Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2007 Jan 24;2007(1):CD005955.
doi: 10.1002/14651858.CD005955.pub2.

Exercise for acutely hospitalised older medical patients

N A de Morton  1 , J L Keating, K Jeffs
Affiliations
Meta-Analysis

Exercise for acutely hospitalised older medical patients

N A de Morton et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: A high incidence of functional decline (deterioration in physical or cognitive function) during hospitalisation of older adults is reported. The role of exercise in preventing these deconditioning effects is unclear.

Objectives: To determine the effect of exercise interventions for acutely hospitalised older medical patients on functional status, adverse events and hospital outcomes.

Search strategy: We searched MEDLINE (1966-Feb 2006), CINAHL (1982-Feb 2006), EMBASE (1988 to Feb 2006), Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), PEDro (1929- Feb 2006), Current Contents (1993- Feb 2006) and Sports Discus (1830-Feb 2006). The Journal of the American Geriatrics Society was hand searched. Additional studies were identified through reference and citation tracking, personal communications with a content expert and contacting authors of eligible trials. There was no language restriction.

Selection criteria: Eligible studies were prospective randomised controlled trials (RCT) or prospective controlled clinical trials (CCT) comparing exercise for acutely hospitalised older medical patients to usual care or no treatment controls.

Data collection and analysis: Two independent reviewers extracted data relating to patient and hospital outcomes and assessed the method quality of included studies. Data were pooled in meta-analysis using the relative risk (RR) and absolute risk reduction (ARR) for dichotomous outcomes and the standardised mean difference (SMD) or the weighted mean difference (WMD) for continuous outcomes.

Main results: Of 3138 potentially relevant articles screened, 7 randomised controlled trials and 2 controlled clinical trials were included. The effect of exercise on functional outcome measures is unclear. No intervention effect was found on adverse events. Pooled analysis of multidisciplinary interventions that included exercise indicated a small significant increase in the proportion of patients discharged to home at hospital discharge (Relative Risk 1.08, 95% CI 1.03 to 1.14 and Numbers Needed to Treat 16, 95% CI 11 to 43) and a small but important reduction in acute hospital length of stay (weighted mean difference, -1.08 days, 95% CI -1.93 to -0.22) and total hospital costs (weighted mean difference, -US$278.65, 95% CI -491.85 to -65.44) compared to usual care. Pooled analysis of exercise intervention trials found no effect on the proportion of patients discharged to home or acute hospital length of stay.

Authors' conclusions: There is 'silver' level evidence (www.cochranemsk.org) that multidisciplinary intervention that includes exercise may increase the proportion of patients discharged to home and reduce length and cost of hospital stay for acutely hospitalised older medical patients.

PubMed Disclaimer

Conflict of interest statement

The first and second authors of this review conducted one of the studies that met inclusion in this review. Other assessors evaluated the quality of this study's methods.

