Reduced Step Count and Clinical Frailty in Hospitalized Adults With Community-Acquired Pneumonia

Abstract

BACKGROUND: In adults hospitalized with community-acquired pneumonia (CAP), increasing ward-based walking may reduce length of stay (LOS). There are few data to describe ward-based walking in this population. In adults hospitalized with CAP, we aimed to report variables of walking and non-walking time, to determine whether demographic or clinical variables influenced daily step count, and to determine whether daily step count influenced LOS. METHODS: Following admission, daily step count and variables related to walking and non-walking time were quantified using the StepWatch Activity Monitor. Details regarding demographics, clinical characteristics, clinical care, and LOS were extracted from the medical records and hospital electronic data systems. Frailty was calculated via the 7-point Clinical Frailty Scale; disease severity was measured via the CURB-65 score. Health care utilization at 30 d following discharge was measured via telephone interview. RESULTS: Two hundred participants completed the study, of whom 121 contributed > 24 h of data from the StepWatch Activity Monitor. The median (interquartile range (IQR)) number of daily steps was 926 (457-1706). These were accumulated over 66 (41-121) min/d, with a usual bout duration of 3 (2-4) min and 1-min peak cadence of 56 (43-74) steps/min. An average of 93% (89-96) of waking hours was spent in non-walking time. In the multivariable model, increased frailty was retained as a predictor of lower step count (incidence rate ratio [IRR] 0.59, 95% CI 0.41-0.85). For every increase in 500 steps/d, LOS reduced by 11% (IRR 0.89, 95% CI 0.80-0.99). CONCLUSIONS: Subjects hospitalized with CAP did very little walking, most of which was accumulated in short bouts at a low intensity. Compared with subjects with mild frailty, those with moderate to severe frailty took 59% fewer steps per day. Those with a higher daily step count had a shorter LOS.

Early walking time is associated with recovery of activities of daily living during hospitalization in older patients with community‐acquired pneumonia: A single‐center prospective study

“…Rice et al reported a median walking time of 66 min/day (IQR 41-121 min/day) in hospitalized patients with CAP. 23 This is almost fourfold longer than in the present study (14 min/day; IQR 4-26 min/day), and might be explained by differences in age, severity of pneumonia and epochs of accelerometer data between the two samples. Participants in the study by Rice et al were younger (66.8 AE 18.2 years) and had less severe pneumonia (confusion, urea, respiratory rate, blood pressure and age ≥65 years [CURB-65 1; IQR 1-2) than the present sample (82 years; IQR 75-89 years, ADROP 2; IQR 1-2).…”

Peripheral Immune Dysfunction: A Problem of Central Importance after Spinal Cord Injury

“…Part of the problem is that higher-level injuries result in loss of innervation to motor neurons that innervate the diaphragm and intercostal muscles, resulting in compromised respiratory motor control (reviewed in [ 18 ]). The lack of mobility in SCI persons also exacerbates this issue since exercise, like walking and running, has been shown to reduce pneumonia-related mortality [ 19 , 20 , 21 , 22 ]. However, what may make respiratory infections particularly deadly for SCI persons is that higher injuries above the level of thoracic segment 6 (T6) result in disruption of descending supraspinal input to sympathetic preganglionic neurons (SPNs) that innervate immune organs and modulate immune function, which we describe in more detail in a later section.…”

The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial

“…Hospitalization is associated with bed rest which can result in prolonged physical inactivity and immobilization. In fact, patients hospitalized with CAP spent over 90% of their waking hours being physically inactive, i.e., either laying or sitting down, with only 926 steps per day during admission [ 6 , 7 ]. Moderate to severe frailty is a predictor of lower daily step count.…”

“…Moderate to severe frailty is a predictor of lower daily step count. It has been reported that frail patients take 59% less steps per day during admission compared to robust patients [ 6 ], which can exacerbate physical deterioration several weeks after discharge [ 8 ]. Frail patients with frequent readmissions may be prone to a more rapid decline in functional ability and associated deteriorations in health-related quality of life [ 9 ], which may cause a viscous cycle of physical inactivity with negative effect on the prognosis [ 10 – 12 ] (Fig.…”

“…However, early mobilization of patients with CAP within the first 24 h of hospitalization has been shown to decrease length of hospital stay by 1.1 to 2.1 days without increasing the risk of adverse events [ 17 – 19 ]. In addition, for every increase in the daily step count above 500 steps, length of hospital stay was reduced by 11% among patients with CAP [ 6 ]. Moreover, we have previously shown that initiating supervised early pulmonary rehabilitation of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) during hospitalization is superior to standard usual care in terms of improving prognosis (reduces the risk of COPD-related hospital readmissions), health-related quality of life, and walking distance [ 20 ].…”