How to Prevent Muscle Mass Loss When You’re Housebound

This article is part of a healthspan series about how to improve or maintain quality of life throughout the years, even when you’re chronically ill right now.

Being stuck at home feeling sick and lonely is bad enough as it is. But if you’re housebound due to chronic illness, chances are, you are struggling to move your body as regularly, freely and intensely as you’d like.

It doesn’t matter if you have arthritis, a heart condition or COPD, being physical inactive puts you at risk of losing muscle mass, which in turn can trigger a cascade of health problems. Studies show that even more than 5 days of bedrest, such as lying in a hospital bed, can already lead to a significant decrease in muscle size, strength and functioning.

That’s a pretty depressing statistic if you’re living with chronic pain, fatigue and symptoms that limit your movements. Is there any realistic way you can prevent muscle mass loss if you’re housebound and require lots of rest? 

To be honest, that depends on your specific condition, but I’ve rounded up some research-backed, illness-proof strategies to stay active despite your physical limitations. But first, we’ll dive in to the science behind muscle mass loss, and why it hurts your health and quality of life.

How do you lose muscle mass?

Your skeletal muscles are one of the most dynamic tissues in your body – meaning they will easily adapt to how often you use them and how heavily they’re taxed. In healthy adults, around 40% of the total body weight will be made up of muscles, which in turn contain high amounts of bodily proteins to function.

Throughout childhood to young adulthood, muscles grow in size in response to hormonal changes and to physical activities, from playing tag and climbing trees to doing sports. But as you age, you will begin to lose muscle mass – and this natural process starts much sooner than you probably realize. From age 30 onwards, you will lose around 1% of muscle each year, and this decrease will speed up to 3 to 5% after age 70. (That is, unless you deliberately train to prevent muscle mass loss and try to improve your healthspan, of course.)

But this age-related, progressive process of sarcopenia is not the only way to lose muscle mass and strength. Sadly for those of us living with chronic illness, the old adage of “use it or lose it” is true. Muscle atrophy is the wasting of muscle tissue due to inactivity, malnutrition or neurological conditions. When you’re on bed rest, lead a sedentary lifestyle or can’t move your body freely because of a stroke, MS or ALS, your muscles will decrease in size and strength. Even a one-week hospital stay can already can lead to a rapid decline in muscle mass, especially if patients are unable to walk.

Finally, severe loss of muscle mass and body weight can also be part of a complex metabolic condition called cachexia, which is caused by serious underlying illnesses like cancer, heart failure and dementia.

The treatment of cachexia and its causes always requires professional medical help and falls outside of the scope of this article. The same statement also applies to neurogenic muscular atrophy caused by conditions like MS, spinal cord injury or Charcot-Marie-Tooth disease.

What are the risks of muscle mass loss?

Losing muscle mass due to aging or inactivity doesn’t just lead to muscle weakness that impacts your ability to function well, but it also increases your risk of falls and fractures. And that’s not just painful, but can hurt the healthspan of frail (older) adults.

What’s more, the contracting of your muscles requires energy, so physical inactivity has a negative effect on your metabolism, including your insulin sensitivity. That’s how sarcopenia and muscle atrophy can contribute to an increased risk for diabetes.

It’s a vicious cycle: the less you move your body, the more muscle mass and strength you lose, making it even harder to move your body to do everyday activities. And in turn, being physically inactive further hurts your energy levels, metabolism, heart health and immunity.

Is there anything you can do to break out of that negative spiral? That depends on your specific health and living conditions – see the disclaimers mentioned under ‘How Do You Lose Muscle Mass’! But thankfully, as said before, muscle are dynamic tissue, meaning they will adapt well to new conditions and stimulation.

So let’s take a look at some accessible and adaptable strategies to help prevent muscle mass loss when you’re housebound, with various energy and mobility levels in mind.

What can you do to prevent muscle mass loss?

