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May reduce length of stay in hospital (Hospital Associated Deconditioning Evidence)

Evidence Summary

Two meta-analyses which looked at exercise interventions, including when part of multidisciplinary interventions, in acutely admitted medical patients have shown a reduction in length of stay (LOS) in the intervention group compared to control [1 ,2].  Exercise interventions included walking, strength and balance training, education or a mixture of activities. In addition to exercise interventions, multidisciplinary interventions included geriatric wards, discharge planning and/or occupational therapy. Included RCTs were from Western Europe, US, Australasia and China. The most recent meta-analysis, which only included studies from 2000 onwards, demonstrated a reduction in the median LOS of -2.18 days (95% CI -3.44 to -0.92; p=0.0007; 1355 participants; moderate certainty evidence) [2].   The earlier Cochrane review, which included meta-analysis, found in multicomponent interventions which include exercise a reduction in LOS of -1.08 days (WMD; 95% CI -1.93 to -0.22; I2= 37.6%; 6 studies; 3478 participants) [1]. When looking at exercise interventions alone the effect on LOS was uncertain (MD 0.01; 95%CI -1.23 to 1.26; 3 studies, 680 participants) (

A more recent meta-analysis of exercise interventions alone, in older adults acutely admitted to hospital with a medical problem, found uncertainty on effect on LOS (MD 0.46 days; 95% CI -0.12 to 1.04; 10 studies; 1616 participants) and rehospitalisation (OR 1.29; 95% CI 0.86 to 1.93; 4 studies; 863 participants) [3]. None of the meta-analyses demonstrated an increase in adverse events.

Quality of Evidence

B- evidence from meta-analysis but uncertainty in evidence in exercise interventions alone

Strength of Recommendation

1 – Exercise interventions as part of multicomponent interventions of benefit, but effect of exercise alone unclear, risk of physical activity is low

Conclusion

Exercise interventions, as part of a multi-component intervention, probably reduces length of stay. The effect of exercise interventions alone on length of stay.  Exercise interventions can be recommended to most people, in most circumstances, to try and reduce time spent in hospital, but there is some uncertainty in the supporting evidence base.

References

1                     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

2                    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

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

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