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When we get sick, it's almost an instinctive response to stay in bed until we feel better -- often with a heating pad and a cup of hot tea. The notion that "rest is best" goes as far back as Hippocrates, the father of medicine, who suggested that: "In every movement of the body, whenever one begins to endure pain, it will be relieved by rest."

One obvious reason sick people take to their beds is that many illnesses, especially viral or bacterial infections, cause weakness and fatigue.

"Anyone who has the flu knows that the preferred location to be is in bed," says Dr. Michael Evans, a family physician at the Toronto Western Hospital, and assistant professor at the University of Toronto. "But staying in bed until you feel better is different from bed rest prescribed by a doctor."

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The potential dangers of long-term bed rest have been known for many years -- they include the development of blood clots in the legs, bed sores, pneumonia and thinning of bones (osteoporosis). It's also clear that prolonged bed rest, especially in older people, can cause weakness, loss of appetite, poor sleep, and depressed mood.

Yet bed rest has been advocated as an essential part of treatment for a wide range of acute and chronic health problems, including acute low back pain, uncomplicated heart attack, rheumatoid arthritis, acute infectious hepatitis, and premature labour.

Now an Australian study of nearly 6,000 patients has found evidence that bed rest doesn't really help -- in fact, may actually prolong illness and complicate recovery for many patients.

Researchers from the University of Queensland analyzed more than three dozen trials in which bed rest was used as a treatment for various medical conditions, or to prevent complications after medical procedures. Here's what they found:

Acute back-pain sufferers advised to rest in bed for between two and seven days were more disabled and experienced pain for a longer period of time than patients whose doctors recommended "early mobilization" -- resting for two days, then resuming normal activities.

People recovering from uncomplicated heart attacks did better when they were instructed to get out of bed after 12 hours, and start walking around the ward after 72 hours, compared to those who stayed in bed for a longer time.

Pregnant women with symptoms of early miscarriage who stayed in bed were no less likely to miscarry than a similar group who remained normally active.

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In one study, people with rheumatoid arthritis were admitted to hospital for bed rest, while others were placed in a ward which encouraged activity. After 10 weeks, the bed-rest group had more joint swelling and less strength than those who were active.

Patients with acute infectious hepatitis who were told to stay in bed for an average of 27 days recovered more slowly than other hepatitis patients who were up and about sooner.

In two dozen trials of bed rest after medical procedures such as lumbar puncture (spinal tap) and heart catheterization, only seven outcomes were better with bed rest (although none significantly better), while 26 outcomes were poorer with bed rest (nine significantly worse.)

Another study of 183 patients published last year by researchers from the Netherlands looked at bed rest as a treatment for sciatica -- pain which radiates into the leg from the lower back.

Those in the bed-rest group were told to stay in bed for two weeks, getting up only to use the bathroom and bathe; those in the active group were encouraged to be up and about whenever possible, but to avoid straining their backs or provoking pain.

When the groups were compared, no significant differences were noted: bed-rest patients used the same amount of pain medication for their sciatica and missed the same number of work days as those in the active group.

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"More research is needed before we can say when bed rest should be prescribed, for which patients and for how long," says Dr. Rick Glazier, a scientist with the Arthritis Community Research and Evaluation Unit at the University Health Network in Toronto.

In the meantime, take a common sense approach, advises Dr. Evans. "Unless your doctor gives strict orders to the contrary, stay in bed for a day or so, then try to resume normal activities. This is probably the fastest route to recovery." Reprinted from Health News, the medical letter of the University of Toronto Faculty of Medicine. For information, call 416-324-9191

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