Clinical Assistant Professor Wee Tze Chao, Senior Consultant from the Department of Rehabilitation Medicine at Changi General Hospital (CGH), Ms Lim Jiamin, Senior Physiotherapist from the Department of Rehabilitative Services, CGH, and Ms Hozaidah Binte Hosain, Manager (Projects) from Rehabilitation Services at SingHealth Community Hospitals (SCH) share the dangers of excessive bed rest and how excessive bed rest can impact various aspects of the body.

Please speak to a care provider to find out how you as a caregiver can help your loved one on bed rest continue to stay active!

It is common to experience a decline in physical and or psychological function after an injury or acute medical illness and this is termed deconditioning. Being in hospital often results in prolonged bed rest and inactivity which can affect multiple body systems. There is substantial evidence that prolonged bed rest, particularly in older adults can be harmful.

Local data also suggests that deconditioning is one of the top causes leading to a delayed discharge from the acute hospital.

5 Common dangers of prolonged bed rest and how to prevent them

Brought to you by: 
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alls Prevention Workgroup
An Enterprise Risk Management Centre of Excellence and SingHealth Office of Risk Services


1. Skin and pressure injuries

Immobility and spending excessive time in the same position can increase the risk of skin breakdown and pressure injuries.

What can caregivers do

Helping your bed bound loved one frequently reposition himself/herself and increasing his/her physical activities may help to reduce risks of skin complications during prolonged bed rest.

2. Constipation

Immobility increases the patient’s intestinal transit time that can lead to constipation. Constipation may result in urinary retention and increase the risk of urinary tract infection (UTI).

What can caregivers do

With the right exercise at the right time, exercise does help with constipation. By encouraging the patient to do light, aerobic exercises, such as walking, it would aid to keep the digestive tract healthy. Performing other exercises such as yoga or stretches may also help.

3. Muscle loss

Another consequence of prolonged bed rest is muscle wasting, which also refers to the loss of muscle mass.

Research has shown that while young adults may lose about 1% of muscle mass per day, older adults may lose up to 5% of muscle mass for each day that these muscles are not being used. As a result, one may even end up losing muscle strength of up to 40% within the first week of immobility.

In addition, prolonged bed rest can also cause the collagen fibres to shorten and become more tightly packed within a day. In two to three weeks’ time, an individual may experience joint tightness and subsequently joint stiffness within two to three months of immobility.

This is definitely a concern, as the loss of muscle strength and the muscle tightness have been linked to a reduction in functional movement, one of the factors resulting in falls.

What can caregivers do

Caregivers can encourage the patient to perform regular movement, which reduces muscle wasting and helps to loosen collagen fibers in the joints. This increases functional movement, reducing the harmful effects of prolonged bed rest.

To increase mobility and activity for the patient, a caregiver can encourage the patient to do the following set of simple exercises.

Important reminders before encouraging a patient to exercise

  • Please consult the care provider to confirm whether the patient is allowed to or if it is safe for the patient to exercise.

  • Do stop the exercise if you notice the patient experiencing any pain/discomfort as it would likely indicate that he/she may be performing the exercise wrongly or over-exerting himself/herself.

Ankle pumps

Note: Patient can be in a seated or supine position.

Heel slides

Note: Patients who have undergone total hip replacement surgery must stop sliding their foot before it reaches their knee level.

Straight leg raise

Note: Patients who have undergone total hip replacement surgery must not raise their legs beyond 90˚.


Shoulder circles

Shoulder lift​

4. Weakens the heart and lungs

Bed rest and immobility can have profound effects on the heart and lung system.

Hospitalisation and immobility is a significant risk factor for developing deep vein thrombosis (DVT) also known as venous thromboembolism (i.e. blood clot formation in the blood vessels of the legs and lungs). This is a potentially life-threatening condition.

The use of mechanical calf pumps and medications may help to reduce the risk of venous thromboembolism from occurring. Increasing physical activities with bed exercises and appropriate mobilisation can further reduce the risk.

Lying down for prolonged periods may affect air flow in the lungs and increase the risk of chest infections or atelectasis (i.e. mild lung collapse).

Excessive bed rest can affect the way the body uses oxygen resulting in a decrease in physical performance and the ability to exercise.

Additionally, prolonged bed rest can cause an exaggeration in the drop in blood pressure when one assumes an upright position resulting in giddiness and falls.

What can caregivers do

There are a few things that loved ones can do to help a loved one's prolonged bed rest.

One good way is to encourage the patient to perform activities, that are safe for them, such as walking to the toilet, or sitting in a chair during conversations.

If the patient is in hospital, walking around in the ward or even outside the ward, depending on the patient’s medical condition and hospital guidelines during the pandemic, would also be beneficial.

To prevent a drop in blood pressure causing giddiness when the patient stands up, do remind the patient to move slowly from lying to standing position. Also, before getting out of bed, ensure that the patient sits on the edge of bed for a minute before standing.

5. Affects mental health

Patients who are confined to bed in hospitals often experience a reduction in environmental and psychosocial stimuli. This may result in several adverse effects such as depressed mood, anxiety, reduced cognitive skills and more commonly, the loss of appetite.

Prolonged bed rest is also associated with restlessness, aggression and insomnia.

What can caregivers do

The use of technology and the availabilities of patients’ phones are a really good way for caregivers to encourage and talk to patients, especially when visits are limited such as if the patient is in a hospital.

During visits, the caregivers can encourage interaction with activities or discussions such as what is happening around the world, or in the country. Even news about the entertainment industry can be a point of discussion.

If the caregiver visits during meal times, take the opportunity to encourage the patient to eat or help to prepare meals that are suitable for the patient to eat.

The adverse effects of prolonged bed rest collectively results in the reduced ability for the patient to do self-care, to walk, to engage in leisure activities and to work. It can also likely increase the hospital length of stay for the patient.

Therefore, as a caregiver, please speak to a care provider for further advice on how you can help your loved one on bed rest continue to stay active. Your loved one's complete and speedy recovery is the best gift he/she can receive!

Ref: J22

Check out other articles on first aid:

How to Prevent Bed Sores and Pressure Injuries

Home Emergency Kit: What Every Home Should Have

How to Treat Minor Injuries at Home and When to See a Doctor