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Can augmented exercise in hospitals improve physical performance?

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Older patients may especially experience a positive transition post discharge, points out a recent trial.

It is commonly known that older medical inpatients are only moderately active in the hospital. In Augmented exercise in hospital improves physical performance and reduces negative post hospitalisation events: a randomised controlled trial, published by BMC Geriatrics, patients reportedly walk an average of 600 steps per day, which translates to 12 minutes of walking; 49 per cent of elderly patients are on bedrest or simply transition from bed to chair, and less than 19 per cent of patients walk in hospital hallways. The study suggests that patients who walked more had a shorter hospital stay, with a 50 per cent increase in step count being associated with a 6 per cent reduction in hospital stay, while those with poor physical performance on admission were the least active in hospital. Following a hospital stay, these frailer patients are at a higher risk of functional impairment.

The trial was carried out to compare the impact of an augmented prescribed exercise programme versus the standard care on physical performance, quality of life, and healthcare utilisation in frail elderly medical patients admitted to the hospital. The method was based on a parallel single-blinded randomised controlled trial. Older medical inpatients with an expected stay of fewer than three days and who need help or assistance to walk were assigned to the intervention or control group within two days of arrival. Both groups got half-hour guided exercises twice a day, Monday through Friday, from a staff physiotherapist until release.

The intervention group completed personalised strengthening and balancing exercises, while the control group stretched and relaxed. The major outcome metric was the length of stay. Readmissions within three months, as well as physical performance (Short Physical Performance Battery) and quality of life (EuroQOL-5D-5 L) at discharge, were all assessed secondary variables.

Time-to-event analysis was used to compare lengths of stay, and regression models were used to compare physical performance, quality of life, adverse events (falls, fatalities), and negative events (prolonged hospitalisation, institutionalisation).

Data from 190 individuals (aged 80 ± 7.5 years) were assessed out of the 199 patients assigned. At the start, the groups were comparable. In an intention-to-treat analysis, there was no difference in length of stay between groups (HR 1.09 (95 per cent CI, 0.77–1.56) p = 0.6).

Physical performance was better in the intervention group at discharge (difference 0.88 (95 per cent CI, 0.20–1.57) p = 0.01), but lost at follow-up (difference 0.45 (95 per cent CI, − 0.43 – 1.33) p = 0.3). An improvement in quality of life was detected at follow-up in the intervention group (difference 0.28 (95 per cent  CI, 0.9–0.47) p = 0.004). Overall, fewer negative events occurred in the intervention group (OR 0.46 (95 per cent CI 0.23–0.92) p = 0.03).

To conclude, improvements in physical performance, quality of life, and the occurrence of fewer negative events show that this intervention is beneficial to fragile medical inpatients. However, its impact on the length of stay is not defined.

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