Figures

1
1
1.1
1.1. Analysis
Comparison 1 Function ‐ multidisciplinary intervention versus usual care, Outcome 1 Maintained or improved ADL scores between hospital admission and discharge ‐ MDI versus usual care.
1.2
1.2. Analysis
Comparison 1 Function ‐ multidisciplinary intervention versus usual care, Outcome 2 Maintained or improved mobility scores between hospital admission and discharge ‐ MDI versus usual care.
1.3
1.3. Analysis
Comparison 1 Function ‐ multidisciplinary intervention versus usual care, Outcome 3 Maintained or improved ADL scores between 2 weeks prior to hospital admission and discharge‐ MDI v usual care.
2.1
2.1. Analysis
Comparison 2 Function ‐ additional exercise only versus usual care, Outcome 1 Change in Barthel Index between hospital admission and discharge ‐ additional exercise versus usual care.
2.2
2.2. Analysis
Comparison 2 Function ‐ additional exercise only versus usual care, Outcome 2 Change in TUG scores between hospital admission and discharge ‐ additional exercise versus usual care.
3.1
3.1. Analysis
Comparison 3 Adverse events ‐ multidisciplinary intervention versus usual care, Outcome 1 Patient mortality during hospitalisation ‐ MDI versus usual care.
3.2
3.2. Analysis
Comparison 3 Adverse events ‐ multidisciplinary intervention versus usual care, Outcome 2 Patient mortality 3 months after hospital discharge ‐ MDI versus usual care.
3.3
3.3. Analysis
Comparison 3 Adverse events ‐ multidisciplinary intervention versus usual care, Outcome 3 Patient complications during hospitalisation ‐ MDI versus usual care.
4.1
4.1. Analysis
Comparison 4 Adverse events ‐ additional exercise versus usual care, Outcome 1 Patient mortality during hospitalisation ‐ additional exercise versus usual care.
4.2
4.2. Analysis
Comparison 4 Adverse events ‐ additional exercise versus usual care, Outcome 2 Admission to the Intensive Care Unit (ICU) ‐ additional exercise versus usual care.
4.3
4.3. Analysis
Comparison 4 Adverse events ‐ additional exercise versus usual care, Outcome 3 Falls during hospitalisation ‐ additional exercise versus usual care.
5.1
5.1. Analysis
Comparison 5 Hospital outcomes ‐ multidisciplinary intervention versus usual care, Outcome 1 Discharge to preadmission residence/home from hospital ‐ MDI versus usual care.
5.2
5.2. Analysis
Comparison 5 Hospital outcomes ‐ multidisciplinary intervention versus usual care, Outcome 2 Acute hospital length of stay ‐ MDI versus usual care.
5.3
5.3. Analysis
Comparison 5 Hospital outcomes ‐ multidisciplinary intervention versus usual care, Outcome 3 Cost of acute hospital stay ‐ MDI versus usual care.
6.1
6.1. Analysis
Comparison 6 Hospital outcomes ‐ additional exercise versus usual care, Outcome 1 Discharge to preadmission residence/home from hospital ‐ additional exercise versus usual care.
6.2
6.2. Analysis
Comparison 6 Hospital outcomes ‐ additional exercise versus usual care, Outcome 2 Acute hospital length of stay ‐ additional exercise versus usual care.
6.3
6.3. Analysis
Comparison 6 Hospital outcomes ‐ additional exercise versus usual care, Outcome 3 Total (acute plus subacute) hospital length of stay‐ additional exercise versus usual care.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Asplund 2000 {published data only}
    1. Asplund K, Gustafson Y, Jacobsson C, Bucht G, Wahlin A, Peterson J, et al. Geriatric‐based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. Journal of the American Geriatrics Society 2000;48:1381‐8. - PubMed
Collard (C) 1985 {published data only}
    1. Collard AF, Bachman SS, Beatrice DF. Acute care delivery for the geriatric patient: an innovative approach. Quality Review Bulletin 1985;11:180‐5. - PubMed
Collard (S) 1985 {published data only}
    1. Collard AF, Bachman SS, Beatrice DF. Acute care delivery for the geriatric patient: an innovative approach. Quality Review Bulletin 1985;11:180‐5. - PubMed
Counsell 2000 {published data only}
    1. Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, et al. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. Journal of the American Geriatrics Society 2000;48:1572‐81. - PubMed
Covinsky 1997 {published data only}
    1. Covinsky KE, King J T, Quinn LM, Siddique R, Palmer R, Kresevic DM, et al. Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective. Journal of the American Geriatrics Society 1997;45:729‐34. - PubMed
de Morton 2006 {unpublished data only}
    1. Morton NA, Keating JL, Berlowitz DJ, Lim WK, Jackson B. A controlled clinical trial of the effects of additional exercise on patient health and health care service utilisation: a pilot study. Australian Journal of Physiotherapy "in press".
Jones 2006 {unpublished data only}
    1. Jones C, Lowe A, McGregor L, Brandt C, Tweddle N, Russell D. A randomised controlled trial of an exercise intervention to reduce functional decline and health service utilization in the hospitalized elderly. Australasian Journal of Ageing 2006;25(3):126‐33.
Landefeld 1995 {published data only}
    1. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J, et al. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. New England Journal of Medicine 1995;332:1338‐44. - PubMed
Siebens 2000 {published data only}
    1. Siebens H, Aronow H, Edwards D, Ghasemi Z. A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. Journal of the American Geriatrics Society 2000;48:1545‐52. - PubMed
Slaets 1997 {published data only}
    1. Slaets JP, Kauffmann RH, Duivenvoorden HJ, Pelemans W, Schudel, WJ. A randomized trial of geriatric liaison intervention in elderly medical inpatients. Psychosomatic Medicine 1997;59:585‐91. - PubMed

