The Korean Journal of Rehabilitation Nursing (재활간호학회지)

Korean Academic Society of Rehabilitation Nursing (한국재활간호학회)
권호 표지

Concept Analysis: Deconditioning

개념분석: 쇠약 (Deconditioning)

  • Received : 2009.02.20
  • Accepted : 2009.05.11
  • Published : 2009.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to explore the concept of deconditioning within the field of nursing allied health sciences. Method: The concept analysis method described by Walker and Avant(1995) was used. Critical attributes, antecedents, consequences, and empirical referents were identified. Also model, borderline, contrary and related cases were proposed. Results: The definition of concept 'deconditioning' was a decrease in the function of general system that occured after long periods of immobility and might be marked by frail upon return to normal conditions. The attributes of deconditioning were as follows; 1) the deconditioning was caused by lengthening of physical inactivity; 2) the deconditioning state was resulted by respiratory system, cardiovascular system, musculoskeletal system, hematologic system and generalized manifestation; 3) the deconditioning state could be reconditioned. 4) The reinforced functions by exercise could be compromised by physical inactivity. Conclusion: Deconditioning is important concept in nursing practice since it occurs commonly in any patients who lack physical activity for long time and affects many aspects of clinical outcomes, but it could be reversible by nurses' efforts.

Keywords

References

  1. Babb, T. G., Long, K. A., & Rodarte J. R. (1997). The relationship between maximal expiratory flow and increases of maximal exercise capacity with exercise training. Am J Respir Crit Care Med, 156(1), 116-121. https://doi.org/10.1164/ajrccm.156.1.9511021
  2. Baztan, J. J., Arias, E., Gonzalez, N., & Rodriguez de Prada, M. I. (2005). New-onset urinary incontinence and rehabilitation outcomes in frail older patients. Age Ageing, 34(2), 172-175. https://doi.org/10.1093/ageing/afi001
  3. Beere, P. A., Russell, S. D., Morey, M. C., Kitzman, D. W., & Higginbotham, M. B. (1999). Aerobic exercise training can reverse age-related peripheral circulatory changes in healthy older men. Circulation, 100(10), 1085-1094. https://doi.org/10.1161/01.CIR.100.10.1085
  4. Berger, A. (2003). Treating fatigue in cancer patients. Oncologist, 1, 10-14.
  5. Bleeker, M. W., De Groot, P. C., Pawelczyk, J. A., Hopman, M. T., & Levine, B. D. (2004a). Effects of 18 days of bed rest on leg and arm venous properties. J Appl Physiol, 96(3), 840-847. https://doi.org/10.1152/japplphysiol.00835.2003
  6. Bleeker, M. W., De Groot, P. C., Poelkens, F., Rongen, G. A., Smits, P., & Hopman, M. T. (2005a). Vascular adaptation to 4 wk of deconditioning by unilateral lower limb suspension. Am J Physiol Heart Circ Physiol, 288(4), H1747-1755. https://doi.org/10.1152/ajpheart.00966.2004
  7. Bleeker, M. W., De Groot, P. C., Rongen, G. A., Rittweger, J., Felsenberg, D., Smits, P., & Hopman, M. T. (2004b). Vascular adaptation to deconditioning and the effect of an exercise countermeasure: results of the Berlin Bed Rest study. J Appl Physiol, 99(4), 1293-1300. https://doi.org/10.1152/japplphysiol.00118.2005
  8. Bleeker, M. W., Kooijman, M., Rongen, G. A., Hopman, M. T., & Smits, P. (2005b). Preserved contribution of nitric oxide to baseline vascular tone in deconditioned human skeletal muscle. J Physiol, 565(Pt 2), 685-694. https://doi.org/10.1113/jphysiol.2005.085936
  9. Carter, R., Nicotra, B., Blevins, W., & Holiday, D. (1993). Altered exercise gas exchange and cardiac function in patients with mild chronic obstructive pulmonary disease. Chest, 103(3), 745-750. https://doi.org/10.1378/chest.103.3.745
  10. Coyle, C. P., & Santiago, M. C. (2002). Healthcare utilization among women with physical disabilities. Medscape Womens Health, 7(4), 2.