First of all, get medical advice tailored to your unique situation by consulting your doctor. I’m a psychologist with a long history of chronic conditions who loves translating research findings into doable, illness-proof tips, but not an expert on physiology nor on how your body is impacted by your specific illness and/or by taking up gentle exercising.

A physical therapist is also a valuable help in maintaining and rebuilding muscle strength and mobility, while an occupational therapist can teach you how to make daily living activities easier to maximize what you can do independently

Again, please also be aware that muscle atrophy due to neurological damage cannot always be reversed, and that neurogenic atrophy and cachexia require professional medical attention that goes beyond the advice written below.

With these precautions in mind, here are 7 accessible ways to stay active at home and help prevent muscle mass loss, despite (certain) chronic illness.

1. Gentle exercises in bed

• Regular repositioning. If you’re bed bound, you should change your position every 2 hours (like moving from lying on one side to the other) to prevent muscle atrophy and pressure injuries. When possible, you may also consider less-typical resting positions, like Child’s pose or the ‘reclined butterfly pose’. Even better, try to rotate your joints and stretch and flex your limbs when you’re repositioning in bed.

Unable to move your muscles actively? Consider asking a caregiver or physical therapist to help you with passive range of motion (ROM) exercises, like moving your arms or legs for you, to help maintain joint flexibility and stimulate muscle activity.

• Restorative yoga. Gentle movement in bed may not build much strength or stamina, but it will activate your muscles and get your blood circulation flowing, which is a great place to start. You could lay in Happy Baby pose, do some supine spinal twists, or stretch yourself with seated forward bends. For instruction videos, just type “bed yoga” in your search bar to get you going.

• Resistance bands. Yes, if you feel well enough, you can still do some light resistance training when you’re stuck in bed. Get a low-budget resistance band and do a pull-apart, held underhand or overhand with your arms stretched out over your chest. You could also try the “clamshell” to open up your hips or practice a banded single leg lowering – whatever feels doable for your body.

2. Seated exercises

• Active sitting. Did you know that taking an active seat, without leaning against a chair, sofa or the wall, has benefits for your health? It engages your back and core muscles, supports your posture and increases your overall movement, without taxing your body.

You could try an ergonomic stool or medicine ball for active sitting, but simply getting down on the floor and sitting cross-legged, with your legs stretched out in a V-shape or folded to one side while watching TV will also work to activate different muscles.

• Chair exercises. More proof that you don’t even have to stand to start rebuilding your muscle strength: Chair exercises can provide an effective workout without straining your muscles and joints. Even with limited mobility, you can do seated stretches and use light weights, or have fun with a chair dance workout.

• Ground movement. From rolling and rocking on all fours to practicing getting up from the ground unassisted, floor exercises are accessible ways to work on your functional fitness. You could also practice the cat/cow pose to increase your mobility, as well as strengthen your core with the bridge pose.

3. NEAT Movement

NEAT stands for non-exercise activity thermogenesis, the scientific term for the energy expended on all physical activities that aren’t sleeping, eating or exercising in the form of workouts or sports. It basically involves everything from walking around, taking the stairs and doing chores, but also hobbies and fidgeting. In turns out that even small NEAT movements can have a big impact on your health, mostly by burning more calories and activating your muscles.

So one ‘neat’ way to stay active and prevent muscle mass loss while you’re housebound with chronic illness, is to sneak more micro-movements into your routines.

For example, fidgeting can actually help reduce the risks of excessive sitting (or resting in our case). Pretty impressive right? So put a fidget toy or therapy stress ball on your nightstand if you’re stuck in bed, and place a pen, paper and lap cushion near the couch so you can doodle while watching your favorite series.

Also, when possible, save some energy for ‘hands-on’ hobbies you can do lying or sitting down, from knitting, journaling and stringing beads to doing jigsaw puzzles and video gaming. It’s not the same as exercising, but these small movements do add up.

