Physical Medicine and Rehabilitation for Hospital Inpatients with Deconditioning

Assessment and Initial Approach

The American Thoracic Society recommends conducting a targeted assessment to determine underlying problems amenable to physiotherapy and identify appropriate interventions for hospitalized patients 1
Evaluate cardiorespiratory reserve, muscle strength, joint mobility, and functional status to guide progressive mobilization for patients with deconditioning 3
Monitor vital functions during interventions to ensure safety and therapeutic benefit for hospitalized patients 1
For critically ill patients, assess level of cooperation, neurological status, and hemodynamic stability before determining appropriate activity level 3, 4

Early mobilization should be initiated as soon as a hospitalized patient is medically stable to prevent complications of prolonged inactivity and improve functional outcomes 1, 2
Begin rehabilitation as early as possible after medical stabilization to prevent deconditioning, which can lead to muscle weakness, joint stiffness, and reduced functional capacity 1, 4
Start with positioning changes to increase gravitational stress through head tilt and positions that approximate upright posture for patients with deconditioning 4
Progress through a stepwise approach based on patient tolerance and clinical condition, including passive range of motion exercises, active-assisted exercises, sitting on edge of bed, transfer to chair, standing with assistance, and walking with appropriate aids 3, 4

Implement aerobic training using appropriate modalities, with intensity at 40-70% of heart rate reserve, frequency of 3-7 days per week, and duration of 20-60 minutes per session 5
Begin with resistance training for clinically stable patients using circuit training, weight machines, free weights, or isometric exercises, with a prescription of 1-3 sets of 10-15 repetitions of 8-10 exercises 5
Include stretching exercises to increase range of motion and prevent contractures, with frequency of 2-3 days per week and holding each stretch for 10-30 seconds 5

For critically ill patients, implement passive cycling, joint mobilization, muscle stretching, and neuromuscular electrical stimulation, and consider continuous passive motion to prevent contractures 3
For mechanically ventilated patients, protocolized rehabilitation directed toward early mobilization reduces ventilation duration and increases likelihood of walking at discharge 2
For patients with respiratory insufficiency, consider inspiratory muscle training to improve respiratory muscle function 6
For patients with heart failure, implement a combined program of aerobic and resistance training 9

Gradually increase exercise intensity and duration based on patient tolerance and progress 5
Assess functional status regularly using standardized tools to track progress and adjust rehabilitation program accordingly 5
For long-term maintenance of benefits, consider supervised exercise programs, home exercise programs with regular follow-up, or repeat rehabilitation sessions 6