  11. Crannell, C. E., & Stone, E. (2008). Bedside physical therapy project to prevent deconditioning in hospitalized patients with cancer. Oncol Nurs Forum, 35(3), 343-345. https://doi.org/10.1188/08.ONF.343-345
  12. De Lorenzo, F., Xiao, H., Mukherjee, M., Harcup, J., Suleiman, S., Kadziola, Z., & Kakkar, V. V. (1998). Chronic fatigue syndrome: physical and cardiovascular deconditioning. QJM, 91(7), 475-481. https://doi.org/10.1093/qjmed/91.7.475
  13. Demiot, C., Dignat-George, F., Fortrat, J., Sabatier, F., Gharib, C., Larina, I., Gauquelin-Koch, G., Hughson, R., & Custaud, M. (2007). WISE 2005: chronic bed rest impairs microcirculatory endothelium in women. Am J Physiol Heart Circ Physiol 293, H3159-H3164. https://doi.org/10.1152/ajpheart.00591.2007
  14. Dressendorfer, R. H., Franklin, B. A., Smith, J. L., Gordon, S., & Timmis, G. C. (1997). Rapid cardiac deconditioning in joggers restricted to walking: training heart rate and ischemic threshold. Chest, 112(4), 1107-1111. https://doi.org/10.1378/chest.112.4.1107
  15. Feinberg, M. J., & Ekberg, O. (1991). Videofluoroscopy in elderly patients with aspiration: importance of evaluating both oral and pharyngeal stages of deglutition. Am J Roentgenol, 156(2), 293-296. https://doi.org/10.2214/ajr.156.2.1898801
  16. Fischer, D., Arbeille, P., Shoemaker, J. K., O'Leary, D. D., & Hughson, R. L. (2007). Altered hormonal regulation and blood flow distribution with cardiovascular deconditioning after short-duration head down bed rest. J Appl Physiol, 103(6), 2018-2025. https://doi.org/10.1152/japplphysiol.00121.2007
  17. Fulcher, K. Y., & White, P. D. (2000). Strength and physiological response to exercise in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry, 69(3), 302-307. https://doi.org/10.1136/jnnp.69.3.302
  18. Hijazi, O. M., Ramanathan, M., Estrera, A. S., Peshock, R. M., & Hsia, C. C. (1998). Fixed maximal stroke index in patients after pneumonectomy. Am J Respir Crit Care, 157(5 Pt 1), 1623-1629. https://doi.org/10.1164/ajrccm.157.5.9708007
  19. Hopman, M. T., Groothuis, J. T., Flendrie, M., Gerrits, K. H., & Houtman, S. (2002). Increased vascular resistance in paralyzed legs after spinal cord injury is reversible by training. J Appl Physiol, 93(6), 1966-1972. https://doi.org/10.1152/japplphysiol.00897.2001
  20. Hui, D. S., Joynt, G. M., Wong, K. T., Gomersall, C. D., Li, T. S., Antonio, G., Ko, F. W., Chan, M. C., Chan, D. P., Tong, M. W., Rainer, T. H., Ahuja, A. T., Cockram, C. S., & Sung, J. J. (2005). Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax, 60(5), 401-409. https://doi.org/10.1136/thx.2004.030205
  21. Jeffery Mador, M., Kufel, T. J., & Pineda, L. (2000). Quadriceps fatigue after cycle exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 161(2 Pt 1), 447-453. https://doi.org/10.1164/ajrccm.161.2.9904092
  22. Jeppesen, T. D., Schwartz, M., Olsen, D. B., Wibrand, F., Krag, T., Duno, M., Hauerslev, S., & Vissing, J. (2006). Aerobic training is safe and improves exercise capacity in patients with mitochondrial myopathy. Brain, 129(Pt 12), 3402-3412. https://doi.org/10.1093/brain/awl149
