From 1900 to 1940, doctors routinely put people to bed for at least two months after a heart attack. In the 1950s the first studies came out to show that men who were put to bed after a heart attack were more likely to die than those who were active (American Heart Journal, Sept 1951;42(3):406-413). Doctors responded by shortening bed rest from two months to two weeks. Today, most heart attack victims leave the hospital in less than a week, and go back to work and resume all of their normal activities in two weeks to three months. However, these are just averages as each case must be handled individually.
On Sept 23, 1955, the President of the United States, Dwight D. Eisenhower, was playing golf at Cherry Hills Country Club when he complained of pain in his chest and belly. His doctors diagnosed a heart attack and ordered immediate bed rest and kept him in bed for several days. They were afraid to let the President out of bed and were very concerned about an abnormality on his electrocardiogram.
When his doctors started to lose sleep worrying that the president might die, they called Paul Dudley White from Boston. The first thing that Dr White did was check Eisenhower’s electrocardiogram and the second thing he did was to get Eisenhower out of bed and start him walking. Paul Dudley White was at the Mass General Hospital when I was there in the early 1960s. I saw him ride his bicycle to work during the warmer days and he continued to do so through his eighty-fourth birthday.
The Medical Community Wakes Up
The news media of the entire world carried stories of how President Eisenhower was told to walk after his heart attack. Only then did most doctors realize that they would be criticized for keeping heart attack victims in bed when the President of the United States was told to get up and walk around. However, they were afraid to change their recommendations until scientific studies told them to do so.
President Eisenhower recovered and went on to continue serving as president for one more term. This prompted doctors to do more studies and they all showed that bed rest after a heart attack can kill. Now, doctors get people up after heart attacks as soon as they think that it is safe to do so, and that is often within 12 to 24 hours.
Early Critics of Bed Rest
BCE 450, Hippocrates wrote that long-term bed rest can cause loss of bone and teeth. During World War II, American soldiers were drafted and some were sent to do their basic training at the Great Lakes Naval Training Center before they were sent to fight in Europe. A major epidemic of flu occurred affecting almost all the troops. Doctors set up a study of bed rest by having half of the soldiers stay in bed, while the other half kept up the vigorous exercise program of basic training. Both groups took the same amount of time to recover, although those who had to continue their basic training (instead of resting in bed) complained more.
Learning from the Astronauts
After World War II, researchers started to write about inactivity breaking down every cell in your body. When an astronaut was sent to the moon, the combination of weightlessness and immobility caused him to come back:
• looking much older
• being much weaker, with smaller muscles and inability to walk, and
• having smaller and weaker bones that were at increased risk of breaking.
The same things start to happen when you stay in bed more than one day.
What Happens to Your Body When You Stay in Bed?
After you have been lying down for just two hours, one liter of fluid moves from your legs to your belly, chest and head. Your kidneys respond by pumping fluid into your bladder. This decreases your blood volume and your heart doesn’t need to pump as much blood through your body. Therefore your heart pumps less blood with each beat. This decreased work load causes your heart muscle to shrink and weaken. After a few days of staying in bed, your heart can become too weak to pump blood efficiently when you walk, so you feel dizzy and have difficulty walking. After several weeks of staying in bed, you continuously lose the maximal ability to take in and use oxygen. The least bit of activity will make you feel tired. (JEP online 2007;10(3):32-41). Furthermore, the most common cause of death in people who lie in bed for months and years is heart failure. Inactivity causes progressive weakening of the heart muscle until it can eventually fail to be strong enough to pump blood through your body.
More than fifty years after President Eisenhower’s heart attack, researchers reviewed the medical literature and found no difference in healing between heart attack victims assigned to a short bed rest (averaging six days) and those assigned to long bed rest (averaging 13 days) (Cochrane Database Syst Rev, Apr 18, 2007; J Clin Epidemiol, 2003 Aug;56(8):775-81). Further studies showed that there is no advantage to extending bed rest beyond two to 12 days. Today, the American College of Cardiology/American Heart Association recommends at least 12 hours bed rest in patients with uncomplicated heart attacks.
Bed Rest Not Good for Most Cancer Patients
A study in the Physician and Sportsmedicine (May, 2000) showed that exercise helps cancer patients recover faster and improve their lifestyles and attitudes. These studies do not suggest that you should exercise when you feel miserable. They do show that there is no evidence that staying in bed helps you to heal faster.
Bed Rest Also Not Good for Other Diseases
A review of the medical literature from 1966 forward found no evidence that bed rest helps you heal faster from any medical condition (Lancet, October 9, 1999;354:1129-1233). Researchers found only 39 studies testing whether bed rest benefited any medical condition, and 24 of those studies showed that bed rest was of little or no benefit in preventing side effects of medical procedures such as spinal anaesthesia, spinal fluid withdrawal or multiple x ray procedures. Fifteen studies showed no benefit in treating medical conditions such as low back pain, spontaneous labor, high blood pressure during pregnancy, uncomplicated heart attacks, rheumatoid arthritis or infectious hepatitis with bed rest.
The next time you feel sick, you can stay in bed if you like, but bed rest will not help you to heal faster.
