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Recommendations Summary

EE: Rest Periods in Healthy and Non-Critically Ill 2014

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    EE: Rest Periods in Healthy and Non-Critically Ill Adults

    The registered dietitian nutritionist (RDN) should aim for a 30-minute rest period before starting a measurement of resting metabolic rate (RMR) in a healthy adult or those with stable COPD. If this is not possible, a 20-minute rest period may be sufficient. Research primarily in healthy adults showed that resting condition is achieved by the 30th minute of reclined rest, but studies that measured shorter rest times indicate that resting condition can occur in as little as 20 minutes in many adults. Individuals who move during the rest recovery time do not achieve a resting state by 20 minutes and may not be at complete rest at 30 minutes.

     

    Rating: Strong
    Imperative

    EE: Rest Periods in Healthy Children

    The registered dietitian nutritionist (RDN) should aim for a 30-minute rest period before starting a measurement of resting metabolic rate (RMR) in a healthy child. However, if the child cannot cooperate with both a pre-measurement rest and rest during measurement, the RDN may choose to forego the pre-measurement rest period, initiate the RMR measurement immediately and then discard the first 10 minutes of data. Research in healthy children indicates that when doing so,  RMR values recorded at the 20th minute of the measurement may be most indicative of rest in children. With this approach, limited evidence suggests that data recorded after the 10th minute are not significantly different from data at 30 minutes.

     

    Rating: Weak
    Conditional

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      • The recommendation, EE: Rest Periods in Healthy Children, applies to children who are unable to rest
      • When applying the recommendation to children, the child's age should be considered, due to variability in physical and developmental attributes
      • Clinical judgment should be used in applying the recommendation, EE: Rest Periods in Healthy Children,  to non-critically ill children, due to no evidence in this population
      • Clinical judgment should be used in applying the recommendation, EE: Rest Periods in Healthy and Non-Critically Ill Adults,  to non-critically ill adults, other than stable COPD patients, due to limited evidence in this population
      • Minimal physical activity (e.g., walking into facility) is acceptable prior to the rest period; beyond light intensity physical activity, see Physical Activity recommendation
      • Movement (e.g., fidgeting) during the rest period may require extension of the rest period. See the Resting Activities recommendation.

    • Potential Costs Associated with Application

      If the rest period requirements cannot be achieved, time to complete the measurement will be prolonged or the measurement will need to be rescheduled. Additional costs may be incurred.

    • Recommendation Narrative

      EEU: Rest Periods in Healthy and Non-Critically Ill Adults

      • Five studies provide evidence that resting condition is achieved by the 30th minute of reclined rest in adults, but studies that measured shorter rest periods indicate that resting condition can occur in as little as 20 minutes in many adults. Individuals who move during the rest period do not achieve a resting state by 20 minutes and may not be at complete rest at 30 minutes. Rest periods have primarily been tested in healthy adults; one study tested both healthy adults as well as stable COPD patients and found that 20 minutes was required to achieve rest in both groups.
      • Evidence is based on the following: 
        • One neutral-quality randomized controlled trial (RCT) (Frankenfield and Coleman, 2009)
        • One neutral-quality prospective cohort study (Fredrix et al, 1990)
        • One neutral-quality time study (Kashiwazaki et al, 1990)
        • One neutral-quality randomized crossover trial (Turley et al, 1993)
        • One negative-quality cross-sectional study (Schols et, al, 1992).
      EEU: Rest Periods in Healthy Children 
      • One study provides evidence that when a rest period is not given prior to the test, data recorded after the 10th minute of the measurement are not significantly different from data recorded at the 30th minute. RMR values recorded at the 20th minute of the measurement are most indicative of rest in healthy children.
      • Evidence is based one neutral quality non-randomized crossover trial (Mellecker and McManus, 2009).

    • Recommendation Strength Rationale

      • Conclusion statement supporting EE: Rest Periods in Healthy and Non-Critically Ill Adults is Grade I
      • Conclusion statement supporting EE: Rest Periods in Healthy Children is Grade III.

    • Minority Opinions

      None.