Feasibility of progressive sit-to-stand training among older hospitalized patients

Abstract

Background. In older patients, hospitalization is associated with a decline in functional performance and loss of muscle strength. Loss of muscle strength and functional performance can be prevented by systematic strength training, but details are lacking regarding the optimal exercise program and dose for older patients. Therefore, our aim was to test the feasibility of a progression model for loaded sit-to-stand training among older hospitalized patients.Methods. This is a prospective cohort study conducted as a feasibility study prior to a full-scale trial. We included twenty-four older patients (≥65 yrs) acutely admitted from their own home to the medical services of the hospital. We developed an 8-level progression model for loaded sit-to-stands, which we named STAND. We used STAND as a model to describe how to perform the sit-to-stand exercise as a strength training exercise aimed at reaching a relative load of 8–12 repetitions maximum (RM) for 8–12 repetitions. Weight could be added by the use of a weight vest when needed. The ability of the patients to reach the intended relative load (8–12 RM), while performing sit-to-stands following the STAND model, was tested once during hospitalization and once following discharge in their own homes. A structured interview including assessment of possible modifiers (cognitive status by the Short Orientation Memory test and mobility by the De Morton Mobility Index) was administered both on admission to the hospital and in the home setting. The STAND model was considered feasible if: (1) 75% of the assessed patients could perform the exercise at a given level of the model reaching 8–12 repetitions at a relative load of 8–12 RM for one set of exercise in the hospital and two sets of exercise at home; (2) no ceiling or floor effect was seen; (3) no indication of adverse events were observed. The outcomes assessed were: level of STAND attained, the number of sets performed, perceived exertion (the Borg scale), and pain (the Verbal Ranking Scale).Results. Twenty-four patients consented to participate. Twenty-three of the patients were tested in the hospital and 19 patients were also tested in their home. All three criteria for feasibility were met: (1) in the hospital, 83% could perform the exercise at a given level of STAND, reaching 8–12 repetitions at 8–12 RM for one set, and 79% could do so for two sets in the home setting; (2) for all assessed patients, a possibility of progression or regression was possible—no ceiling or floor effect was observed; (3) no indication of adverse events (pain) was observed. Also, those that scored higher on the De Morton Mobility Index performed the exercise at higher levels of STAND, whereas performance was independent of cognitive status.Conclusions. We found a simple progression model for loaded sit-to-stands (STAND) feasible in acutely admitted older medical patients (≥65 yrs), based on our pre-specified criteria for feasibility.

Dementia care mapping to support staff in the care of people with intellectual disability and dementia: a feasibility study

“…The present authors found the framework of Bowen et al (2009) for assessing feasibility also to be applicable regarding intellectual disability-care; it confirmed findings of previous studies on health interventions in patients with advanced, incurable diseases and their caregivers, in older hospitalized patients, and in children with autism (Bowen, Briant, Harris, Hannon, & Buchwald, 2015;Cermak et al, 2015;Pedersen et al, 2015;Siemens et al, 2015). Moreover, the present authors were able to apply all five aspects of Bowen's framework, whereas the previous studies usually addressed only some of them.…”

The Case for Mobility Assessment in Hospitalized Older Adults: American Geriatrics Society White Paper Executive Summary

“…A 12‐month pilot study of the Johns Hopkins inpatient mobility program found more days of ambulation, increases in the proportion of individuals whose mobility levels improved over their hospital stay, and shorter hospital stays in individuals participating in the program . A cohort study demonstrated the feasibility of the SIT to STAND program, which employs a progressive model of loaded sit‐to‐stand exercises to prevent loss of muscle strength is hospitalized men . This program has not been tested in a randomized controlled trial.…”

“…43 A cohort study demonstrated the feasibility of the SIT to STAND program, which employs a progressive model of loaded sit-to-stand exercises to prevent loss of muscle strength is hospitalized men. 44 This program has not been tested in a randomized controlled trial.…”

In acutely admitted geriatric patients, offering increased physical activity during hospitalization decreases length of stay and can improve mobility

“…The randomized controlled design is the gold standard for investigating effects of interventions, but often results cannot be generalized to the real‐world clinical environment because only a small proportion (typically 10%‐15%) of the eligible patients are included …”

“…25 The randomized controlled design is the gold standard for investigating effects of interventions, but often results cannot be generalized to the real-world clinical environment because only a small proportion (typically 10%-15%) of the eligible patients are included. 26,27 The present study is a pragmatic observational study at ward level investigating the results of an increased focus on ambulation in combination with an exercise program on functional performance (mobility and muscle strength) in geriatric patients during hospital admission. We hypothesized that increased physical activity would result in greater improvements in physical performance and shorter length of stay compared to the conventional care.…”