Hospital Associated Deconditioning: Resistance Isn’t Futile!

It’s a well-worn story: grandma or grandpa has a fall or perhaps comes down with the flu, and this acute incident leads to a “quick” hospital stay. What begins as a seemingly minor mishap, however, can quickly snowball into a nightmarish scenario of major functional decline as a result of hospital-associated deconditioning, or HAD. 

The vicious trifecta of the patient’s primary illness or injury, combined with the harsh effects of treatment and the overall deleterious impact of deconditioning can make for the perfect storm of functional decline. This situation tends to make patients and their loved ones feel powerless, as described by Helen M. Hoenig, MD and Laurence Z. Rubenstein, MD, MPH, in their paper, “Hospital-Associated Deconditioning and Dysfunction.” They note that, “While direct adverse effects of the illness are generally understood and accepted by patients, and adverse effects of treatment are fairly predictable and patients are duly informed about them, the deconditioning effects of immobilization are often unanticipated and particularly disabling and disturbing (Hoenig, Rubenstein).” So what are we to do in the face of this seemingly inevitable side effect of age, illness, and hospitalization? Luckily, the intellectual tides surrounding HAD are changing, with increasing numbers of medical professionals coming forward to suggest that there is hope for us yet in our tireless battle against HAD, and that movement may prove to be our most powerful weapon.

Who’s ready to pump some iron?

Published in the Journal of the American Physical Therapy Association (APTA), “Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift” cites actual patient data in support of physical therapy as a highly effective mechanism for combatting HAD. Undertaking a program of early and vigorous exercise during a patient’s stay is perhaps the best antidote to the pernicious deconditioning effects of prolonged hospitalization. Of particular interest is the finding that supervised high-intensity exercise is a highly beneficial addition to a patient’s physical therapy protocol, when fending off HAD. Perhaps we shouldn’t be so quick to associate age with frailty; it turns out the fountain of youth may lie within ourselves, if we are open to a little bit of huffing and puffing to uncover it.

Obviously, there is one major concern with implementing moderate to strenuous exercise programs amongst elderly, low functioning populations: safety, and coupled with that, patient pain management. One would not expect, for instance, a hip replacement patient with limited mobility and at high risk of falling to simply hop out of bed and skip rope, Rocky-style, despite what the all the research in the world may prescribe. The gap then lies between what patients need: consistent, challenging body-weight exercise, and what they can realistically undertake: often a highly limited and thus largely ineffective physical therapy regimen.

That is where a little bit of “moonwalking” can change everything. The AlterG Anti-Gravity Treadmill™ is the ideal tool for helping patients to reap the restorative powers of exercise without risk of injury and free from the pain often associated with chronically debilitating conditions. Patients are able to increase strength, endurance, and confidence in a gently supportive, fall-safe environment, helping them to guard against HAD while maintaining or even improving upon their baseline levels of fitness.

103 years old, and still defying gravity!

In our Functional Decline Case Study, AlterG training was incorporated into a physical therapy regimen for a 72-year-old patient who suffered significant functional decline after a hospital stay. Before physical therapy, this patient required Moderate Assist for transfers and Max Assist for ambulation x3 steps using a rollator walker. His standing activity tolerance was less than one minute, and he was classified as a possible Hospice candidate. This patient initially undertook a 5x/week physical therapy program for 100 days, but showed little functional change under this conventional treatment. Once AlterG Anti-Gravity Treadmill exercise was added to his regimen, however, his improvement skyrocketed. Only 4 weeks after AlterG was built into his therapy, he was able to return home with his family at a SBA level for transfers (no direct assistance needed), and with his ambulation capabilities exceeding 500 feet on both even and uneven surfaces with his rollator walker.

By fighting fire with fire, in this case, fighting HAD with exercise, this patient regained his mobility, his functionality, and most importantly, his life. This is but one example of the potency of physical therapy when it comes to fending off functional decline. By facilitating safe, comfortable, pain-free mobility, the AlterG Anti-Gravity Treadmill sets itself apart as an invaluable tool when it comes to helping patients everywhere reclaim their bodies, and rediscover the joy of movement. We don’t have to take HAD sitting down, and indeed, we shouldn’t. The fight against functional decline must begin with one, single step.

Age: it’s really just a number!