CHAPTER ELEVEN Exercise in Acute Conditions
This chapter will consider how exercise can be used through the stages of rehabilitation following an acute injury or illness. The chapter will define acute conditions, the importance of exercise in the rehabilitation process, the stages of rehabilitation and how suitable exercises may be prescribed and progressed during the recovery process.
ACUTE CONDITIONS
An acute condition is one which comes on suddenly and may be severe in onset. Acute conditions usually last for a limited time span as they have the capacity to improve and recover with the correct treatment. Much of the recovery from an acute condition may be due to the natural healing process but correct treatment will hasten, and help to ensure, a full recovery. This is in contrast to chronic conditions which last over long periods, may have no cure, are often progressive and are characterized by exacerbations and remissions. Exercise may be used to aid recovery in a wide range of acute conditions and illnesses. Some examples of where exercise may be used to help ensure a full recovery include fractures, muscle sprains and tears, ligamentous injuries, following surgical intervention for joint replacement, plastic surgery or skin grafting, coronary artery bypass grafting, and following a severe illness which required treatment in the intensive care unit.
THE IMPACT OF ACUTE CONDITIONS ON EXERCISE ABILITY
Following more severe injuries or illnesses, the patient may require a period of bed rest or limb immobilization. The changes in cardiorespiratory function and muscle function following imposed periods of bed rest have been researched and are well documented. Maximal oxygen uptake has been shown to decrease by between 20% and 30% following 4 weeks of bed rest. The loss in cardiovascular fitness depends on the duration of the bed rest and how fit the individual was before the period of bed rest. Those with a higher maximal oxygen uptake prior to the period of bed rest tend to show a bigger reduction in VO2max than those who are sedentary.
When a person is confined to bed and muscles are inactive, major changes in muscle function can be detected after a few hours. Protein synthesis starts to decrease and this results in muscle atrophy and loss of muscle strength. There is general agreement that muscle atrophy occurs at a rapid rate initially and then slows, and also that lower limb muscles atrophy at a faster rate than those of the upper limb. When a limb is immobilized, for example following a fracture, this causes absorption of sarcomeres, particularly when the muscle is held in a shortened position, and this results in loss of muscle strength. Other types of acute injuries or illnesses will impact on exercise ability in different ways. Some examples of the main ways that acute injuries and their symptoms can affect exercise ability are summarized in Table 11.1.
Table 11.1 Examples of how acute injuries and their symptoms can affect exercise ability
| Acute condition or injury | Possible symptoms | Impact on exercise ability |
|---|---|---|
| Lateral ankle sprain with loss of ability to weight bear | Pain Swelling Redness/bruising | Decreased range of movement at ankle and subtalar joints Loss of muscle strength in plantar flexors, dorsiflexors, invertors and evertors Loss of cardiovascular fitness because of physical inactivity Reduced proprioception at ankle joint |
| Fractured humerus immobilized in a collar and cuff | Pain Swelling | Decreased range of movement at shoulder, elbow and wrist Decreased muscle strength shoulder flexors, extensors, abductors, adductors and lateral and medial rotators |
| Hip replacement | Pain Swelling Redness/bruising | Decreased range of movement at hip and knee Decreased muscle strength and endurance hip flexors, extensors, abductors, adductors and lateral and medial rotators and knee flexors and extensors Reduced proprioception at hip joint Decreased cardiovascular fitness due to reduced activity following joint replacement |
| Severe pneumonia which required intensive care admission and ventilation | Limited functional ability Fatigue and shortness of breath | Global decrease in muscle strength and endurance Decreased cardiovascular fitness |
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