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Consequences
Use it or lose it - No really!

At a glance:
This commentary on 44 studies reveals that an inactive lifestyle has many negative effects on health. Physical inactivity leads to the deterioration of many body functions.

  • The author uses the term “the Disuse Syndrome' to describe what happens when a number of these negative effects occur at the same time.
  • Characteristics of the Disuse Syndrome
    syndrome
    A group of symptoms that together are characteristic of a specific disorder or disease
     are cardiovascular vulnerability, obesity, musculoskeletal, fragility, depression and premature aging.
  • The Disuse Syndrome has repeatedly been shown to occur after prolonged inactivity and, fortunately, prevention and treatment of the negative effects on health is cheap, safe, accessible and effective.
Perspectives:
Employee
For 2 million years humans had to be extremely physically active to survive. Our bodies have evolved to be accustomed to a high level of activity and our good health depends on being active. We become unhealthy and vulnerable to physical and mental disease if we are inactive for extended periods of time.

Humans are subject to a basic law called the Principle of Least Effort. Simply stated, this means that when we have a task to perform, we (like other creatures) will seek the method that demands the least effort. That is, we have a natural tendency not to do any more work than we have to.

To overcome the Principle of Least Effort and get the physical activity we need, we have to be both disciplined and determined. The motto of the Disuse Syndrome is ‘use it or lose it'. The good news is that the problems caused by disuse of the body can be turned around by work, exercise and activity.

An inactive lifestyle without adequate exercise leads to a smorgasbord of illness and disease - muscle and bone wastage, heart disease, blood clots, impaired lung function, digestive and gastrointestinal problems, kidney and bladder problems, a poor sex life, hormone disorders, sensory and nervous disorders are all on the menu. Not giving your body the exercise it needs can cause obesity, depression,
depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 vulnerability to heart disease, muscle and bone fragility, premature aging and early death.

When a person has been inactive for some time, return to activity and fitness can be difficult. A range of approaches can make this easier, such as a program of gradually increasing activity, setting specific goals, doing exercises with others, and using pastimes that you enjoy to keep active. Talk to your treaters about what is important for you, and what might help you to get back to an active lifestyle.
Employer
A problem for employees that arises from any extended time off work due to illness and injury is that they can become used to a physically passive lifestyle, which in turn can have a very damaging effect on the individual's health.

While rest and recuperation may be necessary to overcome some conditions, the earliest possible return to work and to normal activity (as far as possible) will achieve the best health outcome for the sick or injured employee.

On the other hand, a workers' compensation claim should never be used by an employer inappropriately (e.g. to avoid dealing with a troublesome employee), as the employee can suffer additional negative health consequences from imposed physical inactivity. Inappropriate use of the workers compensation system may in the future may be considered a breach of duty of care and be legally compensable.
Treater
It is challenging to motivate patients to be active, particularly if they are in pain and focused on their pain. Nevertheless, the evidence suggests that it is important to advise a patient to be active.

“Use it or lose it' and “motion is the lotion' are catch phrases, but they underpin an important message.
Insurer
A problem for employees who are off work for a long period is that health issues can arise from inactivity. Rest may assist in the short term; however getting back to normal activity is important for physical and psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 well being.

Encourage the patient to discuss these issues with their treating practitioners.
Original Article, Authors & Publication Details:
W. M. Bortz II1 (1984).

The Disuse Syndrome.Western Journal of Medicine; 141(5):691-4.

1Health Care Division, Palo Alto Medical Foundation, Palo Alto, California.
Background, Study Objectives, How It Was Done:
The author declares: ‘We are all much more aware of our bank balance than we are of our health balance. ‘

This paper reviews a large range of research studies that analyse the impact of inactivity on health, bringing together information in order to assist in our understanding of the consequences of inactivity.
Study Findings:
The paper groups the consequences of inactivity into those affecting the following regions of the body:

Musculoskeletal:
The most graphic example of disuse is the limb that has been immobilised in a cast. After only a few weeks of inactivity the muscles shrivel and stiffen. Forced bed rest causes loss of protein and muscle breakdown, which can be measured by increases in nitrogen levels in the urine.

