Barriers and enablers to physical activity in patients during hospital stay: a scoping review

Geelen, Sven J G; Huisman, H; Bie, Robert A. de; Veenhof, Cindy; Engelbert, Raoul; Schaaf, Marike van der; Lenssen, Antoine F.

doi:10.1186/s13643-021-01843-x

Cited by 38 publications

(50 citation statements)

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“…Modifiable factors at the institutional level, including sufficient resources, stimulating physical environment, and patient activities, were also reported in previous research and multidimensional interventions were suggested [ 27 – 29 , 91 , 100 ] which is in line with our results. Our review showed that multidimensional intervention studies, including an increase of resources, adding ambulation pathways, or monitoring physical functioning, might result in positive effects on patients’ step count per day [ 72 , 80 ], or faster recovery of physical functioning [ 79 ].…”

Section: Discussionsupporting

confidence: 93%

“…In line with previous studies [ 27 , 29 , 91 ], the importance of awareness and knowledge about mobilization to improve patients’ PA behavior was recognized in the current review. However, when it comes to prioritizing poor health status or fear of falling, it seems that safety and zero-fall policies can sometimes take precedence over the known benefits of mobility.…”

Section: Discussionsupporting

confidence: 82%

“…To the best of our knowledge, a systematic overview of the literature regarding facilitators and barriers toward PA in older hospitalized patients is lacking. Recently, studies identifying facilitators or barriers to enhancing PA have been reviewed for hospitalized patients of all ages [ 27 – 29 ], as well as for older patients in the home setting [ 30 , 31 ]. From these home-setting studies, it is known that there might be specific factors for older persons, such as fear of falling, that are barriers to PA [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

“…From these home-setting studies, it is known that there might be specific factors for older persons, such as fear of falling, that are barriers to PA [ 30 ]. Furthermore, it is known that there are specific hospital-setting factors, such as the influence of healthcare professionals (HCPs), patients’ health status or lack of resources [ 27 – 29 ]. Given the specific hospital setting in the current review, in which patients enter a different and unfamiliar context, it is conceivable that facilitators and barriers might be different for patients over 65 years than for younger patients.…”

Section: Introductionmentioning

confidence: 99%

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Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

Dijkstra

Sluis

Jager‐Wittenaar

et al. 2022

Int J Behav Nutr Phys Act

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Background To improve older patients’ physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs). Methods In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000–May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels. Results The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients’ fear, and HCPs’ safety concerns; interpersonal level: patient-HCP relation and HCPs’ unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients’ unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators. Conclusion The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

Dijkstra

Sluis

Jager‐Wittenaar

et al. 2022

Int J Behav Nutr Phys Act

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“…Family caregivers (FCs) are often responsible for supporting their relative's recovery after hospital discharge. While healthcare providers have identi ed FCs as potential facilitators of patients' engagement in physical activity [5,6], very few studies have examined FCs' perspectives on their preparedness to support the physical activity of a relative. Furthermore, no studies have focused speci cally on FCs of patients at risk for hospital readmission in rural communities.…”

Section: Introductionmentioning

confidence: 99%

Family Caregivers’ Preparedness to Support the Physical Activity of Patients at Risk for Hospital Readmission in Rural Communities: A Qualitative Study

Fox

Butler

Sidani

et al. 2022

Preprint

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Background Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients’ engagement in physical activity. Yet, there is very little research on family caregivers’ perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored family caregivers’ perspectives on their preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission. Methods In this qualitative descriptive study, semi-structured interviews were conducted by telephone with sixteen family caregivers. Interview transcripts were analyzed using conventional qualitative content analysis. Results Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26–67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 63%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers felt unprepared to support their relative’s physical activity, 2) family caregivers believed that rest was more important than physical activity to their relative’s recovery, 3) insufficient preparation for physical activity led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity. Conclusions Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-relative conflict surrounding physical activity, assess family caregivers’ ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative’s physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

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Exercise Intervention and Hospital-Associated Disability

Rodriguez-Lopez,

Mayordomo-Cava,

Zarralanga-Lasobras

et al. 2024

JAMA Netw Open

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ImportanceInpatient exercise interventions may prevent, at least partly, hospital-associated disability (HAD) in older adults, but whether they also confer clinical benefits in the months following discharge is unclear.ObjectiveTo examine the association of exercise and health education with HAD incidence in hospitalized older adults receiving acute hospital care at discharge and 3 months later.Design, Setting, and ParticipantsThis single-center open-label, nonrandomized controlled clinical trial included patients aged 75 years or older seen at an acute care for elders unit at a tertiary public hospital in Madrid, Spain, from May 1, 2018, to June 30, 2022.InterventionsPatients were allocated to an intervention or control group. Both groups received usual care, but the intervention group also performed a supervised multicomponent exercise program (daily strength, balance, and walking exercises along with inspiratory muscle training) during hospitalization and received health education on how to exercise at home and telephone counseling during follow-up.Main Outcomes and MeasuresThe primary outcome was HAD incidence (determined by the Katz Index of Independence in Activities of Daily Living [hereafter, Katz Index]) at discharge and after 3 months compared with baseline (ie, 2 weeks before admission). Secondary outcomes included HAD incidence determined by the Barthel Index for Activities of Daily Living, ambulatory capacity decline at discharge and follow-up, changes in physical performance at discharge, and incidence of falls, readmissions, and mortality during the follow-up period.ResultsThe study included 260 patients (134 women [51.5%]; mean [SD] age, 87.4 [4.9] years [range, 75-105 years]; median hospital length of stay, 7 days [IQR, 5-10 days]), of whom 130 received the intervention and 130 were in the control group. Differences in HAD incidence did not reach statistical significance at discharge (odds ratio [OR], 0.62; 95% CI, 0.37-1.05; P = .08) or follow-up (OR, 0.65; 95% CI, 0.36-1.17; P = .15) when using the Katz Index. A lower HAD incidence was observed in the intervention group at discharge (OR, 0.47; 95% CI, 0.27-0.81; P = .01) and at follow-up (OR, 0.36; 95% CI, 0.20-0.66; P = .001) when using the Barthel Index for Activities of Daily Living. The intervention was also associated with a lesser decline in ambulatory capacity (OR, 0.55; 95% CI, 0.32-0.96; P = .03) and improved physical performance at discharge (Cohen d, 0.39; 95% CI, 0.12-0.65; P = .004). No significant associations were observed for readmissions, falls, or mortality.Conclusions and RelevanceIn this nonrandomized controlled clinical trial, an exercise and health education intervention was not significantly associated with reduced HAD incidence when measured by the Katz Index. However, the benefits found for several secondary outcomes might support the implementation of in-hospital exercise programs for older patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03604640

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Barriers and enablers to physical activity in patients during hospital stay: a scoping review

Cited by 38 publications

References 108 publications

Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

Family Caregivers’ Preparedness to Support the Physical Activity of Patients at Risk for Hospital Readmission in Rural Communities: A Qualitative Study

Exercise Intervention and Hospital-Associated Disability

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