Une croyance largement ancrée dans nos esprits consiste à penser que lorsque nous sommes à l’hôpital, il faudrait nécessairement se reposer. Pourtant, la littérature est unanime sur le sujet : mobiliser suffisamment son corps pour éviter la fonte musculaire et les conséquences néfastes qui en découlent est absolument essentiel pour une guérison optimale.
La majorité des personnes admises dans les hôpitaux sont des personnes âgées. On sait qu’il existe un risque important pour cette catégorie de la population concernant la perte de capacités fonctionnelles lorsque l’hospitalisation s’étend dans la durée. Cela n’est pas sans conséquences : un risque de réadmission plus élevé (notamment à cause de chutes plus fréquentes), un placement en établissement hospitalier pour personnes âgées dépendantes (Ehpad) en allant jusqu’au décès.
De fait, il va sans dire que le niveau d’activité physique dans les structures hospitalières est très faible et qu’il représente un facteur de risque pour la perte des capacités fonctionnelles et les conséquences qui s’ensuivent. Pourtant, si on regarde le verre à moitié plein, cela veut dire qu’il est possible d’agir pour augmenter ce niveau d’activité physique et réduire les risques associés. Comment faire ? C’est la question que se sont posée des chercheurs néerlandais qui publient une revue systématique dans International Journal of Behavioral Nutrition and Physical Activity.
La difficile réalité du terrain : favoriser l’activité physique à l’hôpital
Les auteurs mettent en évidence l’existence de nombreux freins et moteurs au niveau intra-individuel (ce que ressentent et croient les patients et les soignants), inter-individuel (les interactions entre les patients et les soignants) et institutionnel (les règles qui régissent le soin, l’environnement où se déroule le soin, etc.).
En premier lieu, il faut pointer les obstacles majeurs que représentent certaines croyances comme le fait d’associer systématiquement l’hôpital au repos : « La perception la plus répandue chez les patients lorsqu’ils sont admis à l’hôpital est qu’ils doivent se reposer et que ce repos est nécessaire pour récupérer au mieux. Cela va à l’encontre des données publiées dans la littérature qui montrent bien qu’un patient physiquement actif récupère en moyenne plus rapidement qu’un patient alité », pointe Boris Cheval, chercheur en psychologie de l’activité physique au Centre suisse des sciences affectives intervenant également à l’hôpital universitaire de Genève.
Certaines croyances associent systématiquement l’hôpital au repos, un obstacle majeur pour une meilleure récupération.
De manière analogue, la peur et l’appréhension des patients est un facteur limitant leur mobilité, surtout lorsque le motif de l’admission à l’hôpital est une chute : « Il faut souvent aller voir les patients pour les rassurer et leur rappeler qu’ils ne doivent pas hésiter à nous appeler pour qu’on les aide à se déplacer. La plupart sont gênés à l’idée de représenter une charge pour les soignants. De plus, les personnes qui ont chuté doivent reprendre confiance en elles. La chute est souvent vécue comme un réel choc traumatique. La consultation avec un professionnel de la santé mentale devrait être systématique », développe Vincent Girod, kinésithérapeute au Centre Hospitalier Alpes Isère.
Un patient physiquement actif récupère en moyenne plus rapidement qu’un patient alité
Cependant, il n’y a pas que les patients qui ont des croyances inexactes, des peurs infondées et des représentations stéréotypées. Les soignants aussi en sont victimes et cela vient impacter leurs interactions avec les patients et peut se traduire par un faible support quant à les pousser à recouvrer une certaine autonomie : « Ces idées sont aussi ancrées chez les soignants qui préfèrent généralement suggérer à un patient qui a des douleurs musculaires ou articulaires que cela est normal car il vient d’être opéré et qu’il a besoin de repos », rappelle Boris Cheval.
Vincent Girod évoque également à quel point la représentation collective que nous nous faisons de la personne âgée impacte les recommandations en matière d’activité physique : « On a du mal à se représenter une personne âgée dynamique et qui continue d’être active physiquement. Je me confronte régulièrement à cela dans ma pratique où certains collègues vont suggérer à un patient pourtant très actif physiquement que certains mouvements, certaines activités ou certaines charges à soulever doivent être proscrites ou considérablement limitées sans prendre en compte l’activité initiale de la personne ».
Enfin, l’environnement de l’hôpital n’est généralement pas pensé pour que les déplacements ou les activités y soient facilement réalisables. Dans la littérature, on parle de bed-centrism, pour décrire le fait que, à l’hôpital, tout tourne constamment autour du lit. Cela a des conséquences directes sur les capacités fonctionnelles des patients : « Si tout se déroule au sein du même endroit, les patients n’ont pas de motivations à sortir de leur chambre. L’hôpital s’est trop longtemps focalisé sur le soin au lieu de se focaliser sur les personnes », déplore Vincent Girod.
