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Keep the brain and mind working well (Hospital Associated Deconditioning Evidence)

Evidence Summary
One RCT (reported in three different studies) [1-3] of 370 older adults ( 75 years) admitted to an Acute Care of the Elderly unit in Spain has investigated the effect of an exercise intervention (walking and resistance exercises), compared to usual care, on different cognition-related measures. Participants in the exercise group had improvements in Mini Mental State Exam (MMSE) score (2.10 points; 95% CI 1.75 to 2.46 versus 0.27 points; 95% CI -0.08 to 0.63, p<0.01, minimal clinically important difference 1 to 3 points), dual-task Gait Velocity Test, Trail Making Test Part A and verbal fluency [1,2]. No adverse effects or falls were reported in the intervention group, additionally no patient had to interrupt the intervention or have their hospital stay modified.

One RCT from 2000 showed exercise, in addition to multi-disciplinary interventions, improved MMSE three months after discharge (SMD 0.40; 95% CI 0.19 to 0.61; 413 participants) [4]

Quality of Evidence
C – single RCTs, risk of bias due to missing data, generalisability may be limited as study excluded participants with poorer function at admission (Barthel Index <60).

Strength of Recommendation
1- small effect but within range of minimal clinically important difference, no adverse events reported

Exercise interventions may slightly improve cognitive function in acutely admitted older adults. Exercise interventions to improve cognition should be recommended in most patients, however the supporting evidence base is low quality.

1 Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, et al. Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: Secondary analysis of a randomized trial. PLoS Med 2019;16:1–14. doi:10.1371/journal.pmed.1002852

2 Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, et al. Physical Exercise Improves Function in Acutely Hospitalized Older Patients: Secondary Analysis of a Randomized Clinical Trial. J Am Med Dir Assoc 2019;20:866–73. doi:10.1016/j.jamda.2019.04.001

3 Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern Med 2019;179:28–36.

4 Asplund K, Gustafson Y, Jacobsson C, et al. Geriatric-based versus general wards for older acute medical patients: A randomized comparison of outcomes and use of resources. J Am Geriatr Soc Published Online First: 2000. doi:10.1111/j.1532-5415.2000.tb02626.x