Clinical Question

What are the effects of exercise interventions for patients older than 65 years who are acutely hospitalized?

Evidence-Based Answer

The effects of exercise interventions on functional outcomes are unclear, but there is a trend toward functional improvement. Multidisciplinary interventions that include exercise also show several other benefits, including reduction in length of hospitalization and hospital costs; these benefits have not been shown with exercise-only interventions, however.

Practice Pointers

Older adults experience declines in physical strength, mobility, and functioning during and after acute hospitalization.¹ Exercise training can improve functional outcomes in these patients.²

In this Cochrane review, the authors searched for studies evaluating the effectiveness of inpatient exercise programs for older patients admitted to the hospital with general medical problems. Nine studies with 4,223 total patients were included. Patients in specialized stroke, intensive care, or rehabilitation units or those with primarily orthopedic diagnoses were excluded. Interventions were started within three days of admission and were compared with usual hospital care. The exercise interventions ranged from increased physical activity to individually tailored walking and strengthening programs.

The review found that older patients benefited from a multidisciplinary intervention program that incorporated exercise. The benefits included a decrease in hospital costs of about $300 per hospital stay, an average one-day reduction in length of hospitalization, and a 6 percent increase in the proportion of patients discharged to home rather than to a nursing home or other facility (number needed to treat = 16). It is important to note that exercise-only programs did not demonstrate these outcomes. In addition, the exercise portion of the multidisciplinary interventions was not explained in detail, thus limiting the practical implication of the studies. The authors conclude that the benefits may be from the multidisciplinary effort rather than the exercise itself.

These data support including exercise in multidisciplinary programs initiated as early as hospital admission and continuing until discharge. Multidisciplinary programs generally include individually designed patient exercise plans, a specialized geriatric inpatient unit, and evaluation and treatment by physical and occupational therapists and a physician or nurse trained as a geriatrician. Small but important clinical outcomes can be expected with this multidisciplinary approach.