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Promotion of Physical Activity for Acutely Unwell Older People

  • Nina Beyer
  • Charlotte Suetta
Chapter

Abstract

Hospitalisation is associated with an increased risk of hospital-associated disability among older patients, and bed rest and physical inactivity contribute to this. The functional decline is costly in both economic and human terms. Focus on mobilisation and training during hospitalisation has only been present in recent decades. However, the existing evidence shows that mobilisation and exercise during hospitalisation is safe and results in improved physical performance and an increased chance of being discharged back to one’s own home. Nevertheless, what can and should be done to best counteract loss of muscle mass, muscle strength, and hospitalisation-associated disability is still unclear, and thus there is a great need for research in this field.

References

  1. Allen, C., Glasziou, P., & Del Mar, C. (1999). Bed rest: A potentially harmful treatment needing more careful evaluation. Lancet, 354(9186), 1229–1233.CrossRefGoogle Scholar
  2. Alley, D. E., Koster, A., Mackey, D., Cawthon, P., Ferrucci, L., Simonsick, E. M., et al. (2010). Hospitalization and change in body composition and strength in a population-based cohort of older persons. Journal of the American Geriatrics Society, 58(11), 2085–2091.CrossRefGoogle Scholar
  3. Bean, J. F., Kiely, D. K., LaRose, S., O’Neill, E., Goldstein, R., & Frontera, W. R. (2009). Increased velocity exercise specific to task training versus the National Institute on Aging’s strength training program: Changes in limb power and mobility. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64((9), 983–991.CrossRefGoogle Scholar
  4. Berian, J. R., Mohanty, S., Ko, C. Y., Rosenthal, R. A., & Robinson, T. N. (2016). Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. Journal of the American Medical Association Surgery, 151(9), e161689.Google Scholar
  5. Bodilsen, A. C., Pedersen, M. M., Petersen, J., Beyer, N., Andersen, O., Smith, L. L., Kehlet, H., & Bandholm, T. (2013). Acute hospitalization of the older patient: Changes in muscle strength and functional performance during hospitalization and 30 days after discharge. American Journal of Physical Medicine and Rehabilitation, 92(9), 789–796.CrossRefGoogle Scholar
  6. Bodilsen, A. C., Klausen, H. H., Petersen, J., Beyer, N., Andersen, O., Jørgensen, L. M., Juul-Larsen, H. G., & Bandholm, T. (2016). Prediction of mobility limitations after hospitalization in older medical patients by simple measures of physical performance obtained at admission to the emergency department. PLoS One, 11(5), e0154350.CrossRefGoogle Scholar
  7. Boyd, C. M., Landefeld, C. S., Counsell, S. R., Palmer, R. M., Fortinsky, R. H., Kresevic, D., Burant, C., & Covinsky, K. E. (2008). Recovery of activities of daily living in older adults after hospitalization for acute medical illness. Journal of the American Geriatrics Society, 56(12), 2171–2179.CrossRefGoogle Scholar
  8. Breen, L., Stokes, K. A., Churchward-Venne, T. A., Moore, D. R., Baker, S. K., Smith, K., et al. (2013). Two weeks of reduced activity decreases leg lean mass and induces “anabolic resistance” of myofibrillar protein synthesis in healthy elderly. Journal of Clinical Endocrinology and Metabolism, 98(6), 2604–2612.CrossRefGoogle Scholar
  9. Brown, C. J., Friedkin, R. J., & Inouye, S. K. (2004). Prevalence and outcomes of low mobility in hospitalized older patients. Journal of the American Geriatrics Society, 52(8), 1263–1270.CrossRefGoogle Scholar
  10. Brown, C. J., Roth, D. L., Allman, R. M., Sawyer, P., Ritchie, C. S., & Roseman, J. M. (2009). Trajectories of life-space mobility after hospitalization. Annals of Internal Medicine, 150(6), 372–378.CrossRefGoogle Scholar
