Exercise for acutely hospitalised older medical patients

Hartley, Peter; Keating, Jennifer Lyn; Jeffs, Kimberley J.; Raymond, Melissa; Smith, Toby O

doi:10.1002/14651858.cd005955.pub3

Cited by 15 publications

(11 citation statements)

References 126 publications

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“…In terms of hospital readmissions, our results differ from those of Courtney et al, who reported that multicomponent exercise and telephone counseling reduced readmission rates and general practitioner visits in hospitalized older adults. However, in line with our findings, meta-analytic evidence overall has shown that exercise interventions are not associated with hospital readmissions, falls, or mortality, which might support the safety of these interventions. Nevertheless, larger studies with longer follow-up are needed to confirm these findings.…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, our finding that the intervention was associated with improved Alusti Test scores at discharge compared with the control group is consistent with meta-analytic evidence supporting the benefits of structured physical exercise programs for ADL independence and physical performance in hospitalized older people receiving acute hospital care . Thus, our findings, taken together with previous evidence, suggest that implementing structured and, ideally, multicomponent exercise programs may be associated with reduced nosocomial disability in older adults during acute care hospitalization.…”

Section: Discussionsupporting

confidence: 90%

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Exercise Intervention and Hospital-Associated Disability

Rodriguez-Lopez,

Mayordomo-Cava,

Zarralanga-Lasobras

et al. 2024

JAMA Netw Open

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ImportanceInpatient exercise interventions may prevent, at least partly, hospital-associated disability (HAD) in older adults, but whether they also confer clinical benefits in the months following discharge is unclear.ObjectiveTo examine the association of exercise and health education with HAD incidence in hospitalized older adults receiving acute hospital care at discharge and 3 months later.Design, Setting, and ParticipantsThis single-center open-label, nonrandomized controlled clinical trial included patients aged 75 years or older seen at an acute care for elders unit at a tertiary public hospital in Madrid, Spain, from May 1, 2018, to June 30, 2022.InterventionsPatients were allocated to an intervention or control group. Both groups received usual care, but the intervention group also performed a supervised multicomponent exercise program (daily strength, balance, and walking exercises along with inspiratory muscle training) during hospitalization and received health education on how to exercise at home and telephone counseling during follow-up.Main Outcomes and MeasuresThe primary outcome was HAD incidence (determined by the Katz Index of Independence in Activities of Daily Living [hereafter, Katz Index]) at discharge and after 3 months compared with baseline (ie, 2 weeks before admission). Secondary outcomes included HAD incidence determined by the Barthel Index for Activities of Daily Living, ambulatory capacity decline at discharge and follow-up, changes in physical performance at discharge, and incidence of falls, readmissions, and mortality during the follow-up period.ResultsThe study included 260 patients (134 women [51.5%]; mean [SD] age, 87.4 [4.9] years [range, 75-105 years]; median hospital length of stay, 7 days [IQR, 5-10 days]), of whom 130 received the intervention and 130 were in the control group. Differences in HAD incidence did not reach statistical significance at discharge (odds ratio [OR], 0.62; 95% CI, 0.37-1.05; P = .08) or follow-up (OR, 0.65; 95% CI, 0.36-1.17; P = .15) when using the Katz Index. A lower HAD incidence was observed in the intervention group at discharge (OR, 0.47; 95% CI, 0.27-0.81; P = .01) and at follow-up (OR, 0.36; 95% CI, 0.20-0.66; P = .001) when using the Barthel Index for Activities of Daily Living. The intervention was also associated with a lesser decline in ambulatory capacity (OR, 0.55; 95% CI, 0.32-0.96; P = .03) and improved physical performance at discharge (Cohen d, 0.39; 95% CI, 0.12-0.65; P = .004). No significant associations were observed for readmissions, falls, or mortality.Conclusions and RelevanceIn this nonrandomized controlled clinical trial, an exercise and health education intervention was not significantly associated with reduced HAD incidence when measured by the Katz Index. However, the benefits found for several secondary outcomes might support the implementation of in-hospital exercise programs for older patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03604640

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Exercise Intervention and Hospital-Associated Disability

Rodriguez-Lopez,

Mayordomo-Cava,

Zarralanga-Lasobras

et al. 2024

JAMA Netw Open

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“…However, whether this definition is clinically reasonable has not been established. A recent Cochrane review suggested that the clinically important difference in BI would minimally be 11 points for hospitalized patients aged ≥65 years 43 . However, further investigations are needed regarding clinically meaningful BI improvement in older patients with acute HF.…”

Section: Discussionmentioning

confidence: 99%

Association of early acute‐phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure

Ueno

Kaneko

Kamiya

et al. 2023

J American Geriatrics Society

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Background Data on the potential benefit of acute‐phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure (AHF) have been scarce. Methods We retrospectively analyzed data from the Diagnosis Procedure Combination database, which is a nationwide inpatient database. This study included patients hospitalized for heart failure (HF) from January 2010 to March 2018, those aged ≥90 years, who had a length of stay of ≥3 days, New York Heart Association (NYHA) class of ≥II, and had not undergone major procedures under general anesthesia. Propensity score matching and generalized linear models were used to compare in‐hospital mortality, length of stay, 30‐day readmission rate due to HF, all‐cause 30‐day readmission, and improvement in activities of daily living (ADL) between patients with and without an acute‐phase rehabilitation initiation, which is defined as the rehabilitation initiation within 2 days after hospital admission. Results Acute‐phase rehabilitation was initiated in 8588 of 41,896 eligible patients. Propensity score matching created 8587 pairs. Patients with acute‐phase rehabilitation initiation have lower in‐hospital mortality (9.0% vs. 11.2%, p < 0.001). Acute‐phase rehabilitation initiation was associated with lower in‐hospital mortality (odds ratio, 0.778; 95% confidence interval, 0.704–0.860). Patients with acute‐phase rehabilitation initiation have a shorter median length of stay (17 days vs. 18 days, p < 0.001), lower 30‐day readmission rate due to HF (5.5% vs. 6.4%, p = 0.011) and all‐cause 30‐day readmission (10.2% vs. 11.2%, p = 0.036), and better ADL improvement (49.7% vs. 46.9%, p < 0.001). Subgroup analysis revealed consistent results (sex, body mass index, NYHA class, and Barthel Index). Conclusions The acute‐phase rehabilitation initiation was associated with improved short‐term clinical outcomes in patients aged ≥90 years with AHF.

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“…A recent Cochrane review concluded that there is uncertainty regarding the effect of exercise interventions on functional outcomes for older medical inpatients during acute hospitalisation. 9 Thus, it has been suggested that future research on this topic should focus on consistent reporting of participant characteristics, including baseline level of functional ability, as well as exercise dose and adherence to provide an insight into the reasons for the observed inconsistencies in findings. 9 …”

Section: Introductionmentioning

confidence: 99%

“… 9 Thus, it has been suggested that future research on this topic should focus on consistent reporting of participant characteristics, including baseline level of functional ability, as well as exercise dose and adherence to provide an insight into the reasons for the observed inconsistencies in findings. 9 …”

Section: Introductionmentioning

confidence: 99%

Study protocol for the ‘preventing functional decline in acutely hospitalised older patients (PREV_FUNC)’ study: effects of two multicomponent exercise programmes on physical function – a three-armed randomised controlled trial

Welmer,

Sandberg,

Sandlund

et al. 2023

BMJ Open

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IntroductionAcutely hospitalised older patients often live with frailty and have an increased risk of impaired physical function. Previous studies suggest that exercise might mitigate the risk of physical impairment; however, further research is needed to compare the effect of different types of exercise interventions. In this paper, we report a protocol for a trial that aims to examine (1) if multicomponent exercise interventions (interventions that include both mobility and strengthening exercises) have effects on physical function compared with usual care in older adults and (2) if a comprehensive multicomponent exercise programme is more effective than a simple multicomponent exercise programme that only include walking and sit-to-stand exercises.Methods and analysisThis is a three-armed randomised controlled trial, with two intervention groups (comprehensive and simple exercise programme) and a control group receiving usual care. We will include 320 participants aged ≥75 years from geriatric medical departments of four hospitals in Stockholm, Sweden. Assessments will be conducted at hospital admission, discharge and 3 months thereafter concerning physical function (primary outcome), activities of daily living, health-related quality of life, sarcopenia and falls. The number of readmissions will be registered up to 1 year after discharge. Data will be analysed with linear mixed effects models, according to the intention-to-treat approach.Ethics and disseminationEthical approval for this trial has been granted by the Swedish Ethical Review Authority (approval number 2022-03032-01). Data collection will consider the information requirement, the requirement of consent, confidentiality obligations and the utilisation requirement. Trial findings will be disseminated through multiple channels, including scientific publications and conferences, and workshops with healthcare professionals and the public.Trial registration numberNCT05366075

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Exercise for acutely hospitalised older medical patients

Cited by 15 publications

References 126 publications

Exercise Intervention and Hospital-Associated Disability

Exercise Intervention and Hospital-Associated Disability

Association of early acute‐phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure

Study protocol for the ‘preventing functional decline in acutely hospitalised older patients (PREV_FUNC)’ study: effects of two multicomponent exercise programmes on physical function – a three-armed randomised controlled trial

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