  23. Kesten, S., Garfinkel, S. K., Wright, T., & Rebuck, A. S. (1991). Impaired exercise capacity in adults with moderate scoliosis. Chest, 99(3), 663-666. https://doi.org/10.1378/chest.99.3.663
  24. Keyser, R. E., Rus, V., Cade, W. T., Kalappa, N., Flores, R. H., & Handwerger, B. S. (2003). Evidence for aerobic insufficiency in women with systemic Lupus erythematosus. Arthritis Rheum, 49(1), 16-22. https://doi.org/10.1002/art.10926
  25. Levine, B. D., Zuckerman, J. H., & Pawelczyk, J. A. (1997). Cardiac atrophy after bed-rest deconditioning: a nonneural mechanism for orthostatic intolerance. Circulation, 96(2), 517-525. https://doi.org/10.1161/01.CIR.96.2.517
  26. Lim, S. C., Doshi, V., Castasus, B., Lim, J. K., & Mamun, K. (2006). Factors causing delay in discharge of elderly patients in an acute care hospital. Ann Acad Med Singapore, 35(1), 27-32.
  27. MacIntyre, N. R. (2008). Mechanisms of functional loss in patients with chronic lung disease. Respir Care, 53(9), 1177-1184.
  28. Macko, R. F., Ivey, F. M., Forrester, L. W., Hanley, D., Sorkin, J. D., Katzel, L. I., Silver, K. H., & Goldberg, A. P. (2005). Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: A randomized, controlled trial. Stroke, 36(10), 2206-2211. https://doi.org/10.1161/01.STR.0000181076.91805.89
  29. Mador, M. J., & Bozkanat, E. (2001). Skeletal muscle dysfunction in chronic obstructive pulmonary disease. Respir Res, 2(4), 216-224. https://doi.org/10.1186/rr60
  30. Malek, M. H., Fonkalsrud, E. W., & Cooper, C. B. (2003). Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest, 124(3), 870-882. https://doi.org/10.1378/chest.124.3.870
  31. Man, W. D., Hopkinson, N. S., Harraf, F., Nikoletou, D., Polkey, M. I., & Moxham J. (2005). Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease. Thorax, 60(9), 718-722. https://doi.org/10.1136/thx.2005.040709
  32. Man, W. D., Hopkinson, N. S., Harraf, F., Nikoletou, D., Polkey, M. I., & Moxham J. (2005). Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease. Thorax, 60(9), 718-722. https://doi.org/10.1136/thx.2005.040709
  33. Mangione, K. K., Axen, K., & Haas, F. (1996). Mechanical unweighting effects on treadmill exercise and pain in elderly people with osteoarthritis of the knee. Phys Ther, 76(4), 387-394. https://doi.org/10.1093/ptj/76.4.387
  34. Maron, B. J., Pelliccia, A., Spataro, A., & Granata, M. (1993). Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J, 69(2), 125-128. https://doi.org/10.1136/hrt.69.2.125
  35. Matsunaga, A., Masuda, T., Ogura, M. N., Saitoh, M., Kasahara, Y., Iwamura, T., Yamaoka-Tojo, M., Sato, K., & Izumi, T. (2004). Adaptation to low-intensity exercise on a cycle ergometer by patients with acute myocardial infarction undergoing phase I cardiac rehabilitation. Circ J, 68(10), 938-945. https://doi.org/10.1253/circj.68.938
  36. Matthews, J. I., Bush, B. A., & Ewald, F. W. (1989). Exercise responses during incremental and high intensity and low intensity steady state exercise in patients with obstructive lung disease and normal control subjects. Chest, 96(1), 11-17. https://doi.org/10.1378/chest.96.1.11
