Circulation

PERSPECTIVE

The Dallas Bed Rest and Training Study

Revisited After 50 Years

I
n 1966, a seminal study in exercise science was conducted: the Dallas Bed Rest Jere H. Mitchell, MD
and Training Study. With the primary results published as a 78-page supplement Benjamin D. Levine, MD
to Circulation in 1968, it reported the changes in cardiorespiratory performance Darren K. McGuire, MD,
from extreme changes in physical activity.1 Much of our current knowledge about MHSc
the adaptive capacity of the cardiovascular system derives from this study. Now at
the 50th anniversary of the initial publication, with 2 subsequent evaluations of the
study participants over a 40-year span, here we highlight some of the key lessons
learned from this period of study.
For the initial evaluations in 1966, 5 healthy 20-year-old male volunteers
were assessed at baseline, spent 3 weeks at complete bed rest with no weight
bearing allowed (similar to clinical treatment of acute myocardial infarction
at the time), and then underwent 8 weeks of intensive endurance training.
Cardiopulmonary function was evaluated by determining maximal oxygen up-
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take (VO2max) during stress testing to exhaustion, the gold standard measure of
integrated cardiorespiratory capacity reflecting the capacity of the circulatory
and respiratory systems to deliver oxygen to skeletal muscle during exercise,2
measured at baseline, after bed rest, and after endurance training, with results
summarized in the Table.
Average VO2max declined 27% after bed rest with a subsequent 45% increase
with training. As shown in the Table, average maximal cardiac output declined
by 26% after bed rest followed by a 40% increase with training, with no signifi-
cant changes across the evaluations in maximal arteriovenous oxygen difference
or heart rate. Thus, changes in VO2max were attributable to changes in maximal
cardiac output as a result of changes in maximal stroke volume that declined 31%
with bed rest followed by a 48% increase with training.
Additional important observations were the impact of bed rest and exer-
cise training on submaximal exercise performance. For example, a submaximal
workload of 1.5L/m (~ 100 watts on a bike) would represent 45% of the ob-
served baseline maximal workload, 63% after bed rest, and 38% after training.
These changes in relative work amounts are important because the cardiovas-
cular responses to endurance exercise are determined by the percentage of
VO2max achieved with exercise, and not the absolute workload attained. The
average baseline heart rate at a submaximal work load of 1.5 L/m was 129 The opinions expressed in this article are
beats per minute, after bed rest was 164 beats per minute, and after training not necessarily those of the editors or
of the American Heart Association.
115 beats per minute, a difference of nearly 50 beats per minute at the same
workload; likewise, at the same submaximal workload, blood pressure was Key Words: aging ◼ bed rest ◼ cardiac
rehabilitation ◼ cardiovascular system
higher after bed rest and lower after training. ◼ exercise
These findings must be considered in the context of myocardial oxygen de-
© 2019 American Heart Association, Inc.
mand during exercise, determined by heart rate, left ventricular wall tension (intra-
cardiac pressure and chamber radius), and contractility. Thus, at any submaximal https://www.ahajournals.org/journal/circ

Circulation. 2019;140:1293–1295. DOI: 10.1161/CIRCULATIONAHA.119.041046 October 15, 2019 1293

 Mitchell et al Dallas Bed Rest and Training Study: 50 Years Later

Table.  Group Average Results From Treadmill Maximal Cardiopulmonary Exercise Tests Over the 40-Year Interval
FRAME OF REFERENCE

1966 1996 2006

Variable Baseline After Bed Rest After Training Baseline After Training Baseline
Maximum oxygen uptake (L/min) 3.3 2.4 3.9 2.9 3.3 2.4
Cardiac output (L/min) 20.0 14.8 22.8 21.4 21.7 18.9
Heart rate (bpm) 193 197 190 181 171 174
Stroke volume (mL/beat) 104 75 120 121 129 109
Arteriovenous oxygen difference (mL O2/100 mL) 16.2 16.5 17.1 13.8 15.2 12.7
Systolic blood pressure (mm Hg) 204 153 201 208 192 176
Diastolic blood pressure (mm Hg) 81 63 74 96 103 82

All values are group means.

