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Exercise counters functional decline of older people in hospital

Older people in hospital need an exercise programme to avoid being discharged with a new disability

Older people in hospital need an exercise programme to avoid being discharged with a new disability

Picture: Neil O'Connor

Acute hospitalised older patients, including those who are able to walk independently, spend most of their time in bed. This makes hospital admission a major contributor to disability in older people.

Despite resolution of the reason for hospitalisation, patients, especially those who are frail, are often discharged with a new major disability. More than half of older adults do not recover to their pre-admission function levels one year after discharge and there are high rates of nursing home placement and death.

An exercise programme started early in acute hospitalisation can prevent functional and cognitive decline in older patients and is associated with reduced length of stay and reduced costs.

This single-centre randomised clinical trial involved 370 patients with an average age of 87.3 years. The intervention was programmed in two daily sessions, morning and evening, of 20 minutes duration on five to seven days including weekends.

Balance and gait

Exercise sessions included resistance, balance and walking training. Participants performed three exercises involving mainly lower limb muscles. These included rising from a chair, use of a leg press and bilateral knee extensions. Upper body exercise involved a seated bench press.

Balance and gait retraining exercises gradually progressed in difficulty and included line walking, stepping practice and walking on an unstable surface. The control group had their usual care including physiotherapy as needed.

Results showed that an individualised exercise programme can reverse the functional decline associated with acute hospitalisation in very old patients. It also found other benefits in terms of cognitive status and quality of life.

Ruth Sander is an independent consultant in the care of older people

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