The journal of nutrition, health & aging

, Volume 20, Issue 7, pp 738–751 | Cite as

Physical activity and early rehabilitation in hospitalized elderly medical patients: Systematic review of randomized clinical trials

  • N. Martínez-Velilla
  • E. L. Cadore
  • Á. Casas-Herrero
  • F. Idoate-Saralegui
  • Mikel Izquierdo



To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients.


Systematic review of the literature.


A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar,, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described.


From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned.


The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.


Acute care hospital aged feasibility physical performance 


  1. 1.
    Volpato S, Onder G, Cavalieri M, Guerra G, Sioulis F, Maraldi C, Zuliani G, Fellin R; Italian Group of Pharmacoepidemiology in the Elderly Study (GIFA). Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med 2007; 22:668–674.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc 2009; 57:1660–1665.CrossRefPubMedGoogle Scholar
  3. 3.
    Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003; 51:451–458.CrossRefPubMedGoogle Scholar
  4. 4.
    Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc 2004; 52:1263–1270.CrossRefPubMedGoogle Scholar
  5. 5.
    Allman RM, Goode PS, Patrick MM, Burst N, Bartolucci AA. Pressure ulcer risk factors among hospitalized patients with activity limitation. JAMA 1995; 273:865–870.CrossRefPubMedGoogle Scholar
  6. 6.
    Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118:219–223.CrossRefPubMedGoogle Scholar
  7. 7.
    Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med 1982; 16:1033–1038.CrossRefPubMedGoogle Scholar
  8. 8.
    Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med 1997; 12:203–208.PubMedGoogle Scholar
  9. 9.
    Covinsky KE, King JT, Quinn LM, Palmer RM, Landefeld CS. Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective. J Am Geriatr Soc 1997; 45:729–734.CrossRefPubMedGoogle Scholar
  10. 10.
    Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci 1999; 54:M521–526.CrossRefPubMedGoogle Scholar
  11. 11.
    Hannan EL, Magaziner J, Wang JJ, Eastwood EA, Silberzweig SB, Gilbert M, Morrison RS, McLaughlin MA, Orosz GM, Siu AL. Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 2001; 285:2736–2742.CrossRefPubMedGoogle Scholar
  12. 12.
    Hirsch CH, Sommers L, Olsen A, Mullen L, Winograd CH. The natural history of functional morbidity in hospitalized older patients. J Am Geriatr Soc 1990; 38:1296–1303.CrossRefPubMedGoogle Scholar
  13. 13.
    Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM, Hurst LD, Tinetti ME. A predictive index for functional decline in hospitalized elderly medical patients. J Gen Intern Med 1993; 8:645–652.CrossRefPubMedGoogle Scholar
  14. 14.
    Lakhan P, Jones M, Wilson A, Courtney M, Hirdes J, Gray LC. A prospective cohort study of geriatric syndromes among older medical patients admitted to acute care hospitals. J Am Geriatr Soc 2011; 59:2001–2008.CrossRefPubMedGoogle Scholar
  15. 15.
    Narain P, Rubenstein LZ, Wieland GD, Rosbrook B, Strome LS, Pietruszka F, Morley JE. Predictors of immediate and 6-month outcomes in hospitalized elderly patients. The importance of functional status. J Am Geriatr Soc 1988; 36:775–783.CrossRefPubMedGoogle Scholar
  16. 16.
    Rudberg MA, Sager MA, Zhang J. Risk factors for nursing home use after hospitalization for medical illness. J Gerontol A Biol Sci Med Sci 1996; 51:M189–194.CrossRefPubMedGoogle Scholar
  17. 17.
    Sager MA, Rudberg MA, Jalaluddin M, Landefeld CS, Morgan TM, Rudberg MA, Sebens H, Winograd CH. Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization. J Am Geriatr Soc 1996; 44:251–257.CrossRefPubMedGoogle Scholar
  18. 18.
    Sager MA, Franke T, Inouye SK, Landefeld CS, Morgan TM, Rudberg MA, Sebens H, Winograd CH. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996; 156:645–652.CrossRefPubMedGoogle Scholar
  19. 19.
    Lamont CT, Sampson S, Matthias R, Kane R. The outcome of hospitalization for acute illness in the elderly. J Am Geriatr Soc 1983; 31:282–288.CrossRefPubMedGoogle Scholar
  20. 20.
    McVey LJ, Becker PM, Saltz CC, Feussner JR, Cohen HJ. Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial. Ann Intern Med 1989; 110:79–84.PubMedGoogle Scholar