­ orkload, myocardial oxygen demands are higher after

w As summarized in the Table, average VO2max had de-
bed rest and lower after exercise training.
There were important clinical implications from this
study that changed how patients were treated, almost
immediately. For example, for patients with myocardial
infarction, strict bed rest that underpinned clinical care
at the time was then understood to be harmful because
of the adverse effects on cardiovascular performance,
transitioning care to early ambulation and use of car-
diac rehabilitation.
These same 5 volunteers were studied 30 years
later (1996) at baseline and after endurance train-
ing, with no bed rest exposure evaluated, with results
previously published,3,4 summarized in the Table. Con-
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clined an additional 17% over the 10-year interval, and
27% over 40 years, with the rate of decline increasing
from 13 ml/year over the first 30 years to 50 ml/year
over the final 10 years. It is also notable that average
VO2max was the same after bed rest in 1966 as it was at
the 40-year baseline evaluation; ie, bed rest at the age
of 20 years was as detrimental as 40 years of aging. It is
intriguing that reductions in stroke volume accounted
for reductions in VO2max with bedrest, while reduction
in oxygen extraction (reflected by arteriovenous oxygen
difference) had a greater contribution and endurance
exercise training improved both with aging. This dif-

ference highlights the importance of strength training

trasted with the 27% decline in VO2max with bed rest in
the 1966 study, baseline VO2max had declined by 12%
over the 30-year interval. Thus, 3 weeks of bed rest
at age 20 years reduced cardiovascular capacity more
than 30 years of aging. Compared with the original
study, training at the 30-year follow-up was less in-
tense and titrated slowly over 6 months instead of 8
weeks because of the age of the volunteers and risk
for injury; each achieved the same final weekly dura-
tion of exercise (250 minutes per week).
In the 1966 study, compared with baseline, VO2max
increased with training by 18%. In the 30-year follow-
up, VO2max increased by 14% with training and achieved
levels similar to the 1966 baseline evaluations. Thus,
endurance training in middle-aged men effectively re-
versed the effects of 30 years of aging on cardiovascu-
lar capacity. However, post-training VO2max 15% lower
at the 30-year follow-up.
The same 5 volunteers were studied again 10 years
later in 2006, and at the age of 60 years had developed
comorbidities typical of an aging population.5 Of these,
3 had hypertension, 2 had paroxysmal atrial fibrillation,
and 1 had disabling back pain that compromised his ex-
ercise capacity, ultimately found to be due to metastatic
renal cell carcinoma. At this evaluation, only baseline
cardiopulmonary testing was performed with no train-
ing component.
with aging, especially at more advanced age, to limit
sarcopenia and its associated decline in peripheral oxy-
gen uptake.
The Dallas Bed Rest and Training Study and its
follow-up used VO 2max1 to evaluate the effects of
extremes in physical activity and of age on inte-
grated cardiorespiratory performance. Bed rest
was found to be extremely harmful and endurance
training beneficial across the spectrum of age. The
original study not only demonstrated the extraordi-
nary adaptive capacity of the cardiovascular system
and the compelling adverse effects of sedentary
behavior, but it also had immediate clinical impact,
sustained to the present day, minimizing seden-
tary time in the management of acute and chronic
medical conditions.
ARTICLE INFORMATION
Correspondence
Jere H. Mitchell, MD, or Darren K. McGuire, MD, MHSc, Division of Cardiology,
5323 Harry Hines Boulevard, Dallas, TX 75390. Email jere.mitchell@utsouth-
western.edu or darren.mcguire@utsouthwestern.edu
Affiliation
Division of Cardiology, University of Texas Southwestern Medical Center.

1294 October 15, 2019 Circulation. 2019;140:1293–1295. DOI: 10.1161/CIRCULATIONAHA.119.041046

 Mitchell et al
Disclosures
None.
REFERENCES
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Chapman CB. Response to exercise after bed rest and after training. Cir-
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2. Mitchell JH, Sproule BJ, Chapman CB. The physiological meaning of the
maximal oxygen intake test. J Clin Invest. 1958; 37:538–547. doi:10.1172/
JCI103636
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Circulation. 2019;140:1293–1295. DOI: 10.1161/CIRCULATIONAHA.119.041046
Dallas Bed Rest and Training Study: 50 Years Later
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