Can a hospital-based exercise program prevent functional decline in elderly hospitalized patients?

In this study, a hospital-based exercise program for elderly patients was safe, and it led to decreased functional decline at discharge. Despite this, there was no difference in the rates of discharge to home versus institution. This finding, however, may reflect a nuance of the Spanish health care system (in which the study took place) as only 1% to 2% of patients overall were discharged to an institution in both the intervention group and the control group. (LOE = 1b)

Martinez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization. JAMA Intern Med 2019;179:28-36.  [PMID:30419096]

Randomized controlled trial (single-blinded)

Government

Uncertain

Inpatient (any location) with outpatient follow-up

This study included 370 patients, 75 years or older, who were admitted to an inpatient ward with an expected length of stay of at least 6 days. They were randomized to receive a hospital-based exercise intervention or usual care. Enrolled patients were able to walk, either with or without assistance. Patients with severe cognitive decline, terminal illness, recent myocardial infarction, and recent major surgery were excluded. The usual care group received physical therapy, as needed. The intervention group received two 20-minute exercise sessions daily led by a fitness specialist for 5 to 7 consecutive days. The exercises included resistance, balance, gait, and strength training. The 2 groups each had a mean age of 87.3 years and each group had a similar baseline score on the Barthel Index, which is a measure of functional independence (scale = 0 – 100; 5 is considered a clinically important difference). The analysis was by intention to treat. For the primary outcome of change in functional capacity from start of hospitalization to discharge, the intervention group fared better, with a 2-point increase from baseline on the Barthel Index, as compared with a 5-point decrease in the usual care group. The intervention group also showed improvements in the secondary outcomes of cognitive status, depression, and quality-of-life indicators. No adverse effects were attributed to the exercises. Despite these benefits, there were no significant differences in hospital length of stay, number of falls in the hospital, discharge to home versus institution, or 3-month readmission or mortality rate.