Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

Abstract

ObjectiveTo identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults.DesignSystematic review and Bayesian model-based network meta-analysis.Data sourcesFour databases were searched from inception to 20 June 2022.Eligibility criteria for selecting studiesRandomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models.ResultsNineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days).ConclusionsThis meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.Trial registration numberPROSPERO CRD42021271999.

Standardized mean differences in meta‐analysis: A tutorial

“…For a better understanding of this terminology, we are going to apply different standardization methods on data extracted from a published meta‐analysis [4]. Therefore, we select the Ortiz‐Alonso et al study [5] included in this meta‐analysis, which reported results using the overall score of the Short Physical Performance Battery (an instrument to assess the physical function; SPPB), and extract the “raw” data (i.e., data directly extracted from the study without any transformation) (Table 1).…”

“…We then re‐express this effect size into SPPB units multiplying by the external SD reference for the study population (external SD reference = 3.14), obtaining a scale‐specific pooled effect of MD = 0.97 (95% CI: 0.06–2.42). Considering a predefined minimally clinically important difference of 1 point in the SPPB, [9] we could support the use of an intervention (physical activity in this case [4]) in a specific population due to its clinically meaningful benefit in the outcome of interest.…”

Very low levels of physical activity among a broad group of patients hospitalized following hip fracture: A prospective cohort study (the HIP-ME-UP cohort study)

“…The levels of physical activity were not associated with readmission within 30 days. Existing literature emphasizes the advantages of physical activity during hospitalization, not only for patients with hip fracture [2,6,50,51]. We therefore need a deeper understanding and clarification of clinical practices concerning mobility and physical activity, specifically focusing on reasons for lack of activity.…”

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“…Such excessive time spent in bed may lead to an accelerated development of sarcopenia, frailty, and physical function decline [5,7,8]. Physical exercise plays an essential role in preventing these health consequences in older hospitalized patients [9,10]. A metaanalysis of Randomized Controlled Trials (RCTs) concluded that 25-50 minutes a day of slowpaced walking or multicomponent exercise at the hospital can improve functional capacity and reduce the number of adverse events for older adults [10].…”

“…Physical exercise plays an essential role in preventing these health consequences in older hospitalized patients [9,10]. A metaanalysis of Randomized Controlled Trials (RCTs) concluded that 25-50 minutes a day of slowpaced walking or multicomponent exercise at the hospital can improve functional capacity and reduce the number of adverse events for older adults [10]. It can however be challenging to find feasible interventions for older people with limited physical capacity [11].…”