Months of isolation and reduced levels of activity at home will have an immense deconditioning effect on millions of people, say Muir Gray and William Bird
All healthcare does harm. Much publicity is given to the contribution of poor quality care and errors, but even evidence based healthcare delivered at high quality can cause harm. It is an inevitable consequence of the use of radiation, the prescription of powerful chemicals, interventions such as surgery, or even requiring people who are ageing to stay in their own homes for three, or possibly more, months.
The Academy of Medical Royal Colleges published a report in 2015 called Exercise the Miracle Cure, not only promoting the benefit of activity as a therapy in its own right, but also emphasising the dangers of inactivity. [1] While accepting that rest has a part to play in the acute phase of illness, this usually passes very quickly. What has emerged is that in the high pressure world of the hospital, people—particularly people with multiple health problems—have their acute problem diagnosed and managed quickly, but are then often tucked into bed, because they cannot be discharged, while the staff have to cope with the next wave of acute cases at the other end of the ward. The result is what has been called the “deconditioning syndrome,” a side effect of hospital admission and a consequence of inactivity. [2]
Although less dramatic, the months of isolation at home as a result of the covid pandemic will have an immense deconditioning effect, affecting millions of people. The covid-19 shielding policy was aimed at people over 70 and people under 70 with long term conditions, but we now know that
- the older you are the more activity you need
- the more long term conditions you have, the more activity you need
It is clear that inactivity has a direct effect on mortality through its direct impact on cardiovascular disease, diabetes, and cancer. We calculated using the WHO HEAT Model that imposed sedentary behaviour for three months in those over the age 70 years, or with long term conditions, would result in an extra 7000 premature deaths.
But, it is the other impacts that isolation and inactivity have on older people that will be a greater burden to society, unless addressed urgently.
Spending months at reduced levels of activity will have an impact on all 4 aspects of physical fitness—strength, stamina, suppleness, and skill. It is important to appreciate also that there will be a loss of cognitive and emotional wellbeing as a result of isolation and loneliness, and this will increase the risk of dementia. [3] For those who are already housebound, the impact of quarantine may not be so dramatic physically, but with even fewer visits there will be considerable cognitive and emotional impact.
All of life requires us to balance risk and people certainly need advice on how to reduce the risk of coronavirus infection. However, months of isolation and physical, social, and cognitive inactivity, without giving people information, encouragement, support, and motivation to maintain—or indeed increase fitness—while at home, will increase the numbers needing social care in the years to come.
The harm resulting from the constraints on health service resources resulting in increased mortality from heart disease and cancer has received publicity, but the harm from social distancing will shorten healthspan and increase dependency, and this has not been so widely recognised. The covid-19 pandemic will be followed by a deconditioning pandemic and a reconditioning programme needs to be implemented as an emergency to support and facilitate a significant increase in physical, cognitive, and emotional activity particularly among people living alone. [4]
The first aim would be to reverse the effects of deconditioning, and prevent further harm. This might just lead very many people to rethink what is happening to them as they live longer and take action after the epidemic of covid-19 infection is over that will reduce their risk of dementia, frailty, and the need for social care. [5]
Muir Gray, is a visiting professor in the Nuffield Department of Primary Health Care at the University of Oxford.
William Bird, is Honorary Senior Lecturer, European Centre of Environment and Human Health, University of Exeter
Competing interests: WB is CEO of Intelligent Health which trains doctors about physical activity, and delivers Beat the Street that gets school children and their families more active.
MG is Director of the Optimal Ageing Programme which provides learning programmes for older people and professionals about how to Live Longer Better
References:
- Academy of Medical Royal Colleges (2015), Exercise the Miracle Cure
- 2 Arora A. (2019), Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis, https://www.bmj.com/content/366/bmj.l4185/rapid-responses
- 3 Livingston G et al (2017), The Lancet Commission on “Dementia prevention, intervention, and care” Lancet 390: 2673–734
- 4 Douglas M. et al (2020), Mitigating the wider effects of covid-19 pandemic response, BMJ; 369;141-143
- 5 McNally, S. et al (2017), Focus on physical activity can help avoid unnecessary social care. BMJ Oct 17;359: j4609.