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. 2021 Aug 28;22(1):571.
doi: 10.1186/s13063-021-05503-2.

The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial

Camilla Koch Ryrsø  1   2 , Daniel Faurholt-Jepsen  3 , Christian Ritz  4 , Bente Klarlund Pedersen  2 , Maria Hein Hegelund  1 , Arnold Matovu Dungu  1 , Adin Sejdic  1 , Birgitte Lindegaard #  5   6   7 , Rikke Krogh-Madsen #  2   8
Affiliations

The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial

Camilla Koch Ryrsø et al. Trials. .

Abstract

Background: Community-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level.

Methods: This study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity.

Discussion: If a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP.

Trial registration: ClinicalTrials.gov NCT04094636 . Registered on 1 April 2019.

Keywords: Community-acquired pneumonia; Functional ability; Lean mass; Length of hospital stay; Physical training.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Breaking the vicious cycle of hospitalization, disability, and poor prognosis through physical training. Dark colors, e.g., dark gray, dark blue, and dark green, indicate processes which takes place in hospital during hospitalization. Lighter colors, e.g., light gray, light blue, and light green, indicate time periods, which takes place at home after discharge
Fig. 2
Fig. 2
Flow of patients though the study. Any reasons for discontinuation or exclusion from analysis are reported
Fig. 3
Fig. 3
Exercise programs from the exercise booklet. The exercises are designed for bedridden and ambulant patients. The exercises are divided into 3 programs; A, B, and C, respectively. Programs A and B include strengthening exercises divided into varying degrees of difficulty (e.g., very easy or easy) for both bedridden (A) and ambulant patients (B). Program C includes different walking programs
Fig. 4
Fig. 4
SPIRIT standard protocol items with time schedule of enrolment, interventions and assessments. BIA bioelectrical impedance analysis, DXA dual-energy X-ray absorptiometry, ECG electrocardiogram, EQ-5D-5L health-related quality of life, HbA1c hemoglobin A1c, IPAQ International Physical Activity Questionnaire, OGTT oral glucose tolerance test. Asterisk indicates standard usual care. Superscript digit 1 indicates the following: After radiological diagnose of pulmonary infiltrate on chest X-ray/CT in combination with at least one symptom of lower respiratory tract infection at admission, eligibility will be assessed, and potential participants will be approached. Superscript digit 2 indicates the following: The physical training is a supervised exercise program with one session per day. Superscript digit 3 indicates the following: Basic blood samples will be drawn daily as part of routine tests during hospitalization and analyzed for hematologic, renal, endocrine, cardiac, and hepatologic markers. Blood samples stored in the biobank will be analyzed for markers of inflammation. Superscript digit 4 indicates the following: Readmission up to 3 months after discharge. Superscript digit 5 indicates the following: mortality during admission and up to 6 months after discharge. The table is adapted from the SPIRIT recommendations [25]
See this image and copyright information in PMC

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