Ambulation is optimal for improving functional capacity in acutely hospitalized older adults

1. This systematic review and network meta-analysis found that the optimal dose of exercise to improve functional capacity in acutely hospitalized older adults was 159 Metabolic Equivalents of Task (METs) per day.

2. Furthermore, ambulation was the most efficient intervention for improving functional capacity in this population, with the minimal effective dose being 74 METs per day.

Evidence Rating Level: 1 (Excellent)

Hospitalized patients spend most of their time in bed, which can adversely affect functional capacity and is often associated with deconditioning. Deconditioning can then lead to hospital readmission and several other problems. Many studies have highlighted the importance of maintaining mobilization in older hospitalized patients. However, the exact methods and doses of physical activity to achieve these benefits have yet to be well-established. Thus, the present systematic review and meta-analysis aimed to determine the optimal dose and type of physical activity to achieve functional capacity benefits in hospitalized older adults.

Of 2,905 identified records, 19 studies (n = 3,783 participants) were included from database inception to June 2022. Studies were included if they were randomized controlled trials that investigated adults ≥50 years old who were hospitalized for an acute medical condition, evaluated a form of physical activity as an intervention, and assessed function capacity at baseline and discharge. Studies were excluded if patients were admitted for a condition that prohibited physical activity, used interventions that did not require physical involvement, or used multiple treatment methods, which made determining the role of physical activity challenging to decipher. The review was carried out according to PRISMA guidelines. The primary outcome was the optimal physical activity dose to improve functional capacity.

The results demonstrated that approximately 100 Metabolic Equivalents of Task (METs) per day, equivalent to about 40 minutes of light effort or 25 minutes of moderate effort activity, is the minimal dose needed to improve functional capacity in hospitalized adults. However, the optimal dose to achieve this effect was 159 METs/day. Ambulation was the most efficient intervention for improving functional capacity, with the minimal effective and optimal doses being 74 METs/day and 143 METs/day, respectively. However, the study was limited by the lack of follow-up data following discharge, which limited the ability to assess the long-term impacts of exercise interventions. Nonetheless, the study demonstrated the optimal doses and modes of physical activity to improve functional capacity in hospitalized older adults.

Click to read the study in the BJSM (British Journal of Sports Medicine)

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