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May reduce risk of delirium (Hospital Associated Deconditioning Evidence)

Evidence Summary

Delirium has a multifactorial aetiology and therefore a multicomponent approach (which addresses different risk factors such as cognitive impairment, sleep deprivation, immobility, hearing and/ or visual impairment) is typically used for its prevention [1].  A meta-analysis of multicomponent nonpharmacological delirium interventions, which included early mobilisation and physical activity, in acutely admitted medical and surgical patients has demonstrated a significant reduction in the incidence of delirium versus controls (OR 0.47; 95% CI 0.38 to 0.58; 11 studies; 4267 participants; number needed to treat (NNT) 14.3; 95% CI 11.1 to 20.0) [1].  Adverse events were not reported on but there was a reduction in falls in the intervention group (OR 0.38; 95% CI 0.25 to 0.60; 4 studies; 1038 participants)

A recent RCT of an exercise intervention alone in 370 older adults admitted to an Acute Care of the Elderly unit in Spain, has showed an uncertain effect on the incidence of delirium [2]. No adverse events were reported in the exercise intervention group.

Quality of Evidence

B- meta-analysis multicomponent intervention and intention to reduce incidence of delirium rather than increase physical activity. RCT of exercise intervention alone was uncertain.

Strength of recommendation

2- Effect seen with multicomponent nonpharmacological interventions (which include physical activity interventions) but insufficient evidence to draw conclusions of effect of physical activity alone.

Conclusion

Physical activity, as part of multicomponent interventions, probably reduces the risk of delirium in acute medical and surgical inpatients. The evidence for exercise interventions alone is uncertain. The risk of adverse events is likely to be low.

References

  1. Gual N, García-Salmones M, Brítez L, et al. The role of physical exercise and rehabilitation in delirium. Eur Geriatr Med 2020;11:83–93. doi:10.1007/s41999-020-00290-6
  • Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: A meta-analysis. JAMA Intern Med Published Online First: 2015. doi:10.1001/jamainternmed.2014.7779

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.

doi:10.1001/jamainternmed.2018.486C

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