Why Staying in Bed Can Be Bad for You: The Hidden Effects of Bed Rest in Older People

When we are unwell, bed can be exactly where we need to be. Rest gives the body time to recover while it fights an infection, virus or other illness, and sleep is an important part of recovery. There are also many situations where a person may need to remain in bed for medical reasons.

The problem comes when we are medically well enough to get up, but continue spending most of the day in bed. For older people especially, prolonged inactivity can quickly lead to weakness, loss of fitness, poorer balance and reduced independence. This article looks at why getting moving again, when it is safe to do so, is such an important part of recovery.

When someone is ill, injured or has recently come home from hospital, it is completely understandable that they may want to spend much of the day in bed. Rest is important, and sometimes staying in bed is exactly what a person needs. However, once someone is medically well enough to get up, prolonged and unnecessary bed rest can actually become part of the problem.

For older people in particular, a few days of inactivity can have a surprisingly significant effect. Muscles become weaker, balance deteriorates, appetite and bowel function can change, cardiovascular fitness reduces and confidence can fall. A person who was walking independently before an illness may find themselves struggling to stand or walk safely after spending a prolonged period in bed.

This is often referred to as deconditioning — a decline in physical, functional and sometimes psychological and cognitive ability caused by inactivity. The British Geriatrics Society describes deconditioning as a major and preventable contributor to loss of independence in older people, noting that even relatively short periods of immobility can contribute to muscle loss, impaired balance and falls.

The message isn't that older people should never rest. It is that rest should be balanced with movement whenever it is safe and medically appropriate.

Bed rest can create a vicious cycle

One of the biggest problems with unnecessary bed rest is that it can create a cycle that becomes

increasingly difficult to break. Someone becomes unwell and spends more time in bed. Their muscles become weaker, standing becomes harder and they feel less confident, so they move even less. Their fitness declines and they become more breathless when they eventually try to walk. They may then need more assistance, which can further reduce their opportunities to move independently.

Before long, the original illness may have improved, but the person is left with a new problem: they are no longer functioning at the level they were before they became unwell. Research describes deconditioning as a whole-body syndrome affecting physical, cognitive and functional abilities, rather than simply a loss of muscle.

This is why it is important to think about rehabilitation early rather than waiting until someone has become severely deconditioned.

Muscle wastage can happen surprisingly quickly

Perhaps the most important reason to avoid unnecessary bed rest is what happens to our muscles. We often think of muscle loss as something that happens gradually over many years. Ageing does contribute to a gradual reduction in muscle mass and strength, but inactivity can accelerate the process dramatically.

One particularly striking study looked at healthy older adults with an average age of around 67 who were confined to bed for just 10 days. They experienced reductions in total lean body mass alongside significant reductions in leg strength, walking performance, stair-climbing ability, chair-stand performance and aerobic fitness.

A review of experimental bed-rest studies found that older adults lost approximately 0.86 kg of leg muscle mass on average, with reductions in muscle power as well as muscle mass. Other research suggests that older adults can lose around 1 kg of lean leg mass after only a week of bed rest, while muscle strength can decline even faster.

This is particularly important because older people may already have less muscle reserve than younger adults. If someone begins an illness with relatively little muscle strength, losing even a small amount can be enough to make the difference between being able to get out of a chair independently and needing assistance.

It isn't simply about how the muscles look. Muscle strength is what allows you to stand, walk, climb stairs, get out of bed, recover your balance and remain independent.

It's not just muscle mass — muscle power matters too

There is another important point that is sometimes overlooked. We don't just need muscles to be strong; we need them to be able to produce force quickly. This is known as muscle power.

Imagine catching your foot on a doorstep. Your ability to recover your balance depends partly on whether your leg muscles can react quickly enough to take your weight and prevent you from falling. Bed rest can reduce muscle power as well as strength, and research in older adults has demonstrated reductions in stair-climbing power following only 10 days of bed rest.

This helps explain why someone can appear reasonably strong when sitting in a chair but struggle when suddenly asked to stand, step or react to a loss of balance.

Balance can deteriorate too

Balance is not simply controlled by the inner ear. Good balance relies on information from the eyes, inner ear, muscles, joints and skin, together with the brain's ability to process this information and produce an appropriate movement response.

Walking and standing provide constant practice for this system. When we stop walking, we stop practising. Research into hospital-associated deconditioning describes changes in postural control, joint coordination and balance associated with prolonged inactivity.