  11. Brown, C. J., Foley, K. T., Lowman, J. D., Jr., MacLennan, P. A., Razjouyan, J., Najafi, B., Locher, J., & Allman, R. M. (2016). Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: A randomized clinical trial. Journal of the American Medical Association Internal Medicine, 176(7), 921–927.Google Scholar
  12. Callen, B. L., Mahoney, J. E., Grieves, C. B., Wells, T. J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25(4), 212–217.CrossRefGoogle Scholar
  13. Cermak, N. M., Res, P. T., de Groot, L. C., Saris, W. H., & van Loon, L. J. (2012). Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: A meta-analysis. American Journal of Clinical Nutrition, 96(6), 1454–1464.CrossRefGoogle Scholar
  14. Convertino, V. A. (1997). Cardiovascular consequences of bed rest: Effect on maximal oxygen uptake. Medicine and Science in Sports and Exercise, 29(2), 191–196.CrossRefGoogle Scholar
  15. Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451–458.CrossRefGoogle Scholar
  16. Covinsky, K. E., Pierluissi, E., & Johnston, C. B. (2011). Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure”. Journal of the American Medical Association, 306(16), 1782–1793.Google Scholar
  17. Davenport, S. J., Arnold, M., Hua, C., Schenck, A., Batten, S., & Taylor, N. F. (2015). Physical activity levels during acute inpatient admission after hip fracture are very low. Physiotherapy Research International, 20(3), 174–181.CrossRefGoogle Scholar
  18. de Morton, N. A., Keating, J. L., & Jeffs, K. (2007). Exercise for acutely hospitalised older medical patients. Cochrane Database of Systematic Reviews, 1, CD005955.Google Scholar
  19. Diong, J., Allen, N., & Sherrington, C. (2016). Structured exercise improves mobility after hip fracture: A meta-analysis with meta-regression. British Journal of Sports Medicine, 50(6), 346–355.CrossRefGoogle Scholar
  20. Emed, J. D., Morrison, D. R., Des Rosiers, L., & Kahn, S. R. (2010). Definition of immobility in studies of thromboprophylaxis in hospitalized medical patients: A systematic review. Journal of Vascular Nursing, 28(2), 54–66.CrossRefGoogle Scholar
  21. Feldstein, C., & Weder, A. B. (2012). Orthostatic hypotension: A common, serious and underrecognized problem in hospitalized patients. Journal of the American Society of Hypertension, 6(1), 27–39.CrossRefGoogle Scholar
  22. Ferrando, A. A., Paddon-Jones, D., Hays, N. P., Kortebein, P., Ronsen, O., Williams, R. H., McComb, A., Symons, T. B., Wolfe, R. R., & Evans, W. (2010). EAA supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly. Clinical Nutrition, 29(1), 18–23.CrossRefGoogle Scholar
  23. Fiatarone, M. A., O’Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., Roberts, S. B., Kehayias, J. J., Lipsitz, L. A., & Evans, W. J. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine, 330(25), 1769–1775.CrossRefGoogle Scholar
  24. Fisher, S. R., Goodwin, J. S., Protas, E. J., Kuo, Y. F., Graham, J. E., Ottenbacher, K. J., & Ostir, G. V. (2011). Ambulatory activity of older adults hospitalized with acute medical illness. Journal of the American Geriatrics Society, 59(1), 91–95.CrossRefGoogle Scholar
  25. Fisher, S. R., Graham, J. E., Ottenbacher, K. J., Deer, R., & Ostir, G. V. (2016). Inpatient walking activity to predict readmission in older adults. Archives of Physical Medicine and Rehabilitation, 97(9 Suppl), S226–S231.CrossRefGoogle Scholar
  26. Foss, N. B., Kristensen, M. T., & Kehlet, H. (2006). Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: The cumulated ambulation score. Clinical Rehabilitation, 20(8), 701–708.CrossRefGoogle Scholar
  27. Gibson, J. N., Smith, K., & Rennie, M. J. (1988). Prevention of disuse muscle atrophy by means of electrical stimulation: Maintenance of protein synthesis. Lancet, 2(8614), 767–770.CrossRefGoogle Scholar
  28. Gill, T. M., Allore, H. G., Gahbauer, E. A., & Murphy, T. E. (2010). Change in disability after hospitalization or restricted activity in older persons. Journal of the American Medical Association, 304(17), 1919–1928.CrossRefGoogle Scholar
