Physical Activity During Hospitalization and Hospital-Associated Disability

Condition(s) studied

Investigational drug(s) / intervention(s)

Physical Activity During and After Hospitalization: Participants will receive standard care throughout hospitalization. In addition to standard care, participants will take part in a single supervised assessment of their ability and preferences for different types of physical activity. The assessment includes hallway walking (200 steps, with walking aids or assistance if needed) and resistance exercise consisting of three sets of 8-12 repetition maximum sit-to-stands. Participants will also be asked about their preference for group-based functional training and about their motivation and barriers related to physical activity. Physical activity will be objectively measured using SENS motion® sensor technology continuously during hospitalization and for seven consecutive days prior to the 8-week follow-up after discharge. Self-reported mobility during hospitalization will also be assessed. After discharge, participants' experiences, motivation, barriers, and preferences related to physical activity and rehabilitation will be explored th

Study summary

This study examines physical activity during and after hospitalization in acutely hospitalized older adults and its association with hospital-associated disability (HAD).

Older adults have low levels of physical activity during acute hospitalization, which is associated with an increased risk of HAD. HAD is a decline in the ability to perform activities of daily living that occurs in relation to hospitalization and cannot be explained by the acute illness alone. HAD affects up to 30% of acutely hospitalized older adults and is associated with adverse outcomes, including an increased risk of discharge to a nursing home, readmission, and mortality. Furthermore, patients who develop HAD are at risk of not regaining their pre-admission functional level and experiencing persistent functional decline after discharge.

Physical activity and exercise are recommended as strategies to prevent HAD. However, many acutely hospitalized older adults have limited capacity or motivation to engage in structured exercise. It therefore remains unclear how much physical activity during hospitalization is sufficient to reduce the risk of HAD and which types of physical activity patients are able and prefer to perform. The study will also examine patients' ability and preferences for different types of physical activity during hospitalization and explore their motivation, barriers, and preferences for physical activity after discharge.

The results may help identify clinically relevant levels of physical activity during hospitalization and contribute to more patient-centered approaches to supporting physical activity and preventing functional decline during and after hospitalization.

Eligibility

Primary outcome measure(s)

• Hospital-associated disability — At inclusion and 1, 4 and 8 weeks after discharge
  Hospital-associated disability (HAD) is defined as a new decline in functional independence in at least one activity compared with the participant's pre-admission level. Functional independence is assessed using three components: six basic activities of daily living from the Katz Index (bathing, dressing, toileting, transferring, continence, and feeding); five instrumental activities of daily living inspired by the Lawton IADL Index (shopping, housekeeping, laundry, food preparation, and medication management); and four mobility-related activities (walking 400 meters without rest, climbing or descending one flight of stairs without rest, carrying 5 kg, and driving a car). Each activity is scored as unable to perform (0), able to perform with assistance (1), or able to perform independently (2). Participants with a decline in independence in at least one activity compared with their retrospectively assessed pre-admission level are classified as having HAD.
• Imagined ability to perform physical activity during hospitalization — At inclusion
  Participants' imagined ability to perform physical activity during hospitalization will be assessed by asking whether they can imagine performing the activity daily during hospitalization. Imagined ability will be assessed for hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions) and group-based functionel training.
• Actual ability to perform physical activity during hospitalization — At inclusion
  Participants' actual ability to perform physical activity during hospitalization will be assessed by asking them to perform hallway walking (200 steps) and resistance exercise (three sets of 8-12 sit-to-stand repetitions). For each activity, actual ability will be categorized as able to complete the activity as defined, 0) unable to complete the activity, 1) able to complete the activity with assistance and 2) able to complete the activity independently. Reasons for inability to complete an activity will be recorded.
• Preferred type of physical activity during hospitalization — At inclusion
  Participants will be asked which type of physical activity they prefer: hallway walking, resistance training and group-based functional training. (Group-based functional training will be assessed as a preference only and will not be physically performed as part of the assessment).

Trial sites (1)

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