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Exercise intervention benefits elderly in hospital

Those who did resistance, balance and walking exercises had better functional capacity at discharge

Louise Prime

Tuesday, 13 November 2018

Very elderly people in hospital who took part in an exercise intervention appeared to fare better in both physical and cognitive terms than those not in the programme, according to the results of new research from Spain. The authors of the study,* published in JAMA Internal Medicine, said the intervention appeared to be a safe and effective way of reversing the functional decline usually associated with acute hospitalisation in elderly patients.

Researchers randomised 370 hospitalised patients aged at least 75 years (mean 87.3 years) to either a control group receiving usual care, which included physical rehabilitation when needed; or to an individualised exercise intervention group. The intervention comprised two daily sessions of moderate-intensity resistance, balance and walking exercises.

The research team assessed functional capacity between baseline and hospital discharge, using the Barthel Index of independence and the Short Physical Performance Battery (SPPB). They also recorded secondary end points including changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at three months after discharge.

The groups did not differ in terms of length of hospital stay, which was a median of eight days for both groups; median length of intervention was five days. However, the exercise intervention programme provided other significant benefits over usual care, with no reported adverse events.

Patients in the exercise intervention group had improved functional capacity scales at hospital discharge, with a mean increase of 2.2 points on the SPPB scale and 6.9 points on the Barthel Index, compared with the control group. And whereas the usual-care group experienced an impairment in functional capacity (mean change from baseline to discharge -5.0 points on the Barthel Index), the exercise intervention group had the opposite trend (mean change 1.9 points). Those in the intervention group also improved their SPPB score (2.4 points), compared with 0.2 points in the control group.

The researchers also found evidence of other benefits – including on measures related to cognitive status – in the intervention group relative to the usual-care group.

They acknowledged certain limitations of their study, such as the lack of comparative data on function and cognition before the acute illness that had led to admission. But they concluded: “The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalisation in very elderly patients.”

* Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. JAMA Intern Med. Published online November 12, 2018. doi:10.1001/jamainternmed.2018.4869

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