A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial

Abstract

Background: During hospitalization, older adults (+65) are inactive, which puts them at risk of functional decline and loss of independence. Systematic strength training can prevent loss of functional performance and combining strength training with protein supplementation may enhance the response on muscle mass and strength . However, we lack knowledge about the effect of strength training commenced during hospitalization and continued after discharge in older medical patients. This assessor-blinded, randomized study investigated the effect of a simple, supervised strength training program for the lower extremities, combined with post-training protein supplementation during hospitalization and in the home setting for 4 weeks after discharge on change in mobility in older medical patients. Methods: Older medical patients (≥65 yrs) admitted acutely from their home to the Emergency Department were randomized to either standard care or supervised progressive strength training and an oral protein supplement during hospitalization and at home 3 days/week for 4 weeks after discharge. The primary outcome was between-group difference in change in mobility from baseline to 4 weeks after discharge assessed by the De Morton Mobility Index, which assesses bed mobility, chair mobility, static and dynamic balance, and walking. Secondary outcomes were 24-hour mobility, lower extremity strength, gait speed, grip strength and Activities of Daily Living. Results: Eighty-five patients were randomized to an intervention group (N=43) or a control group (N=42). In the intervention group, 43% were highly compliant with the intervention. Our intention to treat analysis revealed no between-group difference in mobility (mean difference in change from baseline to 4 weeks: -4.17 (95 % CI: -11.09;2.74; p=0.24) nor in any of the secondary outcomes. The per protocol analysis showed that the intervention group increased significantly more in the daily number of steps taken compared to the control group (mean difference in change from baseline to 4 weeks: 1033.4 steps (95 % CI: 4.1;2062.7), p=0.049, adjusted for mobility at baseline and length of stay; 1032.8 steps (95% CI: 3.6;2061.9), p=0.049, adjusted for mobility at baseline, length of stay and steps at baseline). Conclusions: Simple supervised strength training for the lower extremities, combined with protein supplementation initiated during hospitalization and continued at home for 4 weeks after discharge was not superior to usual care on change in mobility at 4 weeks in older medical patients. For the secondary outcome, daily number of steps, high compliance with the intervention resulted in a higher daily number of steps. Less than half of the patients were compliant with the intervention indicating that a simpler intervention might be needed. Trial registration: NCT01964482, https://clinicaltrials.gov/ct2/show/NCT01964482 , registration date: October 14, 2013, trial protocol: PubMed ID (PMID): 27039381.

Effectiveness of home-based exercise for improving physical activity, quality of life and function in older adults after hospitalisation: A systematic review and meta-analysis

“…One trial compared home-based exercise with standard care and measured physical activity as steps per day. 43 Mean difference between groups was 999 (95% CI −24 to 2022) steps favouring the home-based exercise group.…”

“…36–39 Four trials compared home-based exercise with standard care. 40–43 Two trials compared home-based exercise with centre-based exercise. 15,44 Characteristics of all included trials are summarised under the three comparison conditions in Table 1 (further details on individual trials are provided in Appendix 3).…”

“…The active intervention period ranged from 4 weeks to 6 months. 15,36–43 The comparator condition was standard care for all but three trials. 15,38,44 For two trials, the comparator condition was centre-based exercise which involved structured exercise sessions of a certain dose 15,44 For one trial, the comparator condition was no treatment.…”

“…Three trials measured physical activity with three different measures used. 15,39,43 Six trials measured quality of life with validated instruments. 15,36,38,40,42,46 Six trials assessed mobility with various measures used.…”

“…15,38,39,42–44 Four trials assessed performance of ADL and used various indexes. 36,38,42,43 Four trials reported the number of adverse events related to the intervention. 36,37,39,41 Four trials reported data on the number of people requiring unplanned readmission to hospital.…”