This can create another vicious cycle: less movement leads to poorer balance, poorer balance leads to less confidence, and less confidence leads to even less movement. That is one reason getting someone safely back on their feet can be so important.

You can lose the confidence and ability to walk

Sometimes families say that an older person has "forgotten how to walk" after being in hospital or spending a long time in bed. They haven't necessarily literally forgotten the skill. Instead, several things may have happened at the same time. Their leg muscles have weakened, their balance reactions have become less effective, their cardiovascular fitness has reduced, they may feel dizzy when standing and they may have developed a fear of falling.

Walking is also a practised activity. If someone spends weeks mainly lying in bed or sitting in a chair, they have fewer opportunities to practise the sequence of standing, shifting weight, taking steps, turning and responding to their environment. The result can look like someone has "forgotten how to walk", when in reality their physical capacity, confidence, balance and movement practice have all deteriorated.

This is why rehabilitation often focuses not only on strengthening but on repeatedly practising meaningful functional activities such as standing, walking to the bathroom, transferring into a chair and moving around the home.

Your heart and lungs become less conditioned

Our cardiovascular system also responds to how much we move. When we are active, our heart and lungs have to work harder in a controlled way. When we spend most of the day lying down, they have much less work to do.

Over time, cardiovascular fitness can decline and standing can become more difficult. Some people experience postural symptoms such as dizziness or light-headedness when they first get out of bed. Research into hospital-associated deconditioning describes prolonged bed rest as contributing to orthostatic intolerance and reduced physical capacity.

This can make the first few steps feel surprisingly difficult. Someone may therefore say, "I can't walk because I get too breathless", when part of the problem is that their muscles and cardiovascular system have become significantly less conditioned. Where medically appropriate, gradually rebuilding activity can help restore physical capacity.

Your bowels can slow down

Movement is also important for normal bowel function. Constipation is extremely common in older people and can be caused by many factors, including medication, dehydration, changes in diet and underlying health conditions. However, inactivity and prolonged bed rest can make the problem worse.

A study investigating prolonged physical inactivity found that 60% of healthy participants developed functional constipation during 35 days of bed rest, alongside a reduction in bowel movement frequency.

Getting up, walking to the toilet and generally moving throughout the day can therefore be part of maintaining normal bowel function, alongside adequate fluids, nutrition and appropriate medical management.

Appetite and eating can suffer too

When someone spends most of the day in bed, everyday routines can disappear. Instead of getting dressed and sitting at the dining table for breakfast, they may eat breakfast in bed. Lunch may follow in bed, and dinner may be brought to them as well.

This might seem convenient, but it can unintentionally reinforce inactivity. Research involving older nursing-home residents found that those spending less time at bed rest had higher food intake and greater energy sufficiency than those spending longer periods in bed.

There can also be a psychological component. Eating is often more enjoyable when it is part of a normal routine — sitting at a table, talking to someone, smelling and seeing the food and taking part in the social aspect of a meal. For someone recovering from illness, simply getting dressed and sitting out in a chair for meals can therefore be a small but meaningful step towards recovery.

Swallowing can be affected

Swallowing is another area that is easy to overlook. Swallowing involves muscles, coordination and posture. Generalised muscle loss can also affect the muscles involved in swallowing, sometimes referred to as sarcopenic dysphagia.

Research into hospital-associated deconditioning highlights the link between acute muscle loss and swallowing-muscle weakness, creating a potential cycle in which poorer swallowing contributes to reduced nutrition, which can then contribute to further muscle loss.

This doesn't mean that sitting in bed automatically causes swallowing difficulties. There are many causes of dysphagia, including stroke, neurological disease, frailty and acute illness. However, it reinforces the importance of maintaining upright posture, normal mealtime routines, nutrition and activity wherever medically appropriate.

If someone is coughing during meals, experiencing a wet or gurgly voice after swallowing, struggling to swallow food or drinks, or repeatedly developing chest infections, they should be assessed by an appropriate healthcare professional.

Chest infections can become more likely

Our lungs also benefit from movement and an upright position. When someone is lying in bed for long periods, they may take shallower breaths and generally move less. Reduced mobility can make it harder to maintain normal respiratory function and clear secretions, particularly in someone who is already vulnerable because of illness or a respiratory condition.

Our position can also affect how effectively the diaphragm works. The diaphragm is the main muscle we use for breathing and sits underneath the lungs, separating the chest from the abdomen.

