Walk slowly for 25 minutes a day to counter the impact of bedrest, older hospital patients told

‘Post hospital syndrome’

Older people admitted to hospital – even those who can walk unaided – spend most of their stay in bed. But this level of inactivity can cause ‘post hospital syndrome’ – a period of vulnerability after discharge associated with general physical deconditioning. 

If not actively managed, this may have various consequences, including readmission, disability, the need for nursing home care, illness, or death, emphasise the researchers. They point to research findings that show that getting older hospital patients out of bed and moving about can help to stave off physical decline, but it’s not clear what type of activity, or how much of it, might be most effective.

In a bid to find out, the researchers looked for published clinical trials that involved people over the age of 50 who had been admitted to hospital for a serious bout of illness and prescribed any form of physical activity during their inpatient stay. They only included trials that involved a comparison group receiving usual care or another type of physical activity; that assessed changes in functional capacity – ability to perform routine activities of daily living, for example – and that recorded any adverse consequences, at discharge or at any subsequent monitoring point.

The researchers focused on 19 clinical trials out of an initial haul of 44, involving 3,842 participants and published from 2000 to 2022. The final analysis included 3,783 participants, 2,087 of whom were women (55 per cent) , with ages ranging from 55 to 87. Their average length of stay was seven days, and the average monitoring period after discharge was 68 days.

If the most potent intervention is provided [walking], the beneficial effects of in-hospital supervised physical activity programmes can be maximised with as little as around 25 minutes a day of slow-paced walking [Daniel Gallardo-Gómez et al]

Results

Pooling the trial results showed that the minimal ‘dose’ required to counter the effects of bedrest and improve older inpatients’ functional capacity was estimated to be around 40 minutes a day of light intensity physical activity or around 25 minutes a day of moderate intensity physical activity. And the optimal ‘dose’ was estimated to be 70 minutes a day of light intensity activity, or about 40 minutes a day of moderate intensity physical activity. 

There was no clear benefit for ‘doses’ of more than 90 minutes a day of light intensity, or 60 minutes a day of moderate intensity physical activity, suggesting a threshold effect. In terms of the best type of physical activity to ward off physical decline, a mix of physical activity in any one daily session and slow-paced walking were deemed the most effective. 

But only walking was more than 80 per cent effective, with the optimal dose reached at around 50 minutes a day, and the minimal effective dose reached at 25 minutes a day.

The analysis showed that the effectiveness of physical activity interventions increased from admission to discharge, peaking at around 19 days after discharge.

The fall rate – the most common occurrence after discharge – was similar among the intervention and comparison groups, but those prescribed physical activity experienced fewer adverse consequences, overall, than those given usual care. 

Limitations and conclusions

The researchers acknowledge that there was little information on monitoring frequency after discharge and that only participants who were able to move unaided were included – both of which may weaken the findings and the wider applicability of their findings.

But they point out: ‘Older adults are projected to comprise more than 60 per cent of the total hospital inpatient population by 2030. Based on the existing evidence to date, this review has shown the optimal type and dose of physical activity necessary to prevent functional decline and reduce adverse events in older adults admitted to hospital.'

And they conclude: ‘If the most potent intervention is provided [walking], the beneficial effects of in-hospital supervised physical activity programmes can be maximised with as little as around 25 minutes a day of slow-paced walking, an achievable target for most hospitalised older adults. 

‘Together, this meta-analysis has yielded critical information to support the use of physical activity as a core part of the daily routine of acutely hospitalised older adults.’

The article is titled 'Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials'. See: https://bjsm.bmj.com/