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

Daniel Gallardo-Gómez, Jesús del Pozo-Cruz, Hugo Pedder, Rosa M. Alfonso-Rosa, Francisco Álvarez-Barbosa, Michael Noetel, Unyime Jasper, Sebastien Chastin, Javier Ramos-Munell, Borja del Pozo Cruz

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1272-1278
Number of pages8
JournalBritish Journal of Sports Medicine
Volume57
Issue number19
DOIs
Publication statusPublished - Oct 2023
Externally publishedYes

Keywords

  • Optimal dose
  • physical activity
  • acutely hospitalised
  • hospitalised older adults
  • in-hospital physical activity
  • meta-analysis

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