Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review

Abstract

This review examined effects of structured exercise (aerobic walking, with or without complementary modes of exercise) on cardiorespiratory measures, mobility, functional status, healthcare utilization, and Quality of Life in older adults (≥60 years) hospitalized for acute medical illness. Inclusion required exercise protocol, at least one patient-level or utilization outcome, and at least one physical assessment point during hospitalization or within 1 month of intervention. MEDLINE, Embase, and CINAHL databases were searched for studies published from 2000 to March 2015. Qualitative synthesis of 12 articles, reporting on 11 randomized controlled (RCT) and quasi-experimental studies described a heterogeneous set of exercise programs and reported mixed results across outcome categories. Methodological quality was independently assessed by 2 reviewers using the Cochrane Collaboration Risk of Bias tool. Larger, well-designed RCTs are needed, incorporating measurement of pre-morbid function, randomization with intention-to-treat analysis, examination of a targeted intervention with pre-defined intensity, and reported adherence and attrition.

Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures

“…The only study evaluating an exercise-only intervention by using LOS as a primary outcome [44], which resulted in a mismatch with the intervention contents, was unable to detect significant between-group differences. Hospital outcomes seem not to be sufficiently specific and sensitive enough to document unspecific effects of an exercise intervention and may therefore not be considered as the first choice for the evaluation of interventions with a mere exercise focus in the acute geriatric hospital setting [9]. Our findings support the initial assumption that hospital outcomes might be able to reveal benefits of multidisciplinary programs; however, only if the intervention contents were specifically addressed by the intervention contents.…”

“…For example, IADL scales include items that assess an individual’s ability to perform instrumental home or community activities such as housekeeping and going shopping, which cannot be appropriately assessed within the acute care hospital setting [14, 18]. Meeting these requirements in the early hospital-based geriatric rehabilitation poses a particular challenge based on the fact, that acutely hospitalized older patients represent a heterogeneous, multimorbid and vulnerable patient population in a complex environment during a critical phase of recovery [9]. Consequently, potential multiple goals in the treatment of these patients will go along with different intervention strategies and outcome measures to be amalgamated into a specifically tailored study design, which may not have been achieved in previous studies.…”

The Case for Mobility Assessment in Hospitalized Older Adults: American Geriatrics Society White Paper Executive Summary

“…Reviews have concluded that mobility interventions should target individuals at moderate to high risk of mobility loss, rather than unselected populations . In particular, a reanalysis of data from 2 studies found that individuals requiring assistance with ambulation at the time of hospitalization were more likely than other older adults to benefit from additional exercise …”

“…35,36 In particular, a reanalysis of data from 2 studies found that individuals requiring assistance with ambulation at the time of hospitalization were more likely than other older adults to benefit from additional exercise. 34,37 THE WHAT Hospital-based mobility intervention protocols tend to focus on progression from basic to more advanced movement based on premorbid function and mobility at the time of assessment. Typical progressions begin with bed exercises and move on to sitting, standing, walking, and climbing stairs.…”

“…The Up Campaign emphasizes sedation and opioid safety, progressive mobility for all patients, hand hygiene, and optimization of inpatient medications. 30 A writing group of the Quality and Performance Measurement Committee (QPMC) of the American Geriatrics Society (AGS) has reviewed the literature, including several systematic reviews, [31][32][33][34] and developed a white paper supporting greater focus on mobility during acute care and routine mobility assessments and interventions for hospitalized older adults. The full QPMC reviewed the draft white paper, which underwent peer review by the American Physical Therapy Association, Gerontological Advanced Practice Nurses Association, National Alliance for Caregiving, and Society for Hospital Medicine.…”