25 minutes of walking per day may help older hospitalized adults maintain function

Key takeaways:

• Researchers said it is safer for older adults to be active than remain on bed rest.
• Small durations of slow walking were sufficient, but optimal outcomes were observed with longer durations of exercise.

Only 25 minutes of slow walking each day could be enough to mitigate the negative effects of bed rest among older hospitalized patients, a recent study in the British Journal of Sports Medicine found.

According to Daniel Gallardo-Gómez, a PhD student in health sciences at the University of York, and colleagues, prior research has found “that older adults spend only 45 minutes per day out of their hospital bed, less than 5% of a 24-hour period.”

They explained that this prolonged bed rest can significantly contribute to post-hospitalization syndrome, a 30-day period of general deconditioning that poses risks for hospital readmission, disability, morbidity and mortality.

Although physical activity has been shown to prevent functional decline in older hospitalized adults, the researchers said that the most efficient type of intervention, as well as the optimal dose and potential adverse effects, have yet to be determined.

Gallardo-Gómez and colleagues aimed to answer these questions by conducting a systematic review and meta-analysis of 19 randomized controlled trials published between 2002 to 2022 that examined physical activity interventions in 3,783 adults aged 50 years and older (mean age, 78 years; 55% women) who had been admitted to an ICU or general ward for an acute medical condition. The researchers defined doses of interventions as energy expenditure, or Metabolic Equivalents of Task (METs).

They estimated that the minimal dose for improving functional capacity was about 40 minutes of light physical activity or 25 minutes of moderate activity per day, equal to around 100 METs (standardized mean difference [SMD] = 0.28; 95% CI, 0.01-0.55).

Meanwhile, the optimal dose was about 70 minutes of light activity or 40 minutes of moderate activity per day, equal to around 159 METs (SMD = 0.41; 95% CI, 0.08-0.72).

Doses higher than 90 minutes of light activity or 60 minutes of moderate activity, equal to approximately 190 METS, did not show any clear benefits.

The researchers deemed ambulation, an intervention based on walking or daily-living activities such as sit-to-standing, to be the most effective intervention. The optimal ambulation dose was 50 minutes of slow walking per day, or around 143 METs (SMD = 0.76; 95% CI, 0.35-1.16), whereas the minimal dose was 25 minutes of slow walking per day, or 143 METs (SMD = 0.25; 95% CI, 0.01-0.41). Ambulation around 150 METs per day had the highest odds of achieving the greatest response for functional capacity, according to the researchers.

Gallardo-Gómez and colleagues wrote that the positive association of higher ambulation “strongly suggests that hospital care should be organized in such a way as to allow and promote older adult ambulation while in hospital.”

“Similarly, short daily multicomponent intervention sessions may translate into functional capacity improvements, although longer bouts may result in additional gains,” they wrote.

The researchers highlighted feasibility as a key factor to keep in mind when considering interventions. For example, multicomponent interventions “require qualified personnel and multiple resources for their application, both of which are considered important barriers to the implementation of physical activity programs in acutely hospitalized older adults,” they wrote.

“In contrast, ambulatory activities may be easier and simpler to implement in hospital settings, hence such interventions may be a cost-effective solution to reduce the negative consequences of excessive bedtime in hospitalized older adults,” the researchers wrote.

References:

• Gallardo-Gómez D, et al. Br J Sports Med. 2023;doi:10.1136/bjsports-2022-106409.
• Walking 25 mins/day enough to counter physical impact of bedrest on older hospital patients. https://www.eurekalert.org/news-releases/997244. Published Aug. 3, 2023. Accessed Aug. 3, 2023.