  29. Haas, R., Sarkies, M., Bowles, K. A., O’Brien, L., & Haines, T. (2016). Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: A systematic review and meta-analysis examining allied health service models. Osteoarthritis and Cartilage, 24(10), 1667–1681.CrossRefGoogle Scholar
  30. Harridge, S. D., Kryger, A., & Stensgaard, A. (1999). Knee extensor strength, activation, and size in very elderly people following strength training. Muscle and Nerve, 22(7), 831–839.CrossRefGoogle Scholar
  31. Hastings, S. N., Sloane, R., Morey, M. C., Pavon, J. M., & Hoenig, H. (2014). Assisted early mobility for hospitalized older veterans: Preliminary data from the STRIDE program. Journal of the American Geriatrics Society, 62(11), 2180–2184.CrossRefGoogle Scholar
  32. Horn, S. D., DeJong, G., & Deutscher, D. (2012). Practice-based evidence research in rehabilitation: An alternative to randomized controlled trials and traditional observational studies. Archives of Physical Medicine and Rehabilitation, 93(8 Suppl), S127–S137.CrossRefGoogle Scholar
  33. Hvid, L. G., Suetta, C., Nielsen, J. H., Jensen, M. M., Frandsen, U., Ørtenblad, N., Kjaer, M., & Aagaard, P. (2014). Aging impairs the recovery in mechanical muscle function following 4 days of disuse. Experimental Gerontology, 52, 1–8.CrossRefGoogle Scholar
  34. Iovino, P., Chiarioni, G., Bilancio, G., Cirillo, M., Mekjavic, I. B., Pisot, R., & Ciacci, C. (2013). New onset of constipation during long-term physical inactivity: A proof-of-concept study on the immobility-induced bowel changes. PLoS One, 8(8), e72608.CrossRefGoogle Scholar
  35. Karlsen, A., Loeb, M. R., Andersen, K. B., Joergensen, K. J., Scheel, F. U., Turtumoeygard, I. F., Perez, A. L., Kjaer, M., & Beyer, N. (2016). Improved functional performance in geriatric patients during hospital stay. American Journal of Physical Medicine & Rehabilitation, 96(5), e78–e84.CrossRefGoogle Scholar
  36. Kehlet, H. (1997). Multimodal approach to control postoperative pathophysiology and rehabilitation. British Journal of Anaesthesia, 78(5), 606–617.CrossRefGoogle Scholar
  37. Kortebein, P., Symons, T. B., Ferrando, A., Paddon-Jones, D., Ronsen, O., Protas, E., Conger, S., Lombeida, J., Wolfe, R., & Evans, W. J. (2008). Functional impact of 10 days of bed rest in healthy older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63(10), 1076–1081.CrossRefGoogle Scholar
  38. Kosse, N. M., Dutmer, A. L., Dasenbrock, L., Bauer, J. M., & Lamoth, C. J. (2013). Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: A systematic review. BMC Geriatrics, 13, 107. https://doi.org/10.1186/1471-2318-13-107.CrossRefGoogle Scholar
  39. Kronborg, L., Bandholm, T., Palm, H., Kehlet, H., & Kristensen, M. T. (2014). Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery. PLoS One, 9(4), e93332.CrossRefGoogle Scholar
  40. Lindgren, M., Unosson, M., Fredrikson, M., & Ek, A. C. (2004). Immobility – A major risk factor for development of pressure ulcers among adult hospitalized patients: A prospective study. Scandinavian Journal of Caring Sciences, 18(1), 57–64.CrossRefGoogle Scholar
  41. Maffiuletti, N. A. (2010). Physiological and methodological considerations for the use of neuromuscular electrical stimulation. European Journal of Applied Physiology, 110(2), 223–234.CrossRefGoogle Scholar
  42. Maffiuletti, N. A., Roig, M., Karatzanos, E., & Nanas, S. (2013). Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: A systematic review. BMC Medicine, 11, 137.CrossRefGoogle Scholar
  43. Manini, T., Marko, M., VanArnam, T., Cook, S., Fernhall, B., Burke, J., & Ploutz-Snyder, L. (2007). Efficacy of resistance and task-specific exercise in older adults who modify tasks of everyday life. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(6), 616–623.CrossRefGoogle Scholar
  44. Manton, K. G., Corder, L. S., & Stallard, E. (1993). Estimates of change in chronic disability and institutional incidence and prevalence rates in the U.S. elderly population from the 1982, 1984, and 1989 National Long Term Care Survey. Journal of Gerontology, 48(4), S153–S166.CrossRefGoogle Scholar
