Does a daily exercise regimen during a hospital stay improve cognitive function in older patients upon discharge?

For older adults with good functional capacity at baseline, a daily physical exercise regimen during hospitalization, as compared with usual care, can improve cognitive function from admission to discharge. (LOE = 1b)

Saez de Asteasu ML, Martinez-Velilla N, Zambom-Ferraresi F, et al. Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: secondary analysis of a randomized trial. PLOS Medicine 2019;16(7):e1002852.  [PMID:31276501]

Randomized controlled trial (single-blinded)

Unknown/not stated

Concealed

Inpatient (ward only)

This was a secondary analysis of a randomized clinical trial that enrolled patients 75 years or older who were hospitalized in an acute care geriatrics unit in a hospital in Spain. Patients had good functional capacity as assessed by the Barthel Index, were able to ambulate at baseline, and were able to communicate with the research team. Using concealed allocation, the investigators randomized patients to participate in an exercise program (n = 185) or receive usual care (n = 185). The exercise program consisted of two 20-minute sessions of resistance training, balance, and walking every day for 5 to 7 days, supervised by a fitness specialist. The usual care group received physical therapy as needed. The assessment staff were masked to patient allocation. Patients in the 2 groups were similar at baseline: 57% were women and the mean age was 87 years. The mean length of hospital stay was 8 days and mean adherence to the exercise session was 97% for the morning sessions and 85% for the evening sessions. The primary endpoint was change in executive function from admission to discharge as assessed by the dual-task Gait Velocity Test (GVT). In this test, patients walk at their own pace across a smooth surface. Gait velocity is then measured while patients are asked to count backward from 100 to 1 (arithmetic dual task) or to name animals (verbal dual task). Baseline arithmetic and verbal GVT scores were similar in the 2 groups (0.4 m/s). At discharge, the exercise group had a statistically significant mean increase of 0.1 m/s over the usual care group in both the verbal and arithmetic GVT. The exercise group also performed better in secondary endpoints, including the Mini Mental Status Examination and a verbal fluency test.