  21. 21.
    Warshaw GA, Moore JT, Friedman SW, Currie CT, Kennie DC, Kane WJ, Mears PA. Functional disability in the hospitalized elderly. JAMA 1982; 248, 847–850.CrossRefPubMedGoogle Scholar
  22. 22.
    Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc 2011; 59:266–273.CrossRefPubMedGoogle Scholar
  23. 23.
    Martinez-Velilla N, Urbistondo-Lasa G, Veintemilla-Erice E, Cambra-Contín K. Determining the hours hospitalised patients are bedridden due to their medical condition and functional impairment and secondary mortality. Rev Esp Geriatr Gerontol 2013; 48:96.CrossRefPubMedGoogle Scholar
  24. 24.
    Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, Burant C, Covinsky KE. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 2008; 56:2171–2179.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Boyd CM, Ricks M, Fried LP, Guralnik JM, Xue QL, Xia J, Bandeen-Roche K. Functional decline and recovery of activities of daily living in hospitalized, disabled older women: the Women’s Health and Aging Study I. J Am Geriatr Soc 2009; 57:1757–1766.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mudge AM, O’Rourke P, Denaro CP. Timing and risk factors for functional changes associated with medical hospitalization in older patients. J Gerontol A Biol Sci Med Sci 2010; 65: 866–872.CrossRefPubMedGoogle Scholar
  27. 27.
    Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E, Conger S, Lombeida J, Wolfe R, Evans WJ. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci 2008; 63:1076–1081.CrossRefPubMedGoogle Scholar
  28. 28.
    Izquierdo M, Aguado X, Gonzalez R, López JL, Häkkinen K. Maximal and explosive force production capacity and balance performance in men of different ages. Eur J Appl Physiol Occup Physiol 1999; 79:260–267.CrossRefPubMedGoogle Scholar
  29. 29.
    Casas-Herrero A, Cadore EL, Zambom-Ferraresi F, Idoate F, Millor N, Martínez-Ramírez A, Gómez M, Rodríguez-Mañas L, Marcellan T, Ruiz de Gordoa A, Marques MC, Izquierdo M. Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old. Rejuvenation Res 2013; 16:396–403.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Mañas L. [Efficiency of acute geriatric units: a meta-analysis of controlled studies]. Rev Esp Geriatr Gerontol 2011; 46:186–192.CrossRefPubMedGoogle Scholar
  31. 31.
    Gutierrez Rodriguez J, Dominguez Rojas V, Solano Jaurrieta JJ. [Functional deterioration secondary to hospitalization for an acute disease in the elderly. An analysis of its incidence and the associated risk factors]. Rev Clin Esp 1999; 199:418–423.PubMedGoogle Scholar
  32. 32.
    Arora VM, Plein C, Chen S, Sachs GA, Meltzer DO. Relationship between quality of care and functional decline in hospitalized vulnerable elders. Med Care 2009; 47:895–901.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Courtney MD, Edwards HE, Chang AM, Parker AW, Finlayson K, Bradbury C, Nielsen Z. Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. J Eval Clin Pract 2012; 18:128–134.CrossRefPubMedGoogle Scholar
  34. 34.
    Fisher SR, Kuo YF, GrahAm JE, Ottenbacher KJ, Ostir GV. Early ambulation and length of stay in older adults hospitalized for acute illness. Arch Intern Med 2010;170:1942–1943.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Cadore EL, Moneo AB, Mensat MM, Muñoz AR, Casas-Herrero A, Rodriguez-Mañas L, Izquierdo M. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age (Dordr) 2014; 36:801–811.CrossRefGoogle Scholar
  36. 36.
    Baztan JJ, Galvez CP, Socorro A. Recovery of functional impairment after acute illness and mortality: one-year follow-up study. Gerontology 2009; 55:269–274.CrossRefPubMedGoogle Scholar
  37. 37.
    de Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials. Clin Rehabil 2007; 21:3–16.CrossRefPubMedGoogle Scholar
  38. 38.
    de Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2007; CD005955.Google Scholar
  39. 39.
    Kosse NM, Dutmer AL, Dasenbrock L, Bauer JM, Lamoth CJ. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review. BMC Geriatr 2013; 13:107.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Urrútia G, Bonfill X. [PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses]. Med Clin (Barc) 2010; 135:507–511.CrossRefGoogle Scholar
  41. 41.
    Collard AF, Bachman SS, Beatrice DF. Acute care delivery for the geriatric patient: an innovative approach. QRB Qual Rev Bull 1985; 11:180–185.PubMedGoogle Scholar