  45. McGavock, J. M., Hastings, J. L., Snell, P. G., McGuire, D. K., Pacini, E. L., Levine, B. D., & Mitchell, J. H. (2009). A forty-year follow-up of the Dallas bed rest and training study: The effect of age on the cardiovascular response to exercise in men. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64((2), 293–299.CrossRefGoogle Scholar
  46. Mitchell, R., Harvey, L., Brodaty, H., Draper, B., & Close, J. (2016). Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals. Disability and Rehabilitation, 14, 1–10.Google Scholar
  47. Mudge, A. M., O’Rourke, P., & Denaro, C. P. (2010). Timing and risk factors for functional changes associated with medical hospitalization in older patients. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 65(8), 866–872.CrossRefGoogle Scholar
  48. Paton, F., Chambers, D., Wilson, P., Eastwood, A., Craig, D., Fox, D., Jayne, D., & McGinnes, E. (2014). Effectiveness and implementation of enhanced recovery after surgery programmes: A rapid evidence synthesis. BMJ Open, 4(7), e005015.CrossRefGoogle Scholar
  49. Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine – Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine and Science in Sports, 25(Suppl 3), 1–72.CrossRefGoogle Scholar
  50. Pedersen, M. M., Bodilsen, A. C., Petersen, J., Beyer, N., Andersen, O., Lawson-Smith, L., Kehlet, H., & Bandholm, T. (2013). Twenty-four-hour mobility during acute hospitalization in older medical patients. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 68(3), 331–337.CrossRefGoogle Scholar
  51. Pedersen, M. M., Petersen, J., Bean, J. F., Damkjaer, L., Juul-Larsen, H. G., Andersen, O., Beyer, N., & Bandholm, T. (2015). Feasibility of progressive sit-to-stand training among older hospitalized patients. PeerJ, 3, e1500.CrossRefGoogle Scholar
  52. Ploutz-Snyder, L. L., Manini, T., Ploutz-Snyder, R. J., & Wolf, D. A. (2002). Functionally relevant thresholds of quadriceps femoris strength. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57(4), B144–B152.CrossRefGoogle Scholar
  53. Resnick, B., Wells, C., Galik, E., Holtzman, L., Zhu, S., Gamertsfelder, E., Laidlow, T., & Boltz, M. (2016). Feasibility and efficacy of function-focused Care for Orthopedic Trauma Patients. Journal of Trauma Nursing, 23(3), 144–155.CrossRefGoogle Scholar
  54. Roubenoff, R. (2000). Sarcopenia: A major modifiable cause of frailty in the elderly. Journal of Nutrition Health and Aging, 4(3), 140–142.Google Scholar
  55. Shih, S. L., Zafonte, R., Bates, D. W., Gerrard, P., Goldstein, R., Mix, J., Niewczyk, P., Greysen, S. R., Kazis, L., Ryan, C. M., & Schneider, J. C. (2016). Functional status outperforms comorbidities as a predictor of 30-day acute care readmissions in the inpatient rehabilitation population. Journal of the American Medical Directors Association, 17(10), 921–926.CrossRefGoogle Scholar
  56. Soga, Y., Yokoi, H., Ando, K., Shirai, S., Sakai, K., Kondo, K., Goya, M., Iwabuchi, M., & Nobuyoshi, M. (2010). Safety of early exercise training after elective coronary stenting in patients with stable coronary artery disease. European Journal of Cardiovascular Prevention and Rehabilitation, 17(2), 230–234.CrossRefGoogle Scholar
  57. Sourdet, S., Lafont, C., Rolland, Y., Nourhashemi, F., Andrieu, S., & Vellas, B. (2015). Preventable iatrogenic disability in elderly patients during hospitalization. Journal of the American Medical Directors Association, 16(8), 674–681.CrossRefGoogle Scholar
  58. Stenroth, L., Sillanpää, E., McPhee, J. S., Narici, M. V., Gapeyeva, H., Pääsuke, M., Barnouin, Y., Hogrel, J. Y., Butler-Browne, G., Bijlsma, A., Meskers, C. G., Maier, A. B., Finni, T., & Sipilä, S. (2015). Plantarflexor muscle-tendon properties are associated with mobility in healthy older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 70(8), 996–1002.CrossRefGoogle Scholar
