Exercise program implementation proves not feasible during acute care hospitalization

Abstract

Abstract-Functional decline during hospitalization occurs in up to 65% of older adults. This study determined the feasibility of an inpatient followed by an in-home exercise program for patients with limited ambulatory ability on hospital admission. Patients aged ≥ 60 years who were admitted to the hospital with an acute medical illness associated with limited ambulatory ability were eligible for the study. Of 76 eligible patients, 10 were recruited, with only 1 patient completing the 24-week exercise program. Barriers to recruitment included illness severity, short hospital stays, and patient refusal. Hospital readmission during the in-home exercise program occurred for three of the seven exercise group participants. In the exercise group, four of the seven patients participated in at least 3 weeks of exercise posthospitalization. Qualitative interviews suggested most patients believed exercise to be beneficial, but this interest did not translate into adherence to this study protocol. Initiation of an inpatient exercise program was not feasible in the study population. The in-home program was more feasible but target criteria need refinement.

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review

“…Feasibility of early physical rehabilitation programs, was explicitly assessed in four studies (Table 4) comparing usual care with an exercise intervention program [14,30-32]. In addition included randomized controlled trails with an exercise program reported on enrolment (n=3), adherence rate (n=2) and adverse events (n=5), while multidisciplinary studies reported on enrolment (n=3) only.…”

“…In one study [30] only 2% of all admitted patients were included. Of the 76 patients that met the inclusion criteria only 10 consented to participating while 87% of the eligible patients refused to take part in the program.…”

A conceptual model of verbal exchange health literacy

“…Despite multiple communication levels and modes, patients most often prefer and exchange a large percentage of personal health information through interpersonal verbal communication with the healthcare provider [32, 33]. Unfortunately, patients report understanding and retaining only about 50% of the information their providers discuss [34, 35].…”

Identifying Barriers to Remaining Physically Active After Rehabilitation: Differences in Perception Between Physical Therapists and Older Adult Patients

“…For example, education on the benefits of physical activity, counseling to support change, referral to exercise groups, and selfefficacy training have all been found to improve short-term physical activity participation but not to support long-term change. 3,4,10,12,13,17,33 Though this picture may seem bleak, one way of increasing the likelihood of successful activity interventions during physical therapy is to strengthen the relationship between the clinician and the patient. A strong, trusting, and respectful bond between the therapist and the patient may ensure individualized, stage-matched interventions that lead to progression through the stages of the TTM and eventually result in long-term change in physical activity behavior.…”

“…By becoming attuned to patients' personal goals and the environment, factors that are critical in influencing willpower, physical therapists can create interventions that add to depersonalized consciousnessraising approaches (print materials), discussions of exercise benefits, classes, and media campaigns, all of which have been found to assist in promoting forward motion through the staging process but, for the most part, have failed to promote long-term change. 3,4,10,12,13,17,33 We know that taking multiple approaches over a long period of involvement (6 months or more) promotes lasting change. 42 As such, building a physical therapist-patient relationship that may serve as a permanent framework for change is critical.…”