Uneven Recovery of Lower Limb Muscles After Bed Rest in Older Adults: A Muscle Strength–Based Evaluation

Background and/or Objectives: Muscle deconditioning during bed rest is a well-recognized contributor to functional decline in older adults. However, the rate and pattern of strength recovery across different lower limb muscle groups following remobilization remain unclear. This study aimed to evaluate muscle-specific strength recovery after bed rest in hospitalized older adults.

Design: Prospective observational cohort study conducted from January 2018 to December 2022, with follow-up completed in March 2023.

Setting : Inpatient acute care medical and surgical units.

Participants : Adults aged 65 years or older who experienced at least seven consecutive days of bed rest due to medical or postoperative recovery. Individuals with neuromuscular or metabolic conditions were excluded.

Interventions: Participants resumed standard mobility activities and physical therapy following bed rest. Interventions: not applicable.

Main Outcome Measures: Muscle strength was measured using handheld dynamometry for the quadriceps, hamstrings, gastrocnemius, and soleus at three time points: baseline (pre-bed rest), post-bed rest (Day 0), and follow-up (Days 7 and 28). Functional assessments included the Five Times Sit-to-Stand Test and the Timed Up and Go test.

Results: All muscle groups demonstrated significant strength loss following bed rest, with the quadriceps and soleus showing the greatest decline. By Day 28, the hamstrings and gastrocnemius had largely recovered to baseline levels, while the quadriceps and soleus remained significantly weaker (p < 0.05). Functional test improvements paralleled the muscle strength recovery pattern.

Conclusions: Muscle strength recovery following bed rest in older adults is not uniform. Antigravity muscles such as the quadriceps and soleus show prolonged deficits even after 28 days of resumed activity. These findings highlight the need for targeted rehabilitation strategies to address uneven muscle recovery and support functional independence.