Introduction
In recent years, the concept of early mobilization in hospitalized patients has gained increasing attention. Early mobilization refers to initiating movement activities—such as sitting up, standing, and ambulating—at the earliest possible stage in acute care or postoperative settings as part of a rehabilitation strategy.
The primary aim is to prevent disuse syndrome and hospital-acquired complications, while promoting functional recovery. This article outlines the significance, clinical evidence, exercise protocols, and precautions related to early mobilization.
Significance and Benefits of Early Mobilization
1. Prevention of Disuse Syndrome
Prolonged bed rest can lead to muscle atrophy, bone demineralization, and reduced cardiovascular function, increasing the risk of disuse syndrome. In elderly patients, studies report that each additional day of bed rest may result in a 1–5% decrease in muscle strength.
Benefits:
・Maintenance of muscle strength and mass
・Preservation of range of motion (ROM)
・Improvement in functional independence
2. Improvement of Respiratory and Circulatory Functions
Extended bed rest negatively impacts pulmonary and cardiac functions. Early mobilization helps prevent hospital-acquired pneumonia, atelectasis, and venous thromboembolism (VTE) while promoting cardiopulmonary recovery.
Benefits:
・Prevention of pneumonia and atelectasis
・Reduction in the risk of deep vein thrombosis (DVT)
・Maintenance of cardiac output
3. Enhancement of Cognitive and Mental Health
Early mobilization contributes positively to cognitive function and psychological well-being. Prolonged immobilization in the ICU is associated with an increased risk of delirium, highlighting the need for appropriate physical activity interventions.
Benefits:
・Prevention of delirium
・Reduction in anxiety and depressive symptoms
・Improvement in health-related quality of life (HRQOL)
Role of Exercise in Early Mobilization
1. In-Bed Exercise
In the acute phase, begin with gentle bed-based exercises:
・Active range of motion (AROM) of the lower extremities (e.g., ankle pumps, knee flexion/extension)
・Deep breathing exercises
・Frequent repositioning
2. Training in Sitting and Standing
Once the patient is medically stable, progress to bedside sitting and standing training:
・Practicing sitting on the edge of the bed
・Assisted sit-to-stand transfers
・Standing balance exercises using parallel bars
3. Gait Training
For patients regaining ambulation capacity, initiate gait training:
・Walking with a walker or assistive device
・Supervised ambulation under the care of nurses or physical therapists
・Short-distance walking in hallways or patient rooms
Precautions for Early Mobilization
1. Comprehensive Patient Assessment
Prior to mobilization, it is essential to assess vital signs and overall medical status.
Do not proceed in the presence of hypotension, tachycardia, or dyspnea—use clinical judgment and advance cautiously.
2. Fall Risk Management
In elderly or deconditioned patients, the risk of falls or accidental injury increases.
Ensure proper supervision, assistive devices, and a safe environment during mobilization.
3. Pain Management
In postoperative or acutely ill patients, pain can be a barrier to mobilization.
Implement appropriate analgesic protocols and utilize therapeutic positioning techniques to minimize discomfort.
Conclusion
Early mobilization is a critical component of inpatient rehabilitation, facilitating functional recovery and preventing complications. Incorporating structured physical activity aids in maintaining muscular and cardiopulmonary function, as well as improving mental health. Safe and effective implementation requires collaboration with healthcare providers and careful monitoring of patient status.
References
1.Kortebein, P., et al. “Functional impact of 10 days of bed rest in healthy older adults.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008; 63(10): 1076-1081.
2.Schweickert, W. D., et al. “Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial.” The Lancet, 2009; 373(9678): 1874-1882.
