Physical Activity in Hospitalized Old Medical Patients; How Active Are They, and What

Abstract

Objective: To examine how physically active Danish old medical patients are during hospitalization and to achieve knowledge of motivation and barriers to physical activity. Background: Functional decline in frail old patients during hospitalization is an important clinical problem with potential long-lasting undesirable outcomes and complications. Design: A mixed methods study including qualitative and quantitative methods. Methods: Patients >60 years of age were recruited at two medical departments during one week. Three SenseWear armband monitors were used for quantitative monitoring of physical activity. Semi Structured interviews were used for qualitative data. Results: The study comprised 13 patients, five female and eight male, mean age 73 (SD 9); BMI 19.4-32.1, mean 25.2 (SD 3.7). Only 11 patients completed 24-hours of SenseWear armband monitoring. Half of the participants walked less than 50 steps a day. The majority were bedridden 9 to 15 hours a day. Five of 11 patients had very low activity score. Four patients were moderately active for 19-38 minutes. Five patients sleep less than 6,3 hours, mean 9 (SD 3.3). Lying down was recorded for a mean of 11 hours (SD 4). Factors motivating to physical activity were: Praise and recognition from the staff, experienced boredom, continued ability to perform Activities of Daily Living. Barriers: Symptoms of illness, fear of falling, lack of meaningful activities, inadequate facilities and staff’s lack of focus. Organisational routines such as waiting for physical examinations and rounds, were barriers for patients to get out of bed. Conclusion: Old medical patients were very inactive during hospitalization. Motivation for physical activity was continued ADL abilities, boredom and staff interest, however often hindered by organizational barriers, lack of meaningful activities and focus from staff.

Barriers and enablers to physical activity behaviour in older adults during hospital stay: a qualitative study guided by the theoretical domains framework

“…Moreover, the physical environment and lack of available resources do not encourage patients to become active. Our study identified a number of factors within the domain of Environmental Context and Resources that were not identified in previous studies [ 17 , 21 – 27 ], such as unnecessary waiting for HCPs (and ways to reduce this), the use of a bed or wheelchair to take patients to examinations, creating separate areas for sleeping and daytime activities, the availability of technology (e.g., interactive projections, virtual bike rides), attractive places (e.g., coffee corner, exercise room, garden) and activities (e.g., exhibitions, games, crafts, performances). To create a hospital culture aimed at improving older adults’ PA behaviour, our findings suggest that clinicians and researchers should consider reorganising care processes and organisational processes, restructuring the physical hospital environment and creating sufficient resources.…”

“…Several studies have investigated barriers and enablers to PA behaviour during hospital stay for acute care in older adults, from the perspectives of patients [ 17 , 21 ], healthcare professionals (HCPs) [ 22 – 24 ] or both [ 25 – 27 ]. Brown et al were the first to explore barriers to PA from the perspectives of patients and HCPs.…”

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

“…Multicomponent interventions require qualified personnel and multiple resources for their application, both of which are considered important barriers to the implementation of physical activity programmes in acutely hospitalised older adults 56. In contrast, ambulatory activities may be easier and simpler to implement in hospital settings,57 58 hence such interventions may be a cost-effective solution to reduce the negative consequences of excessive bed-time in hospitalised older adults 59. Nevertheless, the information provided in this study supports tailored physical activity advice adapted to individual preferences, needs and availability of resources,60 which may facilitate the adoption of a patient-centred care approach 61…”

A Framework Integrating Augmented Reality and Wearable Sensors for the Autonomous Execution of Rehabilitation Exercises

“…At the end of hospitalization, despite the resolution of the condition for which they were admitted, frail patients are typically discharged in a worse functional status. It has been demonstrated that the muscle strength of elderly people gradually decreases at a rate of 1.5 to 3.5% per year, and if confined to bed for a long period, this loss occurs only one day after the discharge from the hospital [3,4]. Among patients that are bedridden, only one in four says that he/she is satisfied with his/her current life [5].…”