  37. McGuire, D. K., Levine, B. D., Williamson, J. W., Snell, P. G., Blomqvist, C. G., Saltin, B., & Mitchell, J. H. (2001). A 30-year follow-up of the Dallas Bedrest and Training Study: II. Effect of age on cardiovascular adaptation to exercise training. Circulation, 104(12), 1358-1366. https://doi.org/10.1161/hc3701.096099
  38. Mezzani, A., Corra, U., Baroffio, C., Bosimini, E., & Giannuzzi P. (2000). Habitual activities and peak aerobic capacity in patients with asymptomatic and symptomatic left ventricular dysfunction. Chest, 117(5), 1291-1299. https://doi.org/10.1378/chest.117.5.1291
  39. Milani, R. V., Lavie, C. J., & Mehra, M. R. (2004). Cardiopulmonary exercise testing: how do we differentiate the cause of dyspnea- Circulation, 110(4), e27-31. https://doi.org/10.1161/01.CIR.0000136811.45524.2F
  40. Minotti, J. R., Christoph, I., & Massie, B. M. (1992). Skeletal muscle function, morphology, and metabolism in patients with congestive heart failure. Chest, 101(5 Suppl), 333S-339S. https://doi.org/10.1378/chest.101.5_Supplement.333S
  41. Ng, Y. S., Jung, H., Tay, S. S., Bok, C. W., Chiong, Y., & Lim, P. A. (2007). Results from a prospective acute inpatient rehabilitation database: clinical characteristics and functional outcomes using the Functional Independence Measure. Ann Acad Med Singapore, 36(1), 3-10.
  42. Ng, Y. S., Jung, H., Tay, S. S., Bok, C. W., Chiong, Y., & Lim, P. A. (2007). Results from a prospective acute inpatient rehabilitation database: clinical characteristics and functional outcomes using the Functional Independence Measure. Ann Acad Med Singapore, 36(1), 3-10.
  43. Pawelczyk, J. A., Zuckerman, J. H., Blomqvist, C. G., & Levine, B. D. (2001). Regulation of muscle sympathetic nerve activity after bed rest deconditioning. Am J Physiol Heart Circ Physiol, 280(5), H2230-2239.
  44. Pedersen, F., Mehlsen, J., Raymond, I., Atar, D., Skjoldborg, U. S., & Hildebrandt, P. R. (2007). Evaluation of dyspnoea in a sample of elderly subjects recruited from general practice. Int J Clin Pract, 61(9), 1481-1491. https://doi.org/10.1111/j.1742-1241.2007.01428.x
  45. Pelliccia, A., Maron, B. J., De Luca, R., Di Paolo, F. M., Spataro, A., & Culasso, F. (2002). Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation, 105(8), 944-949. https://doi.org/10.1161/hc0802.104534
  46. Rampello, A., Franceschini, M., Piepoli, M., Antenucci, R., Lenti, G., Olivieri, D., & Chetta, A. (2007). Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: a randomized crossover controlled study. Phys Ther, 87(5), 545-555. https://doi.org/10.2522/ptj.20060085
  47. Ryan, A. S., Nicklas, B. J., Berman, D. M., & Dennis, K. E. (2000). Dietary restriction and walking reduce fat deposition in the midthigh in obese older women. Am J Clin Nutr, 72(3), 708-713.
  48. Sager, M. A. (1996). Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med, 156, 645-652. https://doi.org/10.1001/archinte.156.6.645
  49. Saggini, R., Vecchiet, J., Iezzi, S., Racciatti, D., Affaitati, G., Bellomo, R. G., & Pizzigallo E. (2006). Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome. Eura Medicophys, 42(2), 97-102.
