to disrupt blood flow.

Pressure Ulcers

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Causes of Pressure Ulcer

• Prolonged pressure- duration and intensity of pressure- location of pressure on body- extended pressure that

blocks flow to the tissue betweenthe source of pressure & the bone

• Shear• Friction

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Function of both time and pressure(hyperbolic curve)• 70 mmHg pressure for two hours

produces irreversible injury• greater pressure takes less time• lower pressure takes more time• obese may be much lower; emaciated

may be much higher• turning schedules must be

individualized!!!!

Pressure Ulcer

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Pressure Ulcer Staging (depth & tissue type)Stage I Persistent redness

(color pressure insensitive)Stage II Partial thickness skin lossStage III Full thickness skin loss

(subcutaneous)Stage IV Full thickness skin loss (fascia)

Pressure Ulcer

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Immobilization – chronic bed rest

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Epidermis

Subcutaneous tissue

Muscle

Dermis

Bone

Reddened area

Immobilization – chronic bed rest

Blister

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Mortality

• 40% die per year• 60% die within 1 year after hospital

discharge

sources: Thomas DR JAGS 1996; 44:1435.Brandeis GH JAMA 1990;264:2905-9.

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Pain with Pressure Ulcers

• 59% report some degree of pain• Only 2% receive pain medication within

4 hours of dressing change• 45% report pain as distressing or

horrible

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Immobilization – chronic bed rest(Ca and hydroxyproline loss)

Time (weeks)

Control Bedrest

Calcium

Change in u

rinary

calc

ium

(m

g/d

ay)

-10 -5 0 5 10 15 20

150

100

50

0

-50

OH-Proline

Change in u

rinary

hydro

xypro

line (

mg/d

ay)

20

10

0

-10

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VO2max = Qmax x (a-v)O2 Differencemax

Adaptive responses of factors infuencing maximal oxygen uptake (VO2max) in chronic bedrest

Immobilization – chronic bed rest

HR Stroke volumeArterial O2 Venous O2

âSensitivity of the arterial baroreceptor system

âBlood volume â RBC mass âMuscle mass

áSymp/parasympbalance

âAlpha-adrenergic VC â VEmaxâPerfusion pressure

in musclesâMuscle tone á V/Q âCapillary densityâMuscle mass á Diffusion áDiffusion distance in

tissueâBaroreceptor VCresponse âO2 extraction

áBeta-adrenergic activity

âSubstrate transport

âSubstrate metabolism

âEnergy stores

âNumber of mitochondria