References to studies excluded from this review

Aschwanden 2001 {published data only}
    1. Aschwanden M, Labs KH, Engel H, Schwob A, Jeanneret C, Mueller‐Brand J, et al. Acute deep vein thrombosis: Early mobilization does not increase the frequency of pulmonary embolism. Thrombosis & Haemostasis 2001;85:42‐6. - PubMed
Bariola 1999 {published data only}
    1. Bariola JR, Sullivan DH, Wall PT, Hite R, Frost M, McClellan JL. Effects of muscle strength training in recuperating elderly. Journal of the American Geriatrics Society 1999;47:S30‐S30.
Bogardus 2003 {published data only}
    1. Bogardus ST, Desai MA, Williams CS, Leo‐Summers L, Acampora D, Inouye SK. The effects of a targeted multicomponent delirium intervention on post discharge outcomes for hospitalized older adults. American Journal of Medicine 2003;114:383‐90. - PubMed
Boyer 1986 {published data only}
    1. Boyer N, Chuang JL, Gipner D. An acute care geriatric unit. Nursing Management 1986;17:22‐5. - PubMed
Cohen 2002 {published data only}
    1. Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. New England Journal of Medicine 2002;346:905‐12. - PubMed
Cole 2002 {published data only}
    1. Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ, et al. Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial. Canadian Medical Association Journal 2002;167:753‐9. - PMC - PubMed
Curley 1998 {published data only}
    1. Curley C, McEachern JE, Speroff T. A firm trial of interdisciplinary rounds on the inpatient medical wards ‐ An intervention designed using continuous quality improvement. Medical Care 1998;36:AS4‐AS12. - PubMed
Gayton 1987 {published data only}
    1. Gayton D, Wood‐Dauphinee S, Lorimer M, Tousignant P, Hanley J. Trial of a geriatric consultation team in an acute care hospital. Journal of the American Geriatrics Society 1987;35:726‐36. - PubMed
Germain 1995 {published data only}
    1. Germain M, Knoeffel F, Wieland D, Rubenstein LZ. A Geriatric Assessment and Intervention Team for Hospital Inpatients Awaiting Transfer to a Geriatric Unit ‐ a Randomized Trial. Aging‐Clinical and Experimental Research 1995;7:55‐60. - PubMed
Harris 1991 {published data only}
    1. Harris RD, Henschke PJ, Popplewell PY, Radford AJ, Bond, MJ, Turnbull RJ, et al. A randomised study of outcomes in a defined group of acutely ill elderly patients managed in a geriatric assessment unit or a general medical unit. Australian & New Zealand Journal of Medicine 1991;21:230‐4. - PubMed
Hogan 1987 {published data only}
    1. Hogan DB, Fox RA, Badley BW, Mann OE. Effect of a geriatric consultation service on management of patients in an acute care hospital. Canadian Medical Association Journal 1987;136:713‐7. - PMC - PubMed
Hogan 1990 {published data only}
    1. Hogan DB, Fox RA. A prospective controlled trial of a geriatric consultation team in an acute‐care hospital. Age & Ageing 1990;19:107‐13. - PubMed
Inouye 1993a {published data only}
    1. Inouye SK, Acampora D, Miller RL, Fulmer T, Hurst LD, Cooney LM. The Yale Geriatric Care Program: a model of care to prevent functional decline in hospitalized elderly patients. Journal of the American Geriatrics Society 1993;41:1345‐52. - PubMed
Inouye 1993b {published data only}
    1. Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM, Tinetii ME. A controlled trial of a nursing‐centered intervention in hospitalized elderly medical patients ‐ The Yale Geriatric Care Program. Journal of the American Geriatrics Society 1993;41:1353‐60. - PubMed
