Hospitalized seniors may benefit from care programs with exercise

By Laura Kennedy, Contributing Writer
Health Behavior News Service
 

Older hospital patients who participate in special care programs that include exercise may go home sooner and incur fewer medical costs than patients receiving standard care, according to a new review of evidence.
 

The positive effects are “small but significant” according to the review authors, led by Natalie de Morton of Monash University in Australia. However, “it is possible that the multidisciplinary intervention components other than exercise may explain improved hospital outcomes,” they say. More studies are needed to determine if exercise is the key factor in producing the benefits.
 

Although the health benefits of physical activity are well known, senior citizens are not always encouraged to exercise during acute hospitalization. As a result, they may lose strength and mobility and require time in a rehabilitation center before returning home.

The new review is “visionary” in its exploration of “the dual burden of an acute medical condition compounded by inactivity,” said Wojtek Chodzko-Zajko, Ph.D., an exercise physiologist at the University of Illinois at Urbana-Champaign.

Chodzko-Zajko, who was not involved with the review, believes hospitals should operate more like health spas, with staff focusing on “the overall health and well-being of their patients, in addition to programs that target whatever medical condition put them in the hospital.”

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Nine studies with a total of 4,223 patients age 65 and older were included in the review. The programs took place in the United States, Australia, the Netherlands and Sweden. Two of the review authors conducted one of the included studies.

Three studies compared exercise-only programs to standard hospital care, while six focused on multidisciplinary care programs that included physical activity. Each of the programs began within the first few days of hospitalization and was administered by medical, nursing or allied health staff.

Most of the fitness-oriented programs encouraged a regular walking regimen, and some also incorporated other exercises. All were designed to maintain or improve patients’ ability to perform their normal activities of daily living, de Morton said.

There were no clear improvements among patients in the three exercise-only programs, which included fewer than 700 participants.

Patients receiving multidisciplinary care, however, went home one day earlier than those in standard care programs. In addition, six more patients out of 100 went directly home instead of to another health care facility such as a rehabilitation center.

The bill for each patient in the team-based programs was also nearly $300 lower. Since older adults account for almost half of U.S. hospital bed days, these figures could translate into substantial health care savings, according to the review.

There was no increase in mortality of patients participating in the exercise programs.

The authors acknowledge that factors other than physical activity — such as increased attention from hospital staff or better coordination of care — may have led to program benefits. Nevertheless, Chodzko-Zajko continues to promote hospital-based workouts.

Even if exercise doesn’t speed recovery from a specific condition, he said, “It’s still valuable to keep up a regular physical activity regimen just because of the known adverse health consequences of sedentary living.”

David Buchner, M.D., of the U.S. Centers for Disease Control and Prevention, concurs. He urges older adults to discuss physical activity levels with their health care providers both during and after a hospital stay. “To the extent possible, they should avoid extremely low levels of physical activity whether in the hospital or not.”

Further research on the benefits of exercise for hospitalized older adults is needed, say de Morton and colleagues. They call for larger studies with more detailed reporting on exercise type and intensity, negative effects such as falls and fractures and variability among patients.

If patients at greatest risk of functional decline could be identified upon admission to the hospital, health care services could be more effectively targeted at those in greatest need, they conclude.