Internationale Zeitschrift für Physikalische Medizin und Rehabilitation
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Effects of Length of Bed Rest during Hospitalization on Skeletal Muscle in Patients with Conservatively Treated Acute Aortic Dissection

Keiko Takahashi, Yuko Soyama, Naoki Sasanuma, Kazuhisa Domen, Tohru Masuyama, Masaharu Ishihara and Keiichiro Suzuki

Background: Little evidence exists on the effects of exercise guidance in patients with acute aortic dissection after a period of complete bed rest. Few studies have examined changes in skeletal muscle during such periods in patients with cardiovascular disease. This retrospective study sought to investigate changes in skeletal muscle in the standard rehabilitation period in patients with aortic dissection and to discuss an optimal rehabilitation approach to promote safe early return to the community.

Methods: Subjects were 54 patients with conservatively treated acute aortic dissection in whom serial computed tomography (CT) was performed for assessment of complications and follow-up observation of the aortic dissection. Using CT images, cross-sectional areas of the erector spinae muscle at the 7th cervical (A) and 3rd lumber vertebrae (B), the rectus abdominis muscle at the umbilical level (C), and the psoas major muscle at the 5th lumbar vertebra (D), were compared at different time points.

Results: All patients were hypertensive, with the proportion of untreated patients being higher than that of treated patients. Cross-sectional areas of (A) and (B) significantly decreased approximately one week after admission compared with those at admission (p=0.0001). Cross-sectional area of (D) significantly decreased approximately one month after admission (near discharge) (p=0.0002). The decrease in the cross-sectional area of these muscles persisted up to two months after admission (p=0.0002). There were no changes over time with (C).

Conclusion: Muscle weakness not only leads to reduced activities of daily living but also adverse events such as a fall. Development of a rehabilitation program involving resistance training is needed to promote early return to the community, although control of blood pressure is a prerequisite.