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Systemic Effects of Cancer-related De-conditioning

Musculoskeletal effects

In healthy individuals on complete bed rest, strength declines at a rate of 1-1.5% per day, or about 10% per week. Muscle torque may decline as much as 24% in lower-extremity muscles after 5 weeks of bed rest. Loss of strength is often greater in the proximal lower extremities than in the upper extremities; this outcome leads to impairments when the patient walks or assumes a sitting or standing posture.

Muscle shortening occurs in addition to loss of muscle force. Muscle shortening, contributes to joint contractures, tightness of the soft tissue. In the presence of underlying muscle weakness, a decreased levels of activity add to weakness already present. In these settings, dynamic muscle imbalance further increases the risk of joint contracture.

Regular physiotherapy can prevent all of these complications.

Respiratory effects

When a person is lying down for prolonged period, the diaphragm moves upwards because pressure from intra-abdominal contents effectively decreases intrathoracic size. Lying down initially increases pulmonary blood flow as blood redistributes from the lower extremities; however, within 60-90 minutes, pulmonary blood flow returns to baseline or below the level observed when the patient is sitting. Abdominal-muscle activity predominates over rib-cage motion when the patient is lying down, producing a shallow breathing pattern and increasing the respiratory rate. Reduced activity in diaphragmatic and intercostal muscle contributes to weakness of the respiratory musculature, just as inactivity causes weakness in the musculature of the extremities.

Several factors increase the risk of respiratory complications in patients with cancer compared with the general population. Coughing or taking deep breaths may be painful for the patient with rib metastases or for the patient who has undergone surgical procedures of the chest and abdomen. Lung involvement because of primary tumor, metastatic disease, malignant pleural effusion, or complications of chemotherapy or radiation further contributes to reduced oxygenation, retained secretions, and the risk of pneumonia.
Physiotherapy treatment includes frequent changes in position to improve secretion clearance, Encourage patients to take deep breaths at regular intervals,use incentive spirometers, pulmonary resistive exercises, stretching and strengthening of the trunk and abdominal muscles to help prevent or treat rib cage tightness and weakness. With these physiotherapy techniques we can prevent respiratory complications to a great extent.

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