The mineral content and make-up of bone also deteriorates with rest. Bed rest results in a loss of calcium. For example, between 24% and 40% of the mass of the heel bone is lost during 36 weeks of bed rest.

Cardiovascular:
The most vital purpose served by our heart and blood vessels is the transport of oxygen. A typically unfit American has a maximum oxygen intake that is 40% less than a fit person of the same age.

The efficiency of the heart decreases with inactivity, while blood pressure rises. The ability to balance deteriorates after prolonged inactivity. This is at least partially due to a decreasing the body's water content resulting from disuse. The percentage of fluid within the blood falls 10% to 15% with bed rest.

Blood Components:
The amount of red blood cells decreases, and blood clots and inflammation increase with from prolonged bed rest.

Genitourinary System:
If they stop performing their normal functions (filtering and storage), the kidneys and the bladder degenerate and lose vitality.

Reproductive System:
Cutler and co-workers report that women with regular sexual activity have a more regular menstrual cycle length than those with less active sex lives. Masters, Johnson and Kinsey have written extensively on the linkage between good sexual functioning and regular sexual activity.

Hormones:
Physical exercise increases insulin's ability to work by increasing the number of insulin binding sites on muscle cells. A lack of stimulation (exercise) promptly leads to a reduced response to hormones. Exercise helps manage adult-onset diabetes, which occurs when the body stops responding to insulin.

Other Regulatory Functions:
The body temperature falls and normal day/night rhythms are disrupted with inactivity. Enforced bed rest alters the normal fluctuations of various body hormones because the normal control mechanisms for hormone release break down.

Sensory Deprivation:
The space program in the U.S. has studied the phenomenon of “sensory deprivation'. When subjects are deprived of visual and auditory cues, significant and progressive disorientation occurs. It is interesting that bed rest also results in a decreased sensitivity of vision, hearing and taste.

Nervous System:
Physical inactivity results in decreased activity of the nervous system.

Animals raised without much stimulation solve mazes slower and have smaller brains than animals raised in a stimulating environment. Behavioural changes follow prolonged inactivity.


Disease Linkages

Having identified the negative changes that occur from disuse, we should consider how these changes can affect our overall well-being. The author of this paper estimates that disuse and inactivity contribute greatly to human illness. Many sicknesses are caused, at least in part, by the effects of disuse.

These include:
  • Obesity. Inactivity can cause the internal mechanism that links energy output with food intake to become ineffectual.
  • Depression. A group of nervous system hormones (catecholamine) are increased with physical exercise, causing the commonly described "runners' high". Lack of activity can negatively affect our mental state.
  • Aging. Disuse causes changes that are commonly attributed to aging. One study found that the life span of laboratory animals was lengthened by 11-15% if they were always able to exercise, rather than being confined to a caged.
  • Infection. If an organ is stagnant, and the body's fluids can't move through it, it is more susceptible to infection.
Conclusions:
Health problems due to workplace injury can have a third dimension, that is due neither to the disease itself nor to lost time, but to the inactivity which often accompanies a workplace strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 or injury.

Inactivity reduces our general health and renders us more susceptible to disease. Disuse is physically, mentally and spiritually damaging. However, these problems can be reversed by increasing activity; the human body is resilient and its ability to recover is enormous.

The good news is that it is almost never too late to reverse the effects of disuse. The time it takes for the body's tissues
tissue
Collection of cells that perform a similar function. e.g. epithelium (skin), connective tissue (blood, bone), muscle
 to respond to activity varies from seconds (for the sense organs) to weeks and months, but tissues of all ages respond to activity with vigour and renewal.
References:
No PubMed Abstract
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