  50. Schmaling, K. B., Smith, W. R., & Buchwald D. S. (2000). Significant other responses are associated with fatigue and functional status among patients with chronic fatigue syndrome. Psychosom Med, 62(3), 444-450. https://doi.org/10.1097/00006842-200005000-00018
  51. Schulman, S. P., Fleg, J. L., Goldberg, A. P., Busby-Whitehead, J., Hagberg, J. M., O'Connor, F. C., Gerstenblith, G., Becker, L. C., Katzel, L. I., Lakatta, L. E., & Lakatta, E. G. (1996). Continuum of cardiovascular performance across a broad range of fitness levels in healthy older men. Circulation, 94(3), 359-367. https://doi.org/10.1161/01.CIR.94.3.359
  52. Smeets, R. J., Vlaeyen, J. W., Hidding, A., Kester, A. D., van der Heijden, G. J., van Geel, A. C., & Knottnerus, J. A. (2006). Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both- First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]. BMC Musculoskelet Disord, 20, 7:5.
  53. Smorawinski, J., Młynarczyk, C., Ziemba, A. W., Mikulski, T., Cybulski, G., Grucza, R., Nazar, K., Kaciuba-Uscilko, H., & Greenleaf, J. E. (2005). Exercise training and 3-day head down bed rest deconditioning: exercise thermoregulation. J Physiol Pharmacol, 56(1), 101-110.
  54. Smorawinski, J., Młynarczyk, C., Ziemba, A. W., Mikulski, T., Cybulski, G., Grucza, R., Nazar, K., Kaciuba-Uscilko, H., & Greenleaf, J. E. (2005). Exercise training and 3-day head down bed rest deconditioning: exercise thermoregulation. J Physiol Pharmacol, 56(1), 101-110.
  55. Thomas, S. K., Humphreys, K. J., Miller, M. D., Cameron, I. D., Whitehead, C., Kurrle, S., Mackintosh, S., & Crotty, M. (2008). Individual nutrition therapy and exercise regime: a controlled trial of injured, vulnerable elderly (INTERACTIVE trial). BMC Geriatr, 26(8), 4.
  56. Van der Ent, M., Jeneson, J. A., Remme, W. J., Berger, R., Ciampricotti, R., & Visser F. (1998). A non-invasive selective assessment of type I fibre mitochondrial function using 31P NMR spectroscopy. Evidence for impaired oxidative phosphorylation rate in skeletal muscle in patients with chronic heart failure. Eur Heart J, 19(1), 124-131. https://doi.org/10.1053/euhj.1997.0727
  57. Walker, L. O., & Avant, K. S. (1995). Strategies for theory construction in nursing (3rd Ed.). Norwalk, CT: Appleton and Lange.
  58. Walker, L. O., & Avant, K. C. (2005). Strategies for theory construction in nursing (4th Ed.), Upper Saddle River, New Jersey : Prentice hall.
  59. Wang, J. S., Jen, C. J., & Chen, H. I. (1995). Effects of exercise training and deconditioning on platelet function in men. Arterioscler Thromb Vasc Biol, 15(10), 1668-1674. https://doi.org/10.1161/01.ATV.15.10.1668
  60. Wang, J. S., Jen, C. J., & Chen, H. I. (1997). Effects of chronic exercise and deconditioning on platelet function in women. J Appl Physiol, 83(6), 2080-2085. https://doi.org/10.1152/jappl.1997.83.6.2080
  61. Wang, J. S., Li, Y. S., Chen, J. C., & Chen, Y. W. (2005). Effects of exercise training and deconditioning on platelet aggregation induced by alternating shear stress in men. Arterioscler Thromb Vasc Biol, 25(2), 454-460. https://doi.org/10.1161/01.ATV.0000151987.04607.24
  62. Wilson, J. R., Groves, J., & Rayos, G. (1996). Circulatory status and response to cardiac rehabilitation in patients with heart failure. Circulation, 94(7), 1567-1572. https://doi.org/10.1161/01.CIR.94.7.1567
  63. Zuwallack, R. (2007). The nonpharmacologic treatment of chronic obstructive pulmonary disease: advances in our understanding of pulmonary rehabilitation. Proc Am Thorac Soc, 4(7), 549-553. https://doi.org/10.1513/pats.200701-015FM