When we lie flat, the abdominal contents can press upwards against the diaphragm, which can limit how freely it moves downwards during a deep breath. When we sit upright or stand, gravity allows the abdominal contents to sit lower, giving the diaphragm more room to move and helping us take a deeper breath. This can improve ventilation to the lower parts of the lungs and make it easier to expand the lungs fully.

Being upright can also make coughing more effective, which is important for clearing mucus and sputum from the airways. This is particularly relevant for people with conditions such as COPD, bronchiectasis, neurological conditions or swallowing difficulties, who may already have difficulty taking deep breaths or clearing secretions.

For someone who is medically well enough to sit out of bed, getting upright for periods during the day, changing position regularly and gradually increasing activity can therefore be an important part of maintaining respiratory function. Sitting in a chair for meals, spending time in the living room or getting up for a short walk can all provide valuable opportunities to move away from prolonged lying and encourage more effective breathing, alongside any specific respiratory exercises or medical treatment that have been recommended.

Pressure sores become a bigger risk

Pressure ulcers, sometimes called bedsores, are another well-known consequence of prolonged immobility. They occur when sustained pressure damages the skin and underlying tissues, reducing their blood supply.

NICE identifies limited mobility, inability to reposition, nutritional problems and significant cognitive impairment among important risk factors for pressure ulcers.

Regularly changing position reduces prolonged pressure on vulnerable areas. For someone who can safely get out of bed, moving between the bed and chair and taking short periods of standing or walking can provide valuable changes in position. For someone who cannot move independently, appropriate repositioning and pressure-relieving equipment remain extremely important.

Getting out of bed isn't a substitute for a proper pressure-care plan, but movement and regular changes of position are an important part of preventing pressure-related skin damage.

Staying in bed can affect continence

Mobility and continence are closely connected. Someone who previously walked to the toilet may start using a commode or continence pad because getting out of bed feels too difficult. Sometimes this is completely appropriate, particularly during acute illness.

But if the person becomes physically able to walk to the toilet again and the change isn't encouraged, a pattern can develop. They move less, become weaker, rely more heavily on continence products and lose opportunities to practise walking to the bathroom.

Maintaining normal toileting routines can therefore be an important part of maintaining independence, where this is safe and appropriate.

The brain needs stimulation too

Bed rest doesn't just affect the body. An older person who spends most of the day in bed may have fewer opportunities for conversation, movement, problem-solving, orientation and interaction with their environment.

This is particularly important for someone living with dementia or cognitive impairment. It would be too simplistic to say that bed rest causes dementia — it doesn't. However, older people who are already vulnerable to cognitive problems are also at greater risk of delirium, particularly during illness and hospitalisation.

NICE identifies immobility or limited mobility, dehydration, constipation, infection, poor nutrition, sensory impairment and sleep disturbance among factors that should be addressed when preventing delirium. NICE specifically recommends encouraging people to walk where possible and, if they cannot walk, to perform active range-of-motion exercises.

Research into hospital-associated deconditioning also increasingly recognises that deconditioning can involve cognitive as well as physical decline.

Keeping someone engaged with the world around them can therefore be extremely valuable. Sitting in a different room, looking out of the window, having a conversation, eating with other people, watching television, doing a puzzle or reading the newspaper all provide different forms of stimulation.

There are psychological benefits to getting up

Imagine spending almost the entire day in one room. You wake up in your bedroom, eat breakfast there, spend the morning there, eat lunch there, watch television there and then go to sleep there again. For someone recovering from illness, this can gradually affect mood and motivation.

Getting dressed and moving into another room can provide a sense of purpose and normality. Sitting in the garden, having a cup of tea with someone, going for a short walk or simply sitting somewhere different can make the day feel very different.

Research into hospital-associated deconditioning recognises psychological factors including fear, anxiety, vulnerability and helplessness as part of the broader problem.

Movement therefore isn't just about muscles and joints. It can help reconnect someone with normal life.

Getting up can help someone eat, drink and socialise

One of the simplest interventions can be one of the most effective: get out of bed for meals, where safe.

Sitting at the dining table rather than eating lying down can encourage a more normal eating position, improve social interaction and create a reason to be out of bed. It may also encourage someone to drink more regularly, engage with family members and become involved in conversation.

For someone who has become used to staying in their bedroom, moving into the living room for part of the day can make a significant psychological and social difference. They may be able to watch television with family, talk to visitors, have a cup of tea with someone or simply feel more connected with the household.

The danger of "being too helpful"

Families and carers understandably want to help an older person who is recovering from illness. But sometimes doing everything for someone can unintentionally make recovery harder.

