The dose of physical activity to minimise functional decline in older general medical patients receiving 24‐hr acute care: A systematic scoping review

Abstract

Aims and objectives:To identify evidence for a recommended and feasible activity dose to minimise functional decline in older hospitalised general medical patients.Background: Quality 24-hr care of older patients involves balancing activity to minimise functional decline, with rest to aid recovery. However, there is limited guidance regarding an optimal type and dose of activity to minimise functional decline in hospitalised elders receiving acute medical care. Design: A systematic search and scoping review of the literature were conducted following Joanna Briggs methodological guidance. Methods: The results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Study bias was determined using the Joanna Briggs Institute Critical Appraisal Tools.Results: Fifteen primary studies of variable design, rigour and potential for bias were included. Study contexts were general medical wards (n = 11, 73.3%), Acute care of the elderly unit (n = 3, 20%) and a nursing unit (n = 1, 6.7%) located in tertiary referral acute hospitals. Most participants were aged 75-84 years (n = 10, 66%), had variable medical diagnoses and samples were either physically capable (n = 4, 26.7%) of limited physical capability (n = 1, 6.7%) or of mixed capability to mobilise independently (n = 10, 66.7%). Walking at least twice a day for approximately 20 min in total appeared to be associated with less functional decline in older patients of variable physical capabilities, and the overall efficacy of twice-daily exercise to reduce functional decline was supported. Conclusion:The evidence tentatively supported walking for hospitalised elders, irrespective of physical capability, and based on one RCT, suggested likely benefits of graduated exercise in dependent elders. Insufficient evidence limits prescription of optimal doses of physical activity to minimise functional decline. Relevance to clinical practice: This review could provide evidence for nurses to promote function in older patients by specifying a dose of physical activity to be undertaken in hospital. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Ley L, Khaw D, Duke M, Botti M. The dose of physical activity to minimise functional decline in older general medical patients receiving 24-hr acute care: A systematic scoping review.

Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study

“…This study recognises the problems of inactivity in hospitals around the world [9] and responds to a need for recommendations specific to hospitalised older adults. This study centred on inpatients with a medical illness to be consistent with other studies [16,17,19] and balance the internal validity of recommendations to the clinical population (specificity) without being too restrictive (recommendation generalisability). Patients with surgical admissions can similarly experience low PA (step counts) [61] and SB [62], but may be better supported with post-operative mobility or ERAS protocols [29].…”

“…When hospitalised with an acute medical illness, older adults are at high risk of functional decline, newly acquired disabilities and poor outcomes that persist post-hospitalisation such as continued decline, institutionalisation and death [13][14][15]. Research is only beginning to investigate activity dosage in older medical patients with reports of: a reduced risk of 30-day hospital readmission above a threshold of 275 steps per day and further risk reduction for every 100 step increase in mean daily steps [16]; an increased risk of hospital associated functional decline if taking ≤900 steps per day [17,18] and the suggestion that walking at least twice a day for 20 min is associated with less functional decline in people of variable physical capabilities [19]. The problems of low mobility and SB in hospitals are complex because there are system issues, in addition to challenges relating to people, culture, the environment and operational processes [20].…”

A scoping review of physical activity interventions for older adults

“…There is one recent notable exception in Di Lorito et al [ 12 ], although this review targeted structured exercise rather than the wider definition of physical activity and/or alternate approaches to increase physical activity. There are also some scoping reviews of physical activity in older adults [ 13 , 14 ], although none attempt a public health approach. Given our interest in interventions to: [ 1 ] increase total physical activity; and [ 2 ] deliver physical activity programmes and services for older adults, we have chosen a scoping review methodology to deliver a timely, initial assessment of the entire physical activity evidence base.…”

Factors associated with improved walking in older people during hospital rehabilitation: secondary analysis of a randomized controlled trial

“…Recovery during this relatively short time period may reflect recuperation from illness rather than response to exercise. Physical activity during this period may be important in preventing functional decline [38] and loss of muscle strength [39], but higher doses of physical activity during this short time frame may not provide added benefit. This analysis includes supervised upright activity delivered during both usual care physical therapy sessions, which typically provided around 20-25 minutes of upright activity, and intervention sessions, which typically provided an additional 20 minutes of upright activity to participants in the intervention arm.…”