Exercise intervention and functional decline among elderly admitted to hospital

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. Based on this randomized controlled trial, very elderly patients admitted to an acute medical ward who underwent an intervention of regular, moderate intensity exercise demonstrated a reduction in hospital associated functional decline.

2. There were no adverse outcomes among those patients who underwent the exercise-based intervention.

Evidence Rating Level: 2 (Good)

Study Rundown: Functional decline is a common complication in patients admitted to the hospital, especially among the elderly. Prior studies of exercise interventions have demonstrated benefit in reducing functional decline but have excluded very elderly patients and those with cognitive decline. This study sought to evaluate the impact of an exercise intervention on functional decline in elderly patients admitted to an acute medical ward. The trial found that this intervention was associated with improved functional outcomes compared to usual care and was able to reverse the decline associated with hospitalization.

The main strengths of the study are its randomized control design and standardized functional assessments. The main limitation of the study is the small size and exclusion of patients who failed to complete post-intervention functional assessments following clinical deterioration.

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Click to read the study in JAMA Internal Medicine

Relevant Reading: Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial

In-Depth [randomized controlled trial]: This study involved patients admitted to an acute care of the elderly (ACE) unit in a tertiary medical center. Participants were included if they were 75 years or older, were able to ambulate, and were able to communicate with the research team. Patients were excluded if the expected length of stay was less than 6 days, or if the patient had severe cognitive decline, terminal illness, uncontrolled arrhythmias, pulmonary embolism, recent myocardial infarction, or recent surgery. The control group consisted of usual medical care with physiotherapy as needed, while the intervention group had two daily sessions of moderate intensity exercise. Functional status was determined using the Barthel Index of independence and the Short Physical Performance Battery (SPPB).

Of the 370 patients included in the study 185 patients were randomized to the intervention group. The intervention group had an increase in SPPB scale and barthel index of 2.2 points (95%CI, 1.7-2.6 points) and 6.9 points (95%CI, 4.4-9.5 points) respectively. There were not adverse outcomes for those in the intervention group.

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