If someone is physically capable of standing up from a chair but someone always pulls them up, they don't get the opportunity to practise their own strength. If they can walk to the toilet with supervision but are always given a commode, they lose an opportunity to practise walking. If they can dress their upper body but someone dresses them completely, they lose an opportunity to use their arms and practise everyday skills.

Of course, there are times when assistance is essential and safety comes first. But where someone is able to do part of a task safely, encouraging them to do as much as they can for themselves can be an important part of rehabilitation.

"Get up, get dressed and keep moving"

This doesn't mean that everyone who is unwell should be forced out of bed. There are many situations where bed rest is appropriate. Someone may be medically unstable, recovering from certain surgery or injuries, experiencing severe symptoms or have specific instructions from their medical team.

The message is different: if you don't need to be in bed, don't spend the whole day there.

Get dressed if you're able. Sit in a chair. Have your meals out of bed. Walk to the bathroom if it is safe. Stand up regularly. Walk around the house. Do your exercises. Sit in the garden. Visit a friend. Gradually return to the activities you were doing before you became unwell.

NICE guidance on delirium prevention specifically recommends addressing immobility by encouraging people to mobilise and walk where appropriate, and encouraging active range-of-motion exercises for those who cannot walk.

The British Geriatrics Society similarly identifies deconditioning as a major and preventable contributor to loss of independence in older adults.

It doesn't have to be a 5 km walk

When people hear "keep moving", they may imagine someone walking around the neighbourhood. That's not necessary. Movement can be very small.

For someone who is very weak, recovery might begin with getting from the bed to sitting on the edge of the bed, then standing and transferring to a chair. From there, they may progress to walking a few steps, walking to the bathroom, walking to the kitchen and eventually walking around the garden or outside.

The goal is to gradually rebuild the person's ability to do the things they need and want to do.

Strength and nutrition go hand in hand

Movement is only part of the picture. Someone recovering from illness needs adequate nutrition to support recovery, particularly protein and sufficient energy. Older adults who are eating poorly are particularly vulnerable to muscle loss.

This is why rehabilitation often needs to consider movement, strength, nutrition and rest together. Exercise provides the stimulus for muscles to adapt, while adequate nutrition provides the building blocks needed for recovery.

If someone has a poor appetite, unexplained weight loss, difficulty swallowing or is struggling to maintain adequate food and fluid intake, appropriate medical, dietetic or speech and language therapy assessment may be needed.

The goal isn't to eliminate rest

Rest is important. Sleep is important. Recovery from illness requires time. The problem is unnecessary prolonged inactivity.

Think of it as a balance. You might rest after an activity because you are tired — that's sensible. You might spend part of the afternoon relaxing in a chair — that's fine. But spending almost the entire day lying in bed when you are medically capable of being up and moving can gradually make you weaker, less mobile and less independent.

The distinction is important: rest because your body needs recovery, but don't stay in bed simply because you've become used to being there.

A simple goal: more time out of bed

For someone who is medically stable and safe to mobilise, consider gradually increasing the amount of time spent out of bed. That might mean getting dressed in the morning, sitting out for breakfast, returning to bed for a rest and then getting up again for lunch.

Perhaps sit in the living room rather than the bedroom. Walk to the bathroom rather than using a commode if safe. Stand for a few minutes during the day. Take a short walk outside with someone.

The exact amount will depend on the individual. For someone who has become significantly deconditioned, a physiotherapist can assess their strength, balance, transfers and walking ability and develop an appropriate programme.

How Physio At Home can help after hospital

At Physio At Home, we regularly see older people in their own homes following a hospital admission. Sometimes the person has gone into hospital walking reasonably well and comes home noticeably weaker, less mobile and less confident. This isn't necessarily because anything has gone wrong in hospital. Hospitals are increasingly focused on getting people home as soon as it is medically safe to do so, and for many older people being back in their own home can be an important part of recovery. People are often more comfortable, sleep better, eat more normally and are surrounded by familiar people and surroundings.

However, getting someone home is only the beginning of the recovery process. Once home, there can still be a significant amount of rehabilitation needed. Hospital stays can be physically demanding, and opportunities for rehabilitation can vary depending on a person's medical needs, length of stay and the services available. With pressure on health and care services, some people may find themselves waiting for community rehabilitation or physiotherapy after they return home.

We sometimes see people who have come home from hospital but are spending much of the day in bed or in a chair because they are no longer confident enough to move around independently. They may have lost strength during their admission, become more breathless, developed a fear of falling or simply don't know where to start with getting back to their previous level of mobility. The longer this continues, the harder it can become to reverse.