  59. Suetta, C., Magnusson, S. P., Rosted, A., Aagaard, P., Jakobsen, A. K., Larsen, L. H., Duus, B., & Kjaer, M. (2004). Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients–a controlled, randomized study. Journal of the American Geriatrics Society, 52(12), 2016–2022.CrossRefGoogle Scholar
  60. Suetta, C., Magnusson, S. P., Beyer, N., & Kjaer, M. (2007). Effect of strength training on muscle function in elderly hospitalized patients. Scandinavian Journal of Medicine and Science in Sports, 17(5), 464–472.CrossRefGoogle Scholar
  61. Suetta, C., Hvid, L. G., Justesen, L., Christensen, U., Neergaard, K., Simonsen, L., Ortenblad, N., Magnusson, S. P., Kjaer, M., & Aagaard, P. (2009). Effects of aging on human skeletal muscle after immobilization and retraining. Journal of Applied Physiology (1985), 107(4), 1172–1180.CrossRefGoogle Scholar
  62. Suetta, C., Frandsen, U., Mackey, A. L., Jensen, L., Hvid, L. G., Bayer, M. L., Petersson, S. J., Schrøder, H. D., Andersen, J. L., Aagaard, P., Schjerling, P., & Kjaer, M. (2013). Ageing is associated with diminished muscle re-growth and myogenic precursor cell expansion early after immobility-induced atrophy in human skeletal muscle. Journal of Physiology, 591(15), 3789–3804.CrossRefGoogle Scholar
  63. Sullivan, D. H., Sun, S., & Walls, R. C. (1999). Protein-energy undernutrition among elderly hospitalized patients: A prospective study. Journal of the American Medical Association, 281(21), 2013–2019.CrossRefGoogle Scholar
  64. Sullivan, D. H., Wall, P. T., Bariola, J. R., Bopp, M. M., & Frost, Y. M. (2001). Progressive resistance muscle strength training of hospitalized frail elderly. American Journal of Physical Medicine and Rehabilitation, 80(7), 503–509.CrossRefGoogle Scholar
  65. Taraldsen, K., Sletvold, O., Thingstad, P., Saltvedt, I., Granat, M. H., Lydersen, S., & Helbostad, J. L. (2014). Physical behavior and function early after hip fracture surgery in patients receiving comprehensive geriatric care or orthopedic care – A randomized controlled trial. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69((3), 338–345.CrossRefGoogle Scholar
  66. Thingstad, P., Taraldsen, K., Saltvedt, I., Sletvold, O., Vereijken, B., Lamb, S. E., & Helbostad, J. L. (2016). The long-term effect of comprehensive geriatric care on gait after hip fracture: The Trondheim hip fracture trial–a randomised controlled trial. Osteoporosis International, 27(3), 933–942.CrossRefGoogle Scholar
  67. Tudor-Locke, C., Craig, C. L., Aoyagi, Y., Bell, R. C., Croteau, K. A., De Bourdeaudhuij, I., Ewald, B., Gardner, A. W., Hatano, Y., Lutes, L. D., Matsudo, S. M., Ramirez-Marrero, F. A., Rogers, L. Q., Rowe, D. A., Schmidt, M. D., Tully, M. A., & Blair, S. N. (2011). How many steps/day are enough? For older adults and special populations. International Journal of Behavioral Nutrition and Physical Activity, 8, 80.CrossRefGoogle Scholar
  68. Vandervoort, A. A. (2002). Aging of the human neuromuscular system. Muscle & Nerve, 25(1), 17–25.CrossRefGoogle Scholar
  69. Vanhees, L., Rauch, B., Piepoli, M., van Buuren, F., Takken, T., Börjesson, M., Bjarnason-Wehrens, B., Doherty, P., Dugmore, D., & Halle, M. (2012). Writing group, EACPR. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (part III). European Journal of Preventive Cardiology, 19(6), 1333–1356.CrossRefGoogle Scholar
  70. Volaklis, K. A., & Tokmakidis, S. P. (2005). Resistance exercise training in patients with heart failure. Sports Medicine, 35(12), 1085–1103.CrossRefGoogle Scholar
  71. Wells, J. L., & Dumbrell, A. C. (2006). Nutrition and aging: Assessment and treatment of compromised nutritional status in frail elderly patients. Clinical Interventions in Aging, 1(1), 67–79.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Nina Beyer
    • 1
  • Charlotte Suetta
    • 2
  1. 1.Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Clinical Physiology, Nuclear Medine & PET, Rigshospitalet and Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark

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