Movement Is Medicine
I hate that expression in the title. Truthfully, I have a sticker on my laptop that says this exact thing, but I’m not wild about expressions that double as blanket statements, such as “clean eating” and “movement is medicine,” generally because I have an icky feeling towards functional medicine overall. However, that’s a very long blog post and not what I’m addressing today.
The science says: get up, get moving. Movement is healing; movement is good for what ails you. And, yet again, I’m making blanket statements. Movement is not a one-size-fits-all type deal. Not every type of movement will fit every person, primarily because not everyone will like every type of movement! I like to walk and to run—biking and dancing are not for me. While I will be signing up for races, I’ll run in the opposite direction of any Spin or Zumba classes. But let’s take a deeper look at what the science tell us, shall we?
Cruising PubMed (my favorite internet hangout these days), I typed in “exercise+surgery+recovery” then “early+mobilize+recovery” and scrolled through the results. Over 2,500 journal articles came up each time! In fairness, my search terms were very vague, but I deliberately kept it that way. I wanted research that was broad. I wanted research that looked at post-op patients as a whole, not a type of specific patient in particular. The ones I chose met that criteria.
The Tazreean article looked specifically at the enhanced recovery after surgery (ERAS), of which early mobilization is an important part. As Tazreean, et al., explains it, “Early mobilization reduces the risk of postoperative complications, accelerates the recovery of functional walking capacity, positively impacts several patient-reported outcomes and reduces hospital length of stay.” Per the ERAS protocol, nearly every surgical intervention has an early mobility recommendation. However, due to a multitude of reasons like lack of patient and family education; patient pain; low or demotivation; fear of falling; and low and unsafe staff-to-patient ratios, these recommendations are not always being met.
That said, the research consistently shows that early mobility benefits the individual both immediately post-surgery and long term. The Tazreean article wrote about one randomized controlled trial of surgical patients where the early mobilization intervention also included supervised exercises performed twice daily. Ultimately, a greater proportion of those patients were able to walk without human assistance by post-op day five. They also demonstrated an improved functional exercise capacity as determined by a better score on the six-minute walk test.
Kalisch, et al. identified 36 peer reviewed studies that looked at mobilizing hospitalized adults and the outcomes associated with mobilizing them. Within the 21 studies that noted the physical benefits of mobilization, the most common outcomes associated with the patients who were mobilizing were decreased pain, decreased incidence of deep pain thrombosis (AKA blood clots), decreased fatigue, and decreased diagnoses of pneumonia and urinary tract infections (UTI). Those 21 studies found that the physical function of those patients who were mobilizing while in the hospital had a higher level of improved physical function versus those who did not.
Per Kell, et al., “The earlier in life an individual becomes physically active the greater the increase in positive health benefits; however, becoming physically active at any age will benefit overall health.” It seems obvious enough to say, but physical fitness is so important and truly impacts all facets of our body including:
Bone Density
Coronary health
Blood sugar and glucose
Balance
Greater ability to perform ADLs and IADLs
So, what do I do to keep therapeutic exercises interesting for my patients? For starters, I do the exercises with them! I hate point of service documentation (where I type while they work), so we exercise side-by-side. This way, the patient can see the movement and hopefully won’t have too many questions, except for “what muscle is this working?” and “can I have a heavier weight?”.
I also try to change up the exercises. A home exercise program is just that—a home exercise program. Maybe we do that once a week, just to make sure they don’t have questions or need a change, but otherwise the exercises should be different. I don’t want my patients to get bored! I also don’t want to only be working the same few muscles over and over again. We have so many upper body muscles—why would I only focus on a handful? That’s not particularly functional, especially if I can work with them in person.
Functional movement and strengthening are absolutely medicine, and science backs us up 100%. So, the next time your patient tells you to let them rest because they’ve just had surgery… well… you know what the numbers tell you! Get ‘em up and get ’em moving. Their health will thank us!
Sources
Kalisch, B. J., Lee, S., & Dabney, B. W. (2014). Outcomes of inpatient mobilization: a literature review. Journal of clinical nursing, 23(11-12), 1486–1501. https://doi.org/10.1111/jocn.12315
Kell, R.T., Bell, G. & Quinney, A. Musculoskeletal Fitness, Health Outcomes and Quality of Life. Sports Med 31, 863–873 (2001). https://doi.org/10.2165/00007256-200131120-00003
Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. Journal of Comparative Effectiveness Research. 2021 Nov;11(2):121–9.