Beyond Pressure Injuries: The Complex Physiology of Immobility with Margaret Arnold, PT

We all know that staying in bed increases the risk of pressure injuries and DVTs. But the adverse effects of immobilization go far beyond those basics. In this eye-opening episode, Margaret Arnold, PT pulls back the curtain on the rapid and surprising physiological changes that occur when your patients are inactive. You’ll learn about the hidden dangers of immobility most nurses overlook, spanning metabolic, musculoskeletal, cardiopulmonary, and neurological systems. We’ll also equip you with practical tips to incorporate safe mobilization into your busy shift. This discussion will drastically change the way you view the vital importance of patient mobility.

Check out Margaret’s Early Mobility Conference this April 2024. I will be there!

The Physiology of Immobility


  • Joint contractures can occur within 24 hours, making it difficult for patients to move or get out of bed
  • 3% loss of muscle mass and strength per day of immobility (King, 2012)


  • Insulin resistance increases, making blood sugar management more difficult
  • A study found patients who mobilized required less than 1/3 the exogenous insulin compared to immobile patients (Dempsey et al, 2018)


  • Resting heart rate increases by 1 beat per minute for every 2 days of bedrest (De Jonghe et al, 2002)
  • Diaphragm is impeded when laying down, decreasing lung expansion


  • Vestibular system gets sluggish with lack of movement, increasing fall risk
  • Reaction time and balance control declines

Nursing Implications

  1. Make mobility a priority intervention, not just for therapy
    • Mobility improves outcomes: ↓length of stay, ↓insulin needs, ↑ likelihood of discharge home
  2. Change positions frequently
    • The stimulus of moving is more important than time spent in each position
  3. Use mobility equipment
    • Standing aids, walkers with seats, ceiling track lifts, mobility slings
    • Get training to use equipment efficiently
  4. Collaborate with therapy but know you can maintain mobility
    • If patient is at baseline, it is the nurse’s job to maintain mobility
    • Refer to therapy for complicated mobility issues
  5. Address fear of falls
    • Immobility increases future falls. Prioritize safe mobility over bedrest.
  6. Minimize sedation in ICU
    • Light/eliminating sedation allows early mobilization and avoids complications