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.
Study Goal
The researchers aimed to identify the optimal dose and type of physical activity, including walking, to improve functional capacity and reduce adverse events in acutely hospitalized older adults.
Results Summary
The study found that as little as ~25 min/day of slow-paced walking improved functional capacity and minimized adverse events, with the optimal dose estimated at ~50 min/day. Physical activity interventions, particularly ambulation, were effective and safe, showing a decrease in adverse events compared to usual care.
Population
Acutely hospitalized older adults aged ≥50 years.
Effective Dosage
Minimal effective dose: ~25 min/day of slow-paced walking (74 METs-min/day); optimal dose: ~50 min/day (143 METs-min/day).
Duration
Median time of 7 days.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
physical activity-based intervention | increase | functional capacity | acute hospitalised older adults | SMD=0.28, 95% credible interval (CrI) 0.01 to 0.55 | improve | #1 |
physical activity-based intervention | increase | functional capacity | acute hospitalised older adults | 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72) | optimal dose to improve | #2 |
Ambulation | increase | functional capacity | acute hospitalised older adults | optimal dose at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16) | most efficient intervention | #3 |
Ambulation | increase | functional capacity | acute hospitalised older adults | 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41) | minimal effective dose | #4 |
Physical activity interventions | decrease | adverse events | acute hospitalised older adults | ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days | resulted in a decrease in the rate of | #5 |
in-hospital supervised physical activity programmes | increase | functional capacity and adverse events | acutely hospitalised older adults | - | low to moderate evidence supporting the use of | #6 |
~25 min/day of slow-paced walking | increase | functional capacity | this population | - | sufficient to improve | #7 |
~25 min/day of slow-paced walking | decrease | adverse events | this population | - | sufficient to minimise | #8 |
OBJECTIVE: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. DESIGN: Systematic review and Bayesian model-based network meta-analysis. DATA SOURCES: Four databases were searched from inception to 20 June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. RESULTS: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). CONCLUSIONS: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population. TRIAL REGISTRATION NUMBER: PROSPERO CRD42021271999.