Wellness Check: Exercise

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.

There remains a significant intention-behavior gap in physical activity

1. In this systematic review and meta-analysis, the intention-behavior gap in physical activity was 47.6%.

2. Furthermore, a very low proportion of non-intenders engaged in physical activity, indicating that intention is an important first step toward the behavior.

Evidence Rating Level: 1 (Excellent)

Physical activity has several important health benefits. However, a large percentage of the population worldwide does not meet recommended physical activity guidelines. Promoting physical activity is an essential step in improving these statistics. Prior studies have shown that intention is an important antecedent to physical activity, but an intention-behavior gap remains. Therefore, this study aimed to update the knowledge on the intention-behavior gap in physical activity.

Of 3,759 identified records, 22 studies (n = 29,600 participants) were included from inception to February 2023. Studies were included if they measured physical activity, assessed intention of physical activity, and looked at the intention-behavior relationship. Studies were excluded if they were conducted on participants younger than 18 years of age or if they were printed in languages other than English. The review was carried out according to PRISMA guidelines. The primary outcome was the intention-behavior gap in physical activity.

The results demonstrated that the intention-behavior gap for physical activity was 47.6%. Intention was essential to the behavior as 26.0% of participants were non-intenders who did not engage in physical activity, while only 4.2% were non-intenders who exceeded their expectations. Meanwhile, 38.7% of people were successful intenders, while 33.0% were unsuccessful intenders. However, the study was limited by only including English language studies which may have affected the generalizability of the results. Nonetheless, the present study demonstrated a significant intention-behavior gap in physical activity remains.

Many exercise modalities are effective treatments for hypertension

1. In this systematic review and network meta-analysis, aerobic exercise training, dynamic resistance training, combined training, high-intensity interval training, and isometric exercise training were all associated with significant reductions in resting systolic and diastolic blood pressure.

2. However, isometric wall squatting was the most effective exercise for reducing systolic blood pressure, while running was most effective for lowering diastolic blood pressure.

Evidence Rating Level: 1 (Excellent)

It is well known that exercise is an effective non-pharmacological treatment for hypertension. Aerobic exercise remains the main form of physical activity that is suggested for the treatment of hypertension. However, there is limited data on the effects of different exercise modalities on the management of high blood pressure. Therefore, the present study aimed to identify the optimal exercise intervention for reducing resting blood pressure to better inform hypertension management guidelines.

Of 14,553 identified records, 270 randomized controlled trials (n = 15,827 participants) published between 1990 and February 2023 were included in the review. Studies were included if they investigated an exercise intervention in adults and reported pre- and post-intervention systolic and diastolic blood pressure. Studies were excluded if they used concurrent interventions with exercise, such as medications. The risk of bias was evaluated using the TESTEX scale. The study was performed following PRISMA guidelines. The primary outcome was the impact of a given intervention on resting systolic and diastolic blood pressure.

The results demonstrated that aerobic exercise, dynamic resistance, combined, high-intensity interval, and isometric exercise training were all associated with significant reductions in resting blood pressure. Isometric exercise training and combined training were the most effective for lowering systolic blood pressure. Meanwhile, the most effective exercises for reducing blood pressure were isometric wall squats for systolic blood pressure and running for diastolic blood pressure. However, the study was limited by the publication bias in some exercise modalities, such as aerobic and isometric exercise training, over other modalities, such as sprint interval training, which may have influenced the results. Nonetheless, the present study identified optimal exercise modalities for managing hypertension.

Image: PD

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