Sitting less and moving more during acute hospitalisation: a scoping review of interventions

Aim: To identify interventions that may influence objectively measured sedentary behaviour and/or inactivity during acute hospitalisation in medical/surgical conditions Design: Scoping review of interventional studies Methods: Four databases (MEDLINE, CINAHL, Scopus and EMBASE) were searched to May 2018. Studies had to include hospitalised adults and objectively measure sedentary behaviour or inactivity with wearable accelerometry. Items were screened for eligibility in duplicate; first by title and abstract, then full text. Reference lists were screened, and authors contacted for publications using similar datasets. Included studies were synthesised descriptively. Results: Fourteen studies were included (n=9 randomised controlled, n=3 pre-post, and n=2 case-controlled trials). Interventions were categorised as: exercise (n=3), patient behaviour change with self-monitoring (n=3), models of care (n=3), implementing system change (n=2), surgical technique (n=2) and wearing day clothes (n=1). Twelve studies reported accelerometer-derived activity. Increases in step count were reported with self-monitoring, an early mobility bundle and by implementing system change. Only three studies measured sedentary behaviour (using thigh worn devices): a resistance training program where accelerometry was not a primary outcome; an outpatient versus enhanced recovery surgical pathway that did not impact sedentary behaviour; and comprehensive geriatric care that increased up-time compared to usual care. Conclusion: Sedentary behaviour is infrequently measured with accelerometry in the hospital setting. Effective in-hospital strategies to minimise sedentary behaviour are unknown. Key Practice Points: • There is a paucity of interventions to address objectively defined sedentary behaviour during hospitalisation. • Further investigation is warranted to explore different interventions to minimise sedentary behaviour in this setting.