Effect of Exercise Training on Prognosis in Community-acquired Pneumonia: A Randomized Controlled Trial

Abstract

Objective: To investigate the effect of standard care (SoC) combined with supervised in-bed cycling (Bed-Cycle) or booklet exercises (Book-Exe) versus SoC in community-acquired pneumonia (CAP).

Methods: In this randomized controlled trial, 186 patients with CAP were assigned to SoC (n = 62), Bed-Cycle (n = 61), or Book-Exe (n = 63). Primary outcome length of stay (LOS) was analyzed with analysis of covariance. Secondary outcomes, 90-day readmission, and 180-day mortality were analyzed with Cox proportional hazard regression and readmission days with negative-binominal regression.

Results: LOS was -2% (95% CI: -24 to 25) and -1% (95% CI: -22 to 27) for Bed-Cycle and Book-Exe, compared with SoC. Ninety-day readmission was 35.6% for SoC, 27.6% for Bed-Cycle, and 21.3% for Book-Exe. Adjusted hazard ratio (aHR) for 90-day readmission was 0.63 (95% CI: .33-1.21) and 0.54 (95% CI: .27-1.08) for Bed-Cycle and Book-Exe compared with SoC. aHR for 90-day readmission for combined exercise was 0.59 (95% CI: .33-1.03) compared with SoC. aHR for 180-day mortality was 0.84 (95% CI: .27-2.60) and 0.82 (95% CI: .26-2.55) for Bed-Cycle and Book-Exe compared with SoC. Number of readmission days was 226 for SoC, 161 for Bed-Cycle, and 179 for Book-Exe. Incidence rate ratio for readmission days was 0.73 (95% CI: .48-1.10) and 0.77 (95% CI: .51-1.15) for Bed-Cycle and Book-Exe compared with SoC.

Conclusions: Although supervised exercise training during admission with CAP did not reduce LOS or mortality, this trial suggests its potential to reduce readmission risk and number of readmission days.

Clinical trials registration: NCT04094636.

Keywords: admission; community-acquired pneumonia; exercise training; length of stay; readmission.

Figure 1.

CONSORT flow diagram.

Figure 2.

Kaplan–Meier estimation of 90-d readmission and 180-d mortality. Note: Kaplan–Meier estimation of 90-d readmission (A) and 180-d mortality (C) for standard care (black solid line), in-bed cycling (red dashed line), and booklet exercise (green dotted line) groups. Kaplan–Meier estimation of 90-d readmission (B) and 180-d mortality (D) for standard care (black solid line) and the combined exercise training (green dotted line) group.