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Improves walking and movement (Hospital Associated Deconditioning Evidence)

Evidence Summary

A recent meta-analysis from 2020 looked at the effects of exercise interventions alone in older adults acutely admitted to hospital with a medical problem. Exercise interventions included walking, strength and balance training, education or a mixture of activities. Included RCTs were from Western Europe, US, Australasia and Taiwan, and average length of stay was between 4 and 13 days (median = 8 days). Several different physical performance outcomes were combined and assessed (including short physical performance battery, 5-sit-to-stand test, Timed Up and Go (TUG) test and 6-minute walking distance test). Physical performance was shown to be moderately improved (SMD 0.57; 95% CI 0.18 to 0.95; p=0.04; I2= 0%; 9 studies; 1052 participants) in the intervention group [1].

Another meta-analysis from 2019 looked at exercise or mobilisation interventions (including when part of multidisciplinary interventions) compared to usual care, in adults acutely admitted to hospital with a medical problem. Exercise interventions may slightly improve gait speed (MD 0.24m/s; 95% CI 0.01 to 0.48; p=0.04; I2= 79%; 6 studies; 496 participants; moderate certainty evidence, gait speed minimal clinically important difference 0.1m/s) [2].  The effect of interventions on TUG test was uncertain (median 0.80 seconds; 95% CI -0.31 to 1.90; p=0.16; 5 studies; 1175 participants; moderate certainty evidence). Additionally, in an earlier meta-analysis the evidence for effect on TUG was uncertain (MD -2.52 seconds; 95% CI -5.75 to 0.71; 2 studies; 188 participants) [3].

Two meta-analyses looked at the effects of interventions on falls but the evidence in both was uncertain: OR 1.14; 95% CI 0.36 to 3.57; p=0.82; 6 studies; 1148 participants [1], OR 0.62; 95% CI 0.13 to 3.03; p=0.56; 2 studies; 855 participants [2]. None of the meta-analyses reported an increase in adverse events.

Quality of Evidence

A  – Two meta-analyses

Strength of recommendation

1 – clinically important difference in physical function and gait speed, no adverse events reported

Conclusion

Exercise and mobilisation interventions are likely to improve physical performance and increase walking speed in patients acutely admitted to hospital. Exercise interventions can be recommended to most people, in most circumstances, to help improve physical function unless there are compelling reasons to do otherwise.

References

  1. 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
  • Cortes OL, Delgado S, Esparza M. Systematic review and meta-analysis of experimental studies: In-hospital mobilization for patients admitted for medical treatment. J Adv Nurs 2019;75:1823–37. doi:10.1111/jan.13958
  • De Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev Published Online First: 2007. doi:10.1002/14651858.CD005955.pub

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