This is where early physiotherapy can be particularly valuable. The aim isn't necessarily to provide an intensive exercise programme straight away. Often, the first step is understanding what has changed and helping someone safely start moving again. This might involve practising getting in and out of bed, standing from a chair, walking to the bathroom, using the stairs, getting dressed independently or gradually increasing the amount of time spent out of bed.

We can assess strength, balance, walking, transfers and confidence and then develop a realistic rehabilitation programme around the person's home and everyday routine. Importantly, rehabilitation doesn't always have to feel like "exercise". Walking to the kitchen, standing while preparing a drink, getting dressed, sitting out for meals or taking a short walk in the garden can all become part of someone's recovery.

Getting in early can make a difference

One of the reasons we encourage people not to wait too long before addressing a decline in mobility is that deconditioning can become self-perpetuating. The weaker someone becomes, the harder movement feels. The harder movement feels, the less they do. Less activity then leads to further loss of strength, fitness, balance and confidence.

Breaking that cycle early can make rehabilitation much easier. If someone is medically stable and safe to mobilise, starting to rebuild movement soon after returning home can help prevent a short-term loss of mobility from becoming a much longer-term problem.

We are sometimes contacted by people who are waiting for NHS physiotherapy or community rehabilitation to begin. We are very happy to support people during this period. Our role isn't to replace NHS services where they are required, but to provide additional physiotherapy support when someone would benefit from getting started with rehabilitation sooner.

For some people, a few sessions can provide the reassurance and direction they need to start progressing again. For others, particularly those who have become significantly deconditioned, a longer period of support may be appropriate.

Home is often the best place to practise

One of the advantages of physiotherapy at home is that we can work on the things that actually matter in someone's everyday life.

Walking 20 metres in a hospital corridor is useful, but being able to walk safely from the bedroom to the bathroom at home may be the more important goal. Being able to stand from a standard dining chair, manage the stairs, get into the shower or walk to the front door can make a much bigger difference to someone's independence.

Working in the person's own environment also allows us to identify practical barriers to mobility. Perhaps their favourite chair is too low to stand from easily, the walking route to the bathroom is cluttered, the stairs have become difficult or they are relying on furniture to move around the house. Addressing these issues alongside exercise can make rehabilitation much more meaningful.

Rehabilitation is about more than getting stronger

Strength is hugely important, but successful recovery involves much more than muscle strength alone. We also need to rebuild balance, coordination, cardiovascular fitness, confidence and the ability to perform everyday activities.

For someone who has been in bed for several weeks, the goal may initially be simply to sit out for longer periods and stand safely. For someone further along their recovery, it may be walking outside, returning to the shops, managing the stairs independently or getting back to a favourite hobby.

The important thing is to start from where the person is now and gradually work towards where they want to be.

At Physio At Home, our aim is to help people recover not only from the illness that caused their hospital admission, but also from the deconditioning that can accompany illness, hospitalisation and inactivity.

Getting home is a positive step. Getting moving again is the next one.

Physio At Home — helping you regain strength, confidence and independence in your own home.

The bottom line

Bed rest can be necessary and, in some situations, lifesaving. But once someone is medically well enough to get up, prolonged inactivity can become harmful.

The effects can spread throughout the body: muscle loss, reduced strength and power, poorer balance, reduced fitness, constipation, reduced appetite, swallowing difficulties, pressure damage, continence problems, increased dependence and cognitive and psychological effects.

Perhaps the biggest risk is that these problems reinforce each other: weakness leads to less movement, less movement leads to poorer balance and fitness, poorer balance leads to less confidence, and less confidence leads to even less movement.

Breaking that cycle early can make a significant difference. So, when it is safe to do so, get up, get dressed, sit out, eat at the table, walk to the toilet, move around the house, exercise, get outside, talk to people and keep doing the things you can do for yourself.

A few minutes of movement may not seem significant, but for an older person recovering from illness, those minutes can be the beginning of rebuilding strength, confidence and independence.

Important safety advice

This article is about unnecessary bed rest, not situations where medical bed rest is required. Anyone who has been advised to remain in bed by their medical team should follow that advice.

If an older person has recently been unwell and is struggling to stand, walking has become unsafe, they are experiencing dizziness or breathlessness, or there has been a significant change in their physical or cognitive function, they should seek appropriate professional assessment.

Where mobility is safe and medically appropriate, however, movement is one of the most important tools we have for preventing deconditioning and maintaining independence.