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Improves the ability to perform day to day activities (Hospital Associated Deconditioning Evidence)

Evidence Summary

A recent meta-analysis from 2020 looked at the effects of exercise interventions (such as walking, strength and balance training, education or a mixture of activities) alone in older adults acutely admitted to hospital with a medical problem. Included RCTs were from Western Europe, US, Australasia and Taiwan, and average length of stay was between 4 and 13 days (median = 8 days).  Five studies assessing ability to independently perform activities of daily living (ADLs) (mainly measured using Katz or Barthel Index), at admission and discharge, were included in a meta-analysis. An improvement in ADL function was demonstrated in the exercise intervention group compared to usual care (SMD 0.64; 95% CI 0.19 to 1.08; p= 0.005; I2=38%; 870 participants) [1].   The same review also performed meta-analysis on 4 studies which compared ADL function at pre-admission baseline (e.g. 2 weeks prior to admission) to function 1 -3 months after discharge.  Despite exercise interventions finishing at discharge, improvement in ADL function persisted after discharged (SMD 0.28; 95% CI 0.13 to 0.43; P<0.001; I2=0%; 744 participants). 9 out of 12 RCTs included in the review monitored adverse events and none were recorded.

A much earlier meta-analysis from 2007 demonstrated no evidence of a difference between  exercise interventions and controls on activities of daily living when assessed as exercise interventions alone (change in Barthel Index, SMD 0.17; 95% CI -0.06 to 0.40; 2 studies; 293 participants) or as part of multidisciplinary interventions (maintained or improved ADL score between admission and discharge RR 1.05; 95% CI 0.97 to 1.15; I2= 78.6%; 3 studies; 2271 participants)  [2]

Quality of Evidence

B- evidence from meta-analysis but inconsistency with earlier reviews.

Strength of recommendation

1 – Most up to date meta-analysis demonstrates benefits, low risk of physical activity

Conclusion

Exercise interventions may improve ability to perform activities of daily living in adults acutely admitted to hospital with a medical problem, and the evidence suggests this benefit may persist beyond discharge.  Exercise interventions can be recommended to most people, in most circumstances, to help improve function in ADLs 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
  • 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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