In that spirit…

4. Short bursts of activity

You don’t have to do long workouts to prevent muscle mass loss – short bursts of activity will also help you regain strength and stamina. If your health is stable enough, see how you can fit some ‘exercise snacks’ into your schedule. From doing sun salutations after you wake up to taking the stairs and balancing on one foot while brushing your teeth, there are many ways to add 5 to 10 minutes of gentle movement to your daily routines.

And if you’re seriously sick, don’t underestimate the importance of performing activities of daily living (ADL) to stay mobile and independent. Taking a shower and getting dressed, making and eating meals, doing basic chores, this can all take up a lot of energy when you’re chronically ill – and that can feel so frustrating and unfair. But if you look at it through the lens of preventing muscle mass loss, performing ADL yourself counts as physical activity that supports your overall wellbeing.

Tackling household chores also works as an ‘exercise snack’ – and if you’re fit enough, you could even do lunges when vacuuming or calve raises as you’re dusting.

5. Eat enough protein

Proteins are the building blocks of your body, and vital for maintaining muscle mass and function. That’s why it’s important to get enough protein-rich foods in every day, like lean poultry, fish, eggs, dairy and plant-based protein from legumes, soy and nuts. If swallowing or eating large meals is difficult, protein shakes or smoothies can also help.

The general recommended amount for adults is about 0.8 grams of protein per kilogram of body weight, or 0.36 grams per pound. But pregnant women, older adults and chronically ill people may require higher amounts of protein, up to 1g/kg.

However, research suggests that your body can only use 20 to 40g of dietary protein at one time, so it’s important to eat a source of protein with each meal. You could have Greek yoghurt with fruit for breakfast, a cheese sandwich or tuna salad for lunch, an apple with nut butter as a snack and a stir fry with chicken or tofu and cashews for dinner.

6. Get your vitamin D

We know that vitamin D is essential for healthy bones and good mental health, but a lack of vitamin D also contributes to muscle weakness and muscle wasting. And that’s bad news, because vitamin D deficiency is a huge problem around the world. Certain medical conditions can also cause vitamin D deficiency, like cystic fibrosis, Crohn’s disease, celiac disease, liver disease and kidney disease, as well as the use of laxatives and steroids.

Sunlight is the most important source of vitamin D. But when you’re housebound, the term kind of implies that you are probably not getting plenty of time outside, and not enough safe exposure to sunlight. Of course you should check out these helpful tips to head outdoors with chronic illness and/or safely catch enough daylight, but it would also be wise to have you vitamin D levels checked by your doctor and take supplementation if needed.

7. Explore mental imagery for muscle activation

Ok, this may sound out-there, but studies show that mental imagery or visualization can stimulate parts of the brain involved in motor control and even contribute to physical performance or rehabilitation.

You see, when you vividly imagine performing a movement, the same areas of your brain become active that would be activated if you were actually physically make that movement. This phenomenon is known as motor imagery and it’s kind of a mental rehearsal for physical activities. What’s more, even when you’re siting still, simply imagining specific movements (like moving your finger or squeezing your fist) could result in minor muscle activation.

In fact, research suggests that visualizing doing an exercise can actually result in tiny but measurable gains in muscle activation, strength and motor skills, even without performing the exercise physically. That’s why mental imagery is sometimes used to help (immobilized) people recover from strokes or other brain injuries.

You cannot prevent muscle mass loss with mental imagery and visualizations alone, but picturing yourself doing certain activities on a regular basis can help you to rewire your brain and activate your muscles when you’re not able to move. You can find more advice on how to start practicing motor imagery at home here.

Preventing muscle mass loss while you’re housebound with chronic illness requires dedication, patience and a multi-faceted approach, from gentle movement to adequate nutrition and even mental techniques.

It’s not easy, nor always possible for everyone, but rebuilding or maintaining your muscle size and strength can definitely have a positive impact on your health and quality of life.

For more advice, check out these articles on how to stay physically active with chronic illness, as well as 8 realistic practices you can start doing to support your healthspan as you age, even if you’re sick now.