This article is more than 5 years old. Information may no longer be current.

Exercise program reverses functional decline in hospitalized elderly

An individualized, multicomponent exercise intervention demonstrated safety and efficacy in improving functional decline associated with acute hospitalization among elderly patients, according to research published in JAMA Internal Medicine.

“Functional decline is prevalent among acutely hospitalized older patients,” Nicolás Martínez-Velilla, PhD, MD, from Complejo Hospitalario de Navarra, Spain, and colleagues wrote. “Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients.”

Between Feb. 1, 2015, and Aug. 30, 2017, Martínez-Velilla and colleagues conducted a single-center, single-blind randomized clinical trial to determine if an innovative multicomponent exercise intervention can reverse functional and cognitive decline in elderly patients undergoing acute-care hospitalization (n = 309; 56.5% women; mean age, 87.3 years).

Participants were randomly assigned to either the exercise invention, which included two daily sessions of individualized moderate-intensity resistance, balance and walking exercises, or the control intervention, which included usual hospital care, such as physical rehabilitation when needed.

The researchers assessed change in functional capacity from baseline to hospital discharge using the Barthel Index of independence and the Short Physical Performance Battery (SPPB). They also measured changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge.

Both groups had a median length of hospital stay of 8 days. The intervention lasted a median of 5 days, with a mean of five morning and four evening sessions per patient.

Patients in the intervention group showed no signs of adverse events. Compared with usual care, the exercise intervention offered significant benefits.

Upon discharge, patients in the exercise program had a mean increase of 2.2 points (95% CI, 1.7-2.6) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5) on the Barthel Index vs. those in the usual-care group.

Patients in the usual-care group demonstrated an impairment in functional capacity after hospitalization, characterized by a mean change from baseline to discharge in the Barthel Index of –5 points (95% CI, –6.8 to –3.2 points). However, patients in the exercise group showed improvement in functional capacity (1.9 points; 95% CI, 0.2-3.7).

Additionally, the SPPB score increased in the intervention group (2.4 points; 95% CI, 2.1-2.7) compared with the usual-care group (0.2 points; 95% CI, –0.1 to 0.5). Cognition also significantly improved in the intervention group (95% CI, 1.3-2.3) vs. the usual-care group.

“These findings open the possibility for a shift from the traditional disease-focused approach in hospital acute care units for elders to one that recognizes functional status as a clinical vital sign that can be impaired by traditional (bed rest-based) hospitalization but effectively reversed with specific in-hospital exercises,” Martínez-Velilla and colleagues concluded. – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.