Background

Acute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.

Methods

Relevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19^th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.

Results

Fifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19–1.08) and 1–3 months post-discharge (SMD = 0.29, 95%CI = 0.13–0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18–0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).

Conclusions

In-hospital supervised exercise interventions seem overall safe and effective for improving – or attenuating the decline of – functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.

中文翻译：

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运动干预对急性住院老年人功能状态的影响：系统评价和荟萃分析。

背景

急性住院会对老年人产生不利影响，尤其是功能下降。我们旨在总结运动干预对急性住院老年人的影响的证据。

方法

系统地搜索了相关文章（PubMed，Web of Science，康复与运动医学资料来源和EMBASE），直到2020年3月19^日。针对老年人（> 60岁）进行的院内运动干预与常规护理的随机对照试验（RCT）。包括因急性疾病住院的患者。研究的方法学质量用PEDro量表评估。主要结果包括功能独立性和身体机能。还评估了其他主要结局（住院时间，再入院率和死亡率）的干预效果。当≥3项研究分析相同结果时，进行荟萃分析。

结果

包括来自12个RCT的15项研究（n = 1748）。研究的方法学质量总体上很高。没有研究报告任何与干预有关的不良事件。运动干预改善了出院时的功能独立性（标准平均差异[SMD] = 0.64，95％置信区间= 0.19–1.08）和出院后1-3个月（SMD = 0.29，95％CI = 0.13–0.43）作为物理性能（SMD = 0.57，95％CI = 0.18–0.95）。在住院时间，再入院或死亡风险方面均未发现组间差异（所有p > 0.05）。

结论

院内监督运动干预对于改善或减轻急性住院的老年人的功能独立性和身体机能的下降总体而言是安全有效的。这些发现的临床意义仍有待进一步研究证实。