A more detailed summary of the side effects of bed rest is described by both the Sandler and Vernikos and the Fortney, Schneider and Greenleaf groups. Some resulting physiological changes include, but are not limited to, redistribution of circulating blood, altered renal hemodynamics, fluid and electrolyte loss, decreased plasma volume, muscle atrophy, bone demineralization, and altered body metabolism, glucose metabolism, vestibular function, sensory and balance information, and circadian rhythms. Every major organ system is rapidly affected by reduced hydrostatic gradients, and reduced loading and disuse of weight-bearing tissues during bed rest. Figure 1 summarizes the purported causes of physiological change during bed rest and some of the physiological adaptations to bed rest. In numerous investigations, aerospace scientists discovered that not only was muscle atrophy and calcium excretion a side effect of bed rest, but that bed rest also produced an array of other physiological and psychosocial side effects as the body attempted to adapt to the prone state. Studies primarily investigated males and, only occasionally, were women included. Concomitantly, in the 1940s aerospace scientists began to use bed rest as a model to investigate the anticipated effects of weightlessness and space flight. However, during World War II, the value of bed rest began to be questioned as physicians noted that injured soldiers who were immobilized developed muscle weakness and excessive calcium excretion, while those who returned to battle early out of necessity recovered more quickly. The use of bed rest as a treatment in healthcare dates to the early 1900s. Antepartum bed rest is currently used in an attempt to prevent preterm birth by approximately 71–87% of USA obstetricians and, to a lesser extent, in Canadian physicians and midwives to prevent preterm birth, despite questions regarding its effectiveness and safety.
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