Deconditioning After Surgery

Deconditioning, characterized by a significant decline in physical and functional abilities, is an issue some patients face after surgery. This phenomenon is attributed to prolonged immobility during recovery, metabolic stress, and the systemic effects of surgical trauma. Muscle wasting, loss of endurance, and decreased cardiovascular performance are hallmarks of deconditioning. These changes not only delay recovery, but also increase the risk of complications such as thromboembolism, pressure injuries, and prolonged dependency on care (1).

Immobilization is a major contributor to deconditioning after surgery. Research shows that skeletal muscle mass begins to decline within days of inactivity, with atrophic changes being particularly pronounced in weight-bearing muscles. Losses in muscle strength and volume have been reported to exceed 10% within the first two weeks after surgery, with older adults at greater risk due to reduced regenerative capacity (2). Cardiovascular deconditioning exacerbates these effects as reduced physical activity impairs venous return and cardiac output, potentially leading to orthostatic hypotension and exercise intolerance.

In addition, deconditioning has significant psychological and neurocognitive implications. Patients who experience prolonged recovery often report increased rates of depression and anxiety, which may undermine their participation in rehabilitation programs. Furthermore, the systemic inflammatory response associated with surgical trauma may contribute to neurocognitive decline, complicating the recovery trajectory (3).

Preventing and treating deconditioning requires a multidisciplinary approach. Early mobilization is a cornerstone intervention that mitigates muscle atrophy and supports cardiovascular stability. Studies show that patients mobilized within 24 hours of surgery have shorter hospital stays and improved functional outcomes (3). Physical therapy focusing on progressive resistance and endurance exercises has been shown to effectively reverse the effects of deconditioning. Advanced interventions, such as neuromuscular electrical stimulation (NMES), can further preserve muscle function in patients who are unable to engage in active movement.

Nutritional support also plays an important role in combating deconditioning after surgery. Adequate protein intake is essential to promote muscle protein synthesis and prevent catabolism. Emerging evidence supports the use of high-protein enteral feeds and branched-chain amino acid supplementation in postoperative nutritional protocols. In addition, targeted micronutrient supplementation, including vitamin D and omega-3 fatty acids, may enhance recovery by supporting musculoskeletal and inflammatory pathways (4).

Technological innovations such as wearable devices (e.g., Fitbit, Garmin) and medical-grade monitors (e.g., continuous glucose monitors or activity trackers integrated with hospital systems) are increasingly being used to monitor activity levels and guide individualized rehabilitation plans. These tools provide real-time feedback on metrics such as steps taken, heart rate, and energy expenditure to help healthcare providers adjust rehabilitation strategies. In addition, telehealth platforms enable remote monitoring and support, extending rehabilitation services to patients in their home environment, increasing accessibility and compliance (5).

Despite advances, challenges remain in the management of deconditioning after surgery. Compliance with rehabilitation programs is often hindered by pain, fatigue, and limited access to resources. Future research is needed to optimize intervention strategies and identify predictive markers of deconditioning to enable early identification and tailored management.

References

1. Pashikanti L, Von Ah D. Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clin Nurse Spec. 2012;26(2):87-94. doi:10.1097/NUR.0b013e31824590e6
2. Cruz-Jentoft AJ, Landi F, Schneider SM, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014;43(6):748-759. doi:10.1093/ageing/afu115
3. Hashem MD, Parker AM, Needham DM. Early Mobilization and Rehabilitation of Patients Who Are Critically Ill. Chest. 2016;150(3):722-731. doi:10.1016/j.chest.2016.03.003
4. Hoyer EH, Brotman DJ, Chan KS, Needham DM. Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil. 2015;94(4):304-312. doi:10.1097/PHM.0000000000000185
5. Patel S, Park H, Bonato P, Chan L, Rodgers M. A review of wearable sensors and systems with application in rehabilitation. J Neuroeng Rehabil. 2012;9:21. Published 2012 Apr 20. doi:10.1186/1743-0003-9-21