On a du mal à se représenter une personne âgée dynamique et qui continue d’être active physiquement
De plus, cet environnement influence jusqu’aux médecins les plus engagés et conscients de l’importance d’une activité physique aussi infime soit-elle : « Lorsque l’on discute avec les médecins, même les plus motivés à faire bouger leurs patients se laissent avoir par la facilité déconcertante que propose le bed-centrism par manque de temps, en réalisant leur examen clinique simplement en mettant le patient sur le côté, alors que, dans une optique de récupération des capacités fonctionnelles, il faudrait suggérer, encourager et amener le patient à se lever », précise Boris Cheval.
À l’hôpital, tout tourne constamment autour du lit. Les patients doivent être encouragés à sortir de leur chambre afin de faire un minimum d’activités physiques.
Prendre les devants : favoriser l’activité physique dans la population générale
Mais le premier facteur qui détermine l’activité physique d’un patient à l’hôpital, c’est son niveau d’activité physique dans la vie quotidienne. Par conséquent, si des interventions sont possibles en aval de l’admission pour travailler sur les croyances, atténuer l’appréhension ou modifier l’environnement, on peut aussi agir en amont avec les politiques de santé publique pour augmenter le niveau d’activité physique de la population générale. Pourtant, malgré la communication incessante des autorités de santé publique sur les bienfaits de l’activité physique pour la santé ainsi que l’acceptation universelle de cet état de fait dans la population, l’inactivité physique ne cesse d’augmenter.
Le saviez-vous ?
La sédentarité et l’inactivité physique sont deux choses différentes. La sédentarité se réfère au temps passé en position assise ou allongée. L’inactivité physique se réfère au fait de ne pas atteindre les recommandations sanitaires en vigueur en matière d’activité physique. Il est donc possible d’être un « sédentaire actif ».
Encore une fois, il semblerait que les gens ne prennent pas de décision en tant qu’être rationnel parfait comme le postule certaines théories économiques, mais bien en tant qu’être humain étant aussi gouverné par leurs émotions. Des émotions qui sont plus utiles que nous le pensons pour prendre des décisions. C’est en tout cas l’hypothèse que défend Boris Cheval dans ses travaux où il cherche à démontrer que, pour observer le maintien d’une activité physique, il faut que l’expérience affective de cette activité soit positive : « On arrive à démonter, même si les résultats sont pour l’instant peu consistants et que les tailles d’effets sont relativement faibles, que la réponse affective pendant l’effort prédit plutôt bien le maintien de l’activité physique à long terme ».
Vers un changement de paradigme global ?
Si les spécialistes que sont les chercheurs en psychologie de l’activité physique, les professeurs en activité physiques adaptés ou encore les kinésithérapeutes sont globalement tous conscients des enjeux, beaucoup de verrous subsistent, notamment au niveau des moyens : « On manque de personnel pour simplement rendre visite aux patients et les encourager à aller se promener dans les couloirs et en dehors de l’hôpital. Il n’y a rien de plus morose qu’un couloir d’hôpital donc il faut des personnes pour donner envie aux patients de bouger. Malheureusement, ce temps-là n’est pas valorisé car il n’est pas réellement considéré comme du soin », regrette Vincent Girod.
Aussi, comme nous l’évoquions précédemment, peut-être faudrait-il revoir les enjeux de l’éducation physique et sportive à l’école. En effet, si l’expérience affective joue un rôle prépondérant dans l’engagement au sein d’un effort physique, ne faudrait-il pas que les professeurs d’enseignement physique et sportif (EPS) se concentrent avant tout sur ce paramètre ?
Bien sûr, l’EPS vise de multiples objectifs comme le développement de la motricité. Mais délivrer des compétences minimales est inutile si nous n’avons pas envie de nous en servir par la suite. En effet, il existe une corrélation entre la valence des souvenirs que nous avons de nos cours d’EPS et notre propension à nous engager dans une activité physique. Le cours d’EPS pourrait alors aussi devenir un lieu d’exploration pour découvrir ce qui nous plaît, de développement des vertus physiques (à l’instar des vertus morales et des vertus épistémiques) tel que le goût de l’effort et de l’apprentissage de compétences sportives et métacognitives pour s’engager préférentiellement dans des activités qui sont des fins en elles-mêmes.
futura
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