Physical Activity in Acute Care

Physical activity is an important component of care in the hospital setting. In the past, complete bed rest was commonly considered the optimal treatment following trauma, surgery, or acute illness. The assumption was that rest would promote recovery and reduce physiological stress on the body.

However, current evidence suggests that prolonged bed rest is often unnecessary and may even be harmful. While certain medical conditions, such as fractures, require localized immobilization to support healing, many bed rest orders are not based on strict medical necessity. When patients remain inactive for extended periods, significant declines in physical function can occur.

Complications associated with prolonged bed rest include:

• muscle weakness and muscle atrophy

• joint contractures

• disuse osteoporosis

• reduced cardiovascular reserve

• orthostatic hypotension

• venous thromboembolism

• impaired glucose tolerance

• pneumonia

• constipation

• delirium

Despite the growing evidence that bed rest is frequently ineffective or potentially harmful, low levels of patient mobility remain common in the acute care setting. This is particularly concerning among older adults and critically ill patients, where reduced mobility during hospitalization has been associated with functional decline, increased risk of institutionalization, and higher mortality rates.

These findings emphasize the importance of incorporating physical activity as a fundamental component of acute care management.

Determinants of Physical Activity in Acute Care

During hospitalization, several factors may influence a patient's level of physical activity. Many patients encounter barriers that limit their ability to move and remain active during their hospital stay.

Common barriers include:

• surgical procedures

• ongoing medical treatments

• severity of illness or injury

In addition, a culture of immobility may exist within healthcare systems. This culture is often driven by concerns about patient safety and organizational constraints.

Examples include:

• fear of patient falls

• unnecessary bed rest prescriptions

• limited staffing and time constraints

Nursing staff frequently report additional challenges related to patient mobilization, including:

• fear of personal injury when assisting patients

• lack of training in mobilization techniques

• unclear distribution of responsibility between healthcare providers

• perceived increases in workload

Patient and family beliefs may also reinforce inactivity. Many individuals still believe that strict bed rest is necessary for recovery, which can reduce motivation to engage in movement during hospitalization.

The Role of Healthcare Providers

Reducing barriers to physical activity requires coordinated efforts from multiple healthcare professionals. Physicians play a crucial role by critically evaluating activity orders and minimizing unnecessary bed rest prescriptions.

Nurses are often in an ideal position to promote mobility due to their frequent contact with patients. Through continuous interaction and monitoring, nurses can:

• question unnecessary bed rest orders

• advocate for the removal of unnecessary medical devices that limit mobility

• assist patients in mobilizing safely at the highest functional level possible

For patients requiring rehabilitation, physical therapists and occupational therapists play a central role. These professionals use therapeutic exercises, mobility training, and self-care activities to improve functional independence.

They can also provide education and support to nursing staff who may lack the skills or confidence required to assist patients with mobilization.

Patient Mobility Interventions

Many hospitals have introduced structured mobility programs aimed at maintaining patient activity during hospitalization.

Common strategies include:

• limiting the use of physical and chemical restraints

• modifying the hospital environment to facilitate movement

• educating patients about the importance of mobility

• implementing standardized activity protocols

• regularly assessing patient functional status

Physical therapists are involved in the rehabilitation of patients across a wide range of acute care specialties, including:

• neurology

• plastic surgery

• burn care

• trauma

• internal medicine

• surgical care

• oncology

• critical care

• cardiology

Early mobilization in intensive care units has received increasing attention. Research indicates that even critically ill patients can safely participate in physical activity under appropriate supervision.

Many hospitals have also implemented nurse-driven or therapy-driven mobility programs on inpatient wards.

Reported outcomes from these programs include:

• improved maintenance of functional status

• increased likelihood of discharge to home

• reduced hospital length of stay

Outcome Measures in Acute Care

Outcome measures are essential tools for evaluating changes in patient function during hospitalization. They allow healthcare providers to monitor progress and guide rehabilitation planning.

Common outcome measures used in acute care include:

• AM-PAC “6 Clicks”

• Acute Care Index of Function (ACIF)

• Functional Independence Measure (FIM)

• Barthel Index

• Katz Index of Independence in Activities of Daily Living

• Timed Up and Go (TUG)

• 2-minute and 6-minute walk tests

• 4-stage balance test

• Community Balance and Mobility Scale

Contraindications to Physical Activity

Patient safety is the most important consideration when initiating physical activity in hospitalized individuals.

Absolute contraindications to exercise testing or training include:

• acute myocardial infarction

• unstable angina not stabilized by medical therapy

• uncontrolled cardiac arrhythmias causing symptoms or hemodynamic instability

• symptomatic severe aortic stenosis

• uncontrolled symptomatic heart failure

• acute pulmonary embolism or pulmonary infarction

• acute myocarditis or pericarditis

• acute aortic dissection

Relative contraindications include:

• left main coronary artery stenosis

• moderate valvular heart disease

• electrolyte abnormalities

• severe arterial hypertension (SBP >200 mmHg, DBP >100 mmHg)

• hypertrophic cardiomyopathy or other outflow tract obstruction

• mental or physical impairments that prevent safe exercise participation

• high-degree atrioventricular block

Depending on the patient’s illness, injury severity, and comorbidities, additional restrictions or contraindications may apply.

Clinical decisions regarding exercise therapy should always be based on the patient’s overall clinical status and institutional guidelines.

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