  42. 42.
    Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995; 332:1338–1344.CrossRefPubMedGoogle Scholar
  43. 43.
    Tibaek S, Andersen CW, Pedersen SF, Rudolf KS. Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial. Clin Rehabil 2014; 28:319–328.CrossRefPubMedGoogle Scholar
  44. 44.
    Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O. Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc 2002; 50:792–798.CrossRefPubMedGoogle Scholar
  45. 45.
    Nikolaus T, Specht-Leible N, Bach M, Oster P, Schlierf G. A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing 1999; 28:543–550.CrossRefPubMedGoogle Scholar
  46. 46.
    Saltvedt I, Jordhøy M, Opdahl Mo ES, Fayers P, Kaasa S, Sletvold O. Randomised trial of in-hospital geriatric intervention: impact on function and morale. Gerontology 2006; 52:223–230.CrossRefPubMedGoogle Scholar
  47. 47.
    Abizanda P, León M, Domínguez-Martín L, Lozano-Berrio V, Romero L, Luengo C, Sánchez-Jurado PM, Martín-Sebastiá E. Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial. Maturitas 2011; 69:273–278.PubMedGoogle Scholar
  48. 48.
    Asplund K, Gustafson Y, Jacobsson C, Bucht G, Wahlin A, Peterson J, Blom JO, Angquist KA. Geriatric-based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. J Am Geriatr Soc 2000; 48, 1381–1388.CrossRefPubMedGoogle Scholar
  49. 49.
    Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc, 2000; 48:1572–1581.CrossRefPubMedGoogle Scholar
  50. 50.
    Courtney M, Edwards H, Chang A, Finlayson K, Hamilton K. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. J Am Geriatr Soc 2009; 57:395–402.CrossRefPubMedGoogle Scholar
  51. 51.
    Jones CT, Lowe AJ, MacGregor L, Brand CA, Tweddle N, Russell DM. A randomised controlled trial of an exercise intervention to reduce functional decline and health service utilisation in the hospitalised elderly. Aust J Ageing 2006; 25:126–133.CrossRefGoogle Scholar
  52. 52.
    Laver K, George S, Ratcliffe J, Fortinsky RH, Kowal J. Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial. Disabil Rehabil 2012; 34:1802–1808.CrossRefPubMedGoogle Scholar
  53. 53.
    Siebens H, Aronow H, Edwards D, Ghasemi Z. A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc 2000; 48:1545–1552.CrossRefPubMedGoogle Scholar
  54. 54.
    Slaets JP, Kauffmann RH, Duivenvoorden HJ, Pelemans W, Schudel WJ. A randomized trial of geriatric liaison intervention in elderly medical inpatients. Psychosom Med 1997; 59:585–591.CrossRefPubMedGoogle Scholar
  55. 55.
    Blanc-Bisson C, Dechamps A, Gouspillou G, Dehail P, Bourdel-Marchasson I. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes. J Nutr Health Aging 2008; 12:395–399.CrossRefPubMedGoogle Scholar
  56. 56.
    de Morton NA, Keating JL, Berlowitz DJ, Jackson B, Lim WK. Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. Aust. J Physiother 2007; 53:105–111.CrossRefPubMedGoogle Scholar
  57. 57.
    Mallery LH, MacDonald EA, Hubley-Kozey CL, Earl ME, Rockwood K, MacKnight C. The feasibility of performing resistance exercise with acutely ill hospitalized older adults. BMC Geriatr 2003; 3:3.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Nolan J, Thomas S. Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project. BMC Health Serv Res 2008; 8:250.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Brown CJ, Peel C, Bamman MM, Allman RM. Exercise program implementation proves not feasible during acute care hospitalization. J Rehabil Res Dev 2006; 43:939–946.CrossRefPubMedGoogle Scholar
  60. 60.
    Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Idoate F, Millor N, Gómez M, Rodriguez-Mañas L, Izquierdo M. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr) 2014; 36:773–785.CrossRefGoogle Scholar
  61. 61.
    Cadore EL, Izquierdo M. New strategies for the concurrent strength-, power-, and endurance-training prescription in elderly individuals. J Am Med Dir Assoc 2013; 14:623–624.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2016

Authors and Affiliations

  • N. Martínez-Velilla
    • 1
  • E. L. Cadore
    • 1
  • Á. Casas-Herrero
    • 1
  • F. Idoate-Saralegui
    • 1
  • Mikel Izquierdo
    • 1
  1. 1.Department of Health SciencesPublic University of Navarra (Navarra) SpainTudela (Navarra)Spain

Personalised recommendations