Inouye 1999 {published data only}
    1. Inouye SK, Bogardus ST, Charpentier PA, Leo‐Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine 1999;340:669‐76. - PubMed
Landefeld 1988 {published data only}
    1. Landefeld CS, Palmer RM, Fortinsky RH, Kresevic DM, Kowal J. A randomised trial of acute care for elders (ACE) in the current era: lower hospital costs without advers effects on functional outcomes at discharge. Journal of General Internal Medicine 1998; Vol. 13:45.
Landi 1997 {published data only}
    1. Landi F, Zuccala G, Bernabei R, Cocchi A, Manigrasso L, Tafani A, et al. Physiotherapy and occupational therapy: a geriatric experience in the acute care hospital. American Journal of Physical Medicine & Rehabilitation 1997;76:38‐42. - PubMed
Meissner 1989 {published data only}
    1. Meissner P, Andolsek K, Mears, PA, Fletcher B. Maximizing the functional status of geriatric patients in an acute community hospital setting. Gerontologist 1989;29:524‐8. - PubMed
Mundy 2003 {published data only}
    1. Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community‐acquired pneumonia. Chest 2003;124:883‐9. - PubMed
Nagley 1986 {published data only}
    1. Nagley SJ. Predicting and preventing confusion in your patients. Journal of Gerontological Nursing 1986;12:27‐31. - PubMed
Nikolaus 1999 {published data only}
    1. Nikolaus T, Specht‐Leible N, Bach M, Oster P, Schlierf G. A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age & Ageing 1999;28:543‐50. - PubMed
Reuben 1995 {published data only}
    1. Reuben DB, Borok GM, Wolde‐Tsadik G, Ershoff DH, Fishman LK, Ambrosini VL, et al. A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. New England Journal of Medicine 1995;332:1345‐50. - PubMed
Rizzo 2001 {published data only}
    1. Rizzo JA, Bogardus ST, Leo‐Summers L, Williams CS, Acampora D, Inouye SK. Multicomponent targeted intervention to prevent delirium in hospitalized older patients ‐ What is the economic value?. Medical Care 2001;39:740‐52. - PubMed
Rubenstein 1984a {published data only}
    1. Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. New England Journal of Medicine 1984;311:1664‐70. - PubMed
Rubenstein 1984b {published data only}
    1. Rubenstein LZ, Wieland D, English P, Josephson K, Sayre JA, Abrass IB. The Sepulveda VA Geriatric Evaluation Unit: data on four‐year outcomes and predictors of improved patient outcomes. Journal of the American Geriatrics Society 1984;32:503‐12. - PubMed
Rubenstein 1995 {published data only}
    1. Rubenstein LZ, Josephson KR, Harker JO, Miller DK, Wieland D. The Sepulveda GEU Study revisited: long‐term outcomes, use of services, and costs. Aging‐Clinical & Experimental Research 1995;7:212‐7. - PubMed
Saltvedt 2002 {published data only}
    1. Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O. Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. Journal of the American Geriatrics Society 2002;50:792‐8. - PubMed
Wanich 1992 {published data only}
    1. Wanich CK, Sullivan‐Marx EM, Gottlieb GL, Johnson JC. Functional status outcomes of a nursing intervention in hospitalized elderly. Image ‐ the Journal of Nursing Scholarship 1992;24:201‐7. - PubMed
Yohannes 2003 {published data only}
    1. Yohannes AM, Connolly MJ. Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease. Clinical Rehabilitation 2003;17:465‐71. - PubMed

