Exercise for Hospitalized Older Adults

  • Gail M. SullivanEmail author

Key Points

  • Older adults are at high risk for deconditioning as a result of bed rest during hospitalization.

  • Deconditioning results in loss of function and discharge to higher levels of care, such as a nursing home, even after short or elective hospital stays.

  • Older adults can participate in walking, resistance exercises, and early rehabilitation programs without increasing adverse events during acute hospitalization.

  • Geriatric acute hospital units using comprehensive geriatric assessment, multidisciplinary teams, and interventions targeted to preserving function and mobility have the strongest evidence for reducing decline.

  • Older adults for whom exercise may present significant risk or for whom exercise is not possible may benefit from passive range of motion and changes in position.

  • System-wide interventions, such as changing the default activity order to out of bed, are recommended by experts yet require more study.


Hospital Older adult Elder Deconditioning Immobility Bed rest Exercise Geriatric assessment Geriatric unit ACE unit Geriatric consult team Physical therapy Walking in hospital 


  1. 1.
    Healthcare Cost and Utilization Project (HCUP). Hospital utilization among oldest old; 2008. Accessed 16 Mar 2015.
  2. 2.
    Hirsch CH, Sommers L, Olsen A, et al. The natural history of functional morbidity in hospitalized older adults. J Am Geriatr Soc. 1990;38:1296–303.CrossRefPubMedGoogle Scholar
  3. 3.
    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;65:866–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Narain P, Rubenstein LZ, Wieland DG, et al. Predictors of immediate and 6-month outcomes in hospitalized elderly patients. J Am Geriatr Soc. 1998;36:775–83.CrossRefGoogle Scholar
  5. 5.
    Callen BL, Mahoney JE, Grieves CB, et al. Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatr Nurs. 2004;25:212–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004;52(8):1263–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Siebens H, Aronow H, Edwards D, et al. A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. J Am Geriatr Soc. 2000;48:1545–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Nolan JS, Remilton LE, Green MM. The reliability and validity of the Elderly Mobility Scale in the acute hospital setting. Internet J Allied Health Sci Pract. 2008; 6(4):1–7.Google Scholar
  9. 9.
    Rockwood K, Rockwood MRH, Andrew MK, et al. Reliability of the hierarchical assessment of balance and mobility in frail older adults. J Am Geriatr Soc. 2008;56(7):1213–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Ellis G, Whitehead MA, Robinson D, et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d6553.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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
  12. 12.
    de Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev. 2007;(1):CD005955.Google Scholar
  13. 13.
    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
  14. 14.
    Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008;300:1685–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil. 2014;1–11.Google Scholar
  17. 17.
    Tucker D, Molsberger SC, Clark A. Walking for wellness: a collaborative program to maintain mobility in hospitalized older adults. Geriatr Nurs. 2004;25(4):242–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Markey DW, Brown RJ. An interdisciplinary approach to addressing patient activity and mobility in the medical-surgical patient. J Nurs Care Qual. 2002;16(4):1–12.CrossRefPubMedGoogle Scholar


  1. Hospital Elder Life Program (HELP) program to reduce delirium in hospitalized older adults, which prevents functional loss. Accessed 9 Dec 2014.
  2. Kleinpell RM, Fletcher K, Jennings BM. Reducing functional decline in hospitalized elders, in patient safety and quality: an evidence-based handbook for nurses, Chap. 11. Hughes RG, editor. Rockville: Agency for Healthcare Research and Quality; 2008. Accessed 9 Dec 2014.
  3. Nurses Improving Care for Healthsystem Elders (NICHE) Try This® series of assessment tools, For reducing hospital functional decline, Accessed 9 Dec 2014.

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.UConn Center on AgingUniversity of Connecticut School of MedicineFarmingtonUSA

Personalised recommendations