Aim This study aimed to examine changes in lean mass during hospitalization in geriatric patients and the effect of muscle activation by neuromuscular electrical stimulation. Methods Thirteen patients (69–94 yr) at a geriatric ward completed tests at hospital admission (days 2–3) and discharge (days 8–10). One leg received daily stimulation of the knee extensors, whereas the other leg served as a control leg. Lean mass was evaluated by dual-energy x-ray absorptiometry scans and muscle thickness by ultrasound scans. Muscle biopsies were collected from both legs at admission and discharge in nine patients and analyzed for fiber size, satellite cell number, and activation and expression of genes associated with muscle protein synthesis and breakdown, connective tissue, and cellular stress. Results The relative decline in leg lean mass and midthigh region lean mass was larger in the control (−2.8% ± 1.5%) versus the stimulated leg (−0.5% ± 1.4%, P < 0.05). Although there were no changes in fiber size or satellite cell number, the mRNA data revealed that, compared with control, the stimulation resulted in a downregulation of myostatin (P < 0.05) and a similar trend for MAFbx (P = 0.099), together with an upregulation of Collagen I (P < 0.001), TenascinC (P < 0.001), CD68 (P < 0.01), and Ki67 (P < 0.05) mRNA. Conclusion These findings demonstrate a moderate decline in leg lean mass during a hospital stay in geriatric patients, whereas leg lean mass was preserved with daily neuromuscular electrical muscle activation. At the cellular level, the stimulation had a clear influence on suppression of atrophy signaling pathways in parallel with a stimulation of connective tissue and cellular remodeling processes.

Physical inactivity during hospitalization increases the risk of hospital-associated disability in geriatric patients. This open practice-based intervention study investigated the effect on changes in mobility and muscle strength when offering a 15-to 20-minutes chair-based exercise program and aiming at increasing physical activity in acutely hospitalized geriatric patients. In total, 303 patients (85 AE 7 years (meanAESD)) were included. The intervention group (I-group, n = 152) was admitted in 2015 and the historical control group (C-group, n = 151) in 2014. Patients were included if they had an expected length of stay of at least 3 days and their physical and cognitive condition allowed for assessment of basic mobility. No between-group difference was found in changes in mobility and muscle strength during hospital admission. However, length of hospital stay was significantly shorter in the I-group compared to the C-group (9.8 AE 4.9 vs 12.2 AE 7.8 days, P = .001). Furthermore, the 50 last included patients improved significantly more in mobility and had a shorter length of stay than the first 50 included (9.1 AE 4.5 days vs 11.0 AE 5.1, P = .030); and those who fully complied with the exercise program improved in mobility in contrast to those who declined to participate. Thus, in geriatric patients physical activity shortens length of stay in hospital and can improve function.

Background and purpose Hospital admission for older patients has been linked to loss of muscle mass and function, and the former can be measured with ultrasonography during hospitalization. Methods Two studies were carried out. In Study 1, 69 patients' (85 ± 8 years) activity level was measured with ActivPal and quadriceps thickness measured twice with ultrasonography during hospitalization. In Study 2, 10 older patients (85 ± 8 years) and 10 healthy young subjects (23 ± 2 years) had their quadriceps thickness measured on two consecutive days with ultrasonography that included a pressure calibrator. Results In Study 1, the results revealed that the older patients had a reduction in thigh muscle thickness together with very low levels of activity level during hospitalization. Patients with a <95% inactivity level show a 1.8% reduction in muscle thickness, and those with a >95% inactivity level had a 7.0% reduction. In Study 2, ultrasonographic measurements were performed using a pressure calibrator, and these results yielded very good reproducibility. Typical error was 1.7% for the young and 7.2% for the old persons. This high reproducibility and low error improve the ability to detect significant changes over time. Conclusion Improving the ultrasonography method including use of a pressure calibrator can result in greater reproducibility.