Additional references

Alderson 2002
    1. Alderson P, Green S. Cochrane Collaboration open learning material for reviewers Version 1.1. www.cochrane‐net.org/openlearning/HTML/modA1‐5.htm.
Cates 2003
    1. Dr. Chris Cates. EBM Website. www.nntonline.net 2003.
Covinsky 2003
    1. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society 2003;51:451‐8. - PubMed
Creditor 1993
    1. Creditor, M. Hazards of hospitalization of the elderly. Annals of Internal Medicine 1993;118:219‐23. - PubMed
deFrances 2004
    1. deFrances C, Hall M. 2002 National Hospital Discharge Survey. Advance Data From Vital and Health Statistics 2004;342. - PubMed
Egger 1997
    1. Egger M, Smith GD, Schneider M, Minder C. Bias in meta‐analysis is detected by a simple, graphical test. British Medical Journal 1997;315:629‐34. - PMC - PubMed
Feachem 2002
    1. Feachem RK, Neelam KS, White KL. Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente. British Medical Journal 2002;324:135‐43. - PMC - PubMed
Gillick 1982
    1. Gillick M, Serrell N, Gillick LS. Adverse consequences of hospitalization in the elderly. Social Science & Medicine 1982;16:1033‐8. - PubMed
Harper 1988
    1. Harper CM, Lyles YM. Physiology and complications of bed rest. Journal of the American Geriatrics Society 1988;36:1047‐54. - PubMed
Hedges 1985
    1. Hedges LV, Olkin I. Statistical methods for meta‐analysis. United States of America: Academic Press, 1985.
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks J, Altman DG. Measuring inconsistency in meta‐analyses. British Medical Journal 2003;327:557‐60. - PMC - PubMed
Hirsch 1990
    1. Hirsch CH, Sommers L, Olsen A, Mullen L, Winograd CH. The natural history of functional morbidity in hospitalized older patients. Journal of the American Geriatrics Society 1990;38:1296‐303. - PubMed
Hoffman 1996
    1. Hoffman C, Rice D. Persons with chronic conditions:their prevalence and costs. Journal of the American Medical Association 1996;276:1478‐9. - PubMed
Inouye 1993
    1. Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM, Tinetii ME. A controlled trial of a nursing‐centered intervention in hospitalized elderly medical patients ‐ The Yale Geriatric Care Program. Journal of the American Geriatrics Society 1993;41:1353‐60. - PubMed
Latham 2004
    1. Latham NK, Anderson C, Bennett D, Stretton C. Progressive resistance strength training for physical disability in older people. Cochrane Database of Systematic Reviews 2004, Issue 2. - PubMed
Maher 2003
    1. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy 2003;83(8):713‐21. - PubMed
Mahoney 1998
    1. Mahoney JE, Sager MA, Jalaluddin M. New walking dependence associated with hospitalisation for acute medical illness: incidence and significance. Journal of Gerontology 1998;53A(4):M307‐M312. - PubMed
McVey 1989
    1. McVey LJ, Becker PM, Saltz CC, Feussner JR, Cohen H. Effects of a geriatric consult team on functional status in elderly hospitalized patients. Annals of Internal Medicine 1989;110:78‐84. - PubMed
Morris 2004
    1. Morris M, Schoo A. Optimizing exercise and physical activity in older people. Butterworth Heinemann, 2004.
Norman 2003
    1. Norman G, Sloan J, Wyrwich K. Interpretation of changes on health related quality of life. The remarkable universality of half a standard deviation. Medical Care 2003;41(5):582‐92. - PubMed
Palmer 1995
    1. Palmer, R. Acute hospital care of the elderly: minimizing the risk of functional decline. Cleveland Clinical Journal of Medicine 1995;62(2):117‐28. - PubMed
PEDro 1999
    1. Physiotherapy Evidence Database. http://www.pedro.fhs.usyd.edu.au/scale_item.html 1999.
Sager 1996
    1. Sager MA, Franke T, Inouye SK, Landefeld CS, Morgan TM, Rudberg MA, et al. Functional outcomes of acute medical illness and hospitalisation in older persons. Archives of Internal Medicine 1996;156:645‐52. - PubMed
Scott 1999
    1. Scott I. Optimising care of the hospitalised elderly ‐ A literature review and suggestions for future research. Australian and New Zealand Journal of Medicine 1999;29(2):254‐64. - PubMed
Tugwell 2004
    1. Tugwell P, Shea B, Boers M, Brooks P, Simon L, Strand V, et al. Evidence‐based Rheumatology. London: BMJ books, 2004.