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Improves muscle strength (Hospital Associated Deconditioning Evidence)

Evidence Summary

A meta-analysis from 2019 of adults (>18 years) acutely admitted to hospital has shown exercise interventions (including strengthening activities and cycling) lead to a small increases in muscle strength outcomes, such as handgrip strength and knee extension strength (MD 31.87 Newtons; 95% CI 8.82 to 54.9; I2= 69.4; 5 studies; 185 participants) [1]. All patients in this meta-analysis had a respiratory cause for admission (COPD or pneumonia) and strength was measured within 2 days of admission (baseline) and typically again after 8 – 12 days. The authors of the meta-analysis judged the included RCTs to be fair to good quality. The largest benefit was seen in a study which included a younger population and intervention included daily resistance training at 70% of 1 repetition maximum effort contraction [2]. Adverse events were not an outcome in this meta-analysis.

Additionally, a systematic review of exercise interventions in older adults (>60 years) acutely admitted to hospital, for on average between 4 and 13 days, found six studies, that assessed markers of maximal voluntary muscle strength, and all found a beneficial effect of exercise interventions versus usual care [3]. Handgrip strength improved in 2 of the 3 studies in which it was assessed. The authors were unable to perform meta-analysis on the data. No adverse events were reported by any included study.

Quality of Evidence

A – Consistent evidence from meta-analysis and systematic review

Strength of recommendation

1- Small but significant benefit, low risk of physical activity.


Exercise interventions probably result in a slight increase in muscle strength in people acutely admitted to hospital. Exercise interventions can be recommended to most people, in most circumstances, to help increase strength unless there are compelling reasons to do otherwise.


1 Hartley P, Costello P, Fenner R, et al. Change in skeletal muscle associated with unplanned hospital admissions in adult patients: A systematic review and meta-analysis. PLoS One 2019;14:1–21. doi:10.1371/journal.pone.0210186

2 José A, Dal Corso S. Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: A randomised trial. J Physiother 2016;62:96–102. doi:10.1016/j.jphys.2016.02.014

3 Valenzuela PL, Morales JS, Castillo-García A, et al. Effects of exercise interventions on the functional status of acutely hospitalised older adults: A systematic review and meta-analysis. Ageing Res Rev 2020;61:101076. doi:10.1016/j.arr.2020.101076