If not actively managed, this may have various consequences, including readmission, disability, the need for nursing home care, illness, or death. Even recent research indicates that getting older hospital patients out of bed and moving about can help ward off physical decline, but it is not clear what type of activity, or how much of it, might be most effective.
In a bid to find out, researchers looked for published clinical trials that involved people over the age of 50 who had been admitted to the hospital for a serious bout of illness and prescribed any form of physical activity during their hospital stay.
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They included only those trials that involved a comparison group receiving usual care or another type of physical activity; that assessed changes in ability to perform routine activities of daily living, at discharge or any subsequent monitoring point.
Nineteen clinical trials out of an initial haul of 44, involving 3842 participants and published between 2000 and 2022, were included. The final analysis included 3783 participants, over half of whom 2087 (55%) were women, ranging in age from 55 to 87. Their average length of stay was 7 days, and the average monitoring period after discharge was 68 days.
Walking Should be Part of the Daily Routine of Hospitalised Older Adults
Pooling the trial results showed that the minimal ‘dose’ required to counter the effects of bedrest and improve older inpatients’ functional capacity was estimated to be around 40 mins/day of light-intensity physical activity or around 25 mins/day of moderate-intensity physical activity.
And the optimal ‘dose’ was estimated to be 70 mins/day of light intensity or around 40 mins/day of moderate intensity physical activity. There was no clear benefit for ‘doses’ of more than 90 mins/day of light intensity, or 60 mins/day of moderate-intensity physical activity, suggesting a threshold effect.
In terms of the best type of physical activity to ward off physical decline, a mix of physical activity in any one daily session and slow-paced walking were deemed the most effective. But only walking was more than 80% effective, with the optimal dose reached at around 50 mins/day, and the minimal effective dose reached at 25 mins/day().
The analysis showed that the effectiveness of physical activity interventions increased from admission to discharge, peaking at around 19 days after discharge. The fall rate, the most common occurrence after discharge, was similar among the intervention and comparison groups, but those prescribed physical activity experienced fewer adverse consequences.
Researchers acknowledge that there was little information on monitoring frequency after discharge and that only participants who were able to move unaided were included, both of which may weaken the findings and limit their wider applicability().
If the most potent intervention walking is provided, the beneficial effects of in-hospital supervised physical activity programs can be maximized with as little as around 25 mins/day of slow-paced walking, an achievable target for most hospitalized older adults.
References:
- Krumholz, Harlan M. Post-hospital syndrome–an acquired, transient condition of generalized risk. The New England Journal of Medicine vol. 368,2 (2013): 100-2.(https://www.nejm.org/doi/10.1056/NEJMp1212324)
- Gallardo-Gómez et al. Optimal dose and type of physical activity to improve functional capacity and minimize adverse events in acutely hospitalized older adults: a systematic review with dose-response network meta-analysis of randomized controlled trials. British Journal of Sports Medicine. August 2023.(https://bjsm.bmj.com/content/early/2023/05/22/bjsports-2022-106409)
- Valenzuela, Pedro L., et al. Effects of exercise interventions on the functional status of acutely hospitalized older adults: a systematic review and meta-analysis. Aging research reviews 61 (2020): 101076.(https://www.sciencedirect.com/science/article/abs/pii/S1568163720301288)
Source: Eurekalert
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