Study: Prior exercise cuts recovery time

An MU professor says that ‘prehabilitation’ may especially benefit the elderly.
Tuesday, September 9, 2003 | 12:00 a.m. CDT; updated 7:40 p.m. CDT, Friday, July 18, 2008

Moderate exercise before long periods of bed rest could boost chances of a speedy recovery, especially for the elderly, according to new research by an MU professor.

Marybeth Brown, associate professor of physical therapy, found that rats put through an exercise program before simulated bed rest were the first to get back on their feet when released.

Rats that exercised after — but not before — bed rest took slightly longer to walk again. Those with bed rest alone took longest to regain strength, because of lost muscle and bone density, according to the MU News Bureau.

The most notable boost from “prehabilitation” exercise was in older rats, but younger rats also benefited, said Brown, a geriatrics specialist.

'Prehab' not only useful for surgery patients

While “prehab” programs of light exercise would likely help people who plan to have surgery, anyone who expects a long period of bed rest could benefit, Brown said. “It can be used whenever you’re going to have a period of down time.”

Brown simulated bed rest by harnessing the rats’ hind legs off the ground so they did not bear weight. To simulate patients getting out of bed, the harness was removed.

The as-yet unpublished research, funded by the National Institute on Aging, supports observations Brown made of seniors exercising at Health Connection, a gym primarily for senior citizens at the MU School of Health Professions.

Mary Gaub, a physical therapist from Peak Performance Physical Therapy, is assisting in a separate exercise study Brown is conducting at Health Connection. Gaub said older people are often slow to recover from surgery, and many who are already frail do not survive.

Major improvements seen in nine months

By gradually increasing an exercise program over nine months on relatively frail people 75 and older, Gaub has seen major improvements in balance, endurance, flexibility and strength — which in turn have led to faster recovery from those who needed hospital stays.

“I can’t get over the amazing changes I have seen in people,” Gaub said. By seeking an ideal combination of exercises to maintain physical health in seniors, she hopes to minimize hospitalization and improve chances for recovery.

Both the rat model and the senior exercise study compare the physical health of groups that do not exercise to those that do. Brown said using a rat model to study human exercise was at first considered atypical. “People laughed at me — the rat lady,” she said.

An effective prevention program doesn’t have to be strenuous, Brown said. A simple routine of easy aerobics, light weight-lifting or walking can “dust off some of that inactivity,” she said.

Right now, most people interested in prehab therapy will pay for it out of pocket. Larger Missouri health insurers offer limited coverage for physical therapy before surgery, in part because it is relatively untested.

One goal of Brown and Gaub’s research is to find preventive measures to keep seniors healthy and independent. But Gaub said Medicare doesn’t cover most preventive or maintenance programs that could prevent unnecessary stays in nursing homes.

Group says it's premature to consider long-term therapy

UnitedHealthcare of the Midwest promotes physical therapy one to two days before some surgeries, but until more human trials are completed it is premature to consider coverage of long-term therapy before surgery, said spokesman Mike Strand. Mercy Health Plan of the Midwest covers exercise programs before some orthopedic surgery as long as it is not considered “investigational, experimental or unproven,” said Senior Vice President Bill Bennett.

At least two large carriers, Blue Cross and Blue Shield of Kansas City and Blue Cross and Blue Shield of Missouri, offer some coverage of physical therapy before surgery if a doctor recommends it.

Brown said she is glad to see insurers giving “at least a head nod” toward prehab therapy.

In terms of clinical evidence, the rat model offers – at most – a baseline for further research in humans. Brown’s latest findings will most likely be published in the Veterans Affairs’ Journal of Rehabilitation and Development, one of several journals reviewing her data, she said.

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