Deconditioning

Assessing for and reversing the effects of deconditioning

Deconditioning is the decline in physical function of the body as a result of physical inactivity and/or bedrest or an extremely sedentary lifestyle. It is a complex process of physiological change resulting in functional losses in such areas as movement, mental status, degree of continence and ability to accomplish activities of daily living. The most important feature of deconditioning is a decline in muscle strength and bulk. It is often seen in the elderly and the infirm due to bed rest and inactivity. Risk factors include illness, disability, chronic disease, medical and psychosocial circumstances.

"Months of isolation and reduced levels of activity at home will have an immense deconditioning effect on millions of people" reported Muir Gray and William Bird in their BMJ blog in June 2020.  They went on to report that "Covid-19 will be followed by a deconditioning pandemic".

The effects of deconditioning can be reversed over time given appropriate support and guidance.

On this page we provide links and guidance on how to assess for deconditioning and offer guidance you can provide as a healthcare practitioner to support your patients to reverse the effects of deconditioning. Pulmonary rehabilitation is at the cornerstone of reversing the effects of deconditioning and should be considered for all patients meeting the criteria in your locality. Addressing other issues including symptom management for long term conditions, guidance on nutrition and management of psychosocial issues must be considered in tandem with a recommended appropriate movement/activity plan.

External references include:

BLF ‘Stay Active, stay well’ videos Stay active and stay well | British Lung Foundation (blf.org.uk)
BLF exercise handbook Your exercise handbook | British Lung Foundation (blf.org.uk)
Digital tool myCOPD: The COPD app for controlling your symptoms (mymhealth.com)
NHS Fitness Fitness Studio exercise videos - NHS (www.nhs.uk)
Couch to 5K: week by week - NHS (www.nhs.uk)

Frailty and respiratory disease in primary care

PCRS have issued a position statement on strategies to care for patients with respiratory disease and frailty in the community setting. Frailty is thought to affect around 10% of those aged over 65 years and up to half of those aged over 85 years. The health and social care needs of these vulnerable patients can be complex and require a holistic approach that should involve confirmation of current diagnoses and review of all medications giving consideration to the goals of treatment, likely benefits and likely side effects.

Encouraging activity as a gateway to good respiratory health

How can healthcare practitioners encourage patients to increase their baseline activity, especially those who are not participating in a pulmonary rehabilitation programme?

Communicating the benefits of pulmonary rehabilitation

How can referrers and practitioners who run courses communicate the benefits of PR to patients?

You may also be interested in...

Podcast - De-prescribing in the frail and elderly

Valerie Gerrard (Nurse Practitioner in Norfolk) joins Dr Steve Holmes (GP in Somerset) to discuss some of the issues around frailty and older people, using the Rockwood Clinical Frailty Scale and the importance of  de-prescribing medication in the elderly.

Self Directed Exercise Programmes

Self directed exercise programmes can encourage patients to increase their baseline activity, especially those who are not participating in a pulmonary rehabilitation programme?

Primary Care Respiratory Update (PCRU)

Our members' magazine packed with useful features, clinical updates, educational updates, respiratory news and opinion.