Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults

Abstract

We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1–3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p < 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p < 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them—particularly those with a better functional/health status at admission and longer hospitalization—are at higher risk of being adverse responders, which can have negative short/middle-term consequences.

Maintenance of Autonomy Through exerCise in Hospital Setting (MATCH): A Feasibility Study

“…In addition, a recent randomized controlled trial suggests that implementing an in-hospital intervention, including individualized and supervised (by rehabilitation professional) moderate-intensity resistance, balance and walking exercises (two 20-minute daily sessions), statistically and clinically improved functional capacities (SPPB; (13)) and muscle function (power and strength; (14)). Another study, which implemented simple supervised exercises (walking, sit-to-stand) during weekdays, highlighted that only 10% of participants decreased their ADL levels (15,16). Finally, we recently demonstrated that implementing simple unsupervised exercises in a short geriatric unit was not only feasible and acceptable (17), but also an efficient way to improve a patient's functional capacity, increase nonsedentary physical activity and reduce the burden on healthcare (i.e.…”

Anabolic-Androgenic Steroids and Exercise Training: Breaking the Myths and Dealing With Better Outcome in Sarcopenia

“…), severe disability (e.g., bed rest conditions, cachexia conditions, neurological disorders, etc. ), adverse or blunted response to exercise, and low adherence ( Seynnes et al, 2004 ; Rivera-Torres et al, 2019 ; Lalande et al, 2020 ; Valenzuela et al, 2020b ). In addition, many sarcopenic patients may not meet the minimum criteria for exercise recommendations according to recent guidelines ( Fragala et al, 2019 ; Izquierdo et al, 2021b ).…”

A systematic review and meta‐analysis: Assessment of hospital walking programs among older patients

“…Of these, 236 study full-texts were reviewed and 16 publications met eligibility criteria. Two publications were completed on the same study sample (Ortiz-Alonso et al, 2020;Valenzuela et al, 2020) Abbreviations: GFSA, gutter frame with supplemental air; GFSO, gutter frame with supplemental oxygen; LOS, length of stay; NA, not applicable; NR, not reported; RCT, randomized controlled trial; RSA, rollator with supplemental air; RSO, rollator with supplemental oxygen. a Denotes studies that could be used in meta-analysis for hospital length of stay.…”