Original Study| Volume 21, ISSUE 4, P531-537.e1, April 2020

Effect of a Simple Exercise Program on Hospitalization-Associated Disability in Older Patients: A Randomized Controlled Trial

Published:January 20, 2020DOI:



      Hospitalization-associated disability [HAD, ie, the loss of ability to perform ≥1 basic activities of daily living (ADLs) independently at discharge] is a frequent condition among older patients. The present study assessed whether a simple inpatient exercise program decreases HAD incidence in acutely hospitalized very old patients.


      In this randomized controlled trial (Activity in Geriatric Acute Care) participants were assigned to a control or intervention group and were assessed at baseline, admission, discharge, and 3 months thereafter.

      Setting and Participants

      In total, 268 patients (mean age 88 years, range 75–102) admitted to an acute care for older patients unit of a public hospital were randomized to a control (n = 125) or intervention (exercise) group (n = 143).


      Both groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total duration of ∼20 minutes/day). We measured ADL function (Katz index) and incident HAD at discharge and after 3 months (primary outcome) and Short Physical Performance Battery, ambulatory capacity, number of falls, rehospitalization, and death during a 3-month follow-up (secondary outcomes).


      Median duration of hospitalization was 7 days (interquartile range 4 days). The intervention group had a lower risk of HAD with reference to both baseline [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17–0.76, P = .007] and admission (OR 0.29; 95% CI 0.10–0.89, P = .030). A trend toward an improved ADL function at discharge vs admission was found in the intervention group compared with controls (OR 0.32; 95% CI ‒0.04 to 0.68; P = .083). No between-group differences were noted for the other endpoints (all P > .05).

      Conclusion and Implications

      A simple inpatient exercise program decreases risk of HAD in acutely hospitalized, very old patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Covinsky K.E.
        • Pierluissi E.
        • Johnston C.B.
        Hospitalization-associated disability “she was probably able to ambulate, but I'm not sure”.
        JAMA. 2011; 306: 1782-1793
        • Gill T.M.
        • Allore H.G.
        • Holford T.R.
        • Guo Z.
        Hospitalization, restricted activity, and the development of disability among older persons.
        JAMA. 2004; 292: 2115-2124
        • Gill T.M.
        • Allore H.G.
        • Gahbauer E.
        • Murphy T.
        Change in disability after hospitalization or restricted activity in older persons.
        JAMA. 2010; 304: 1919-1928
        • Covinsky K.E.
        • Palmer R.M.
        • Fortinsky R.H.
        • et al.
        Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age.
        J Am Geriatr Soc. 2003; 51: 451-458
        • Boyd C.
        • Landefeld C.
        • Counsell S.
        • et al.
        Recovery in activities of daily living among older adults following hospitalization for acute medical Illness.
        J Am Geriatr Soc. 2008; 56: 2171-2179
        • Inouye S.K.
        • Peduzzi P.N.
        • Robison J.T.
        • et al.
        Importance of functional measures in predicting mortality among older hospitalized patients.
        JAMA. 1998; 279: 1187-1198
        • Fortinsky R.H.
        • Covinsky K.E.
        • Palmer R.M.
        • Landefeld C.S.
        Effects of functional status changes before and during hospitalization on nursing home admission of older adults.
        J Gerontol Ser A Biol Sci Med Sci. 1999; 54: 521-526
        • Brown C.J.
        • Redden D.T.
        • Flood K.L.
        • Allman R.M.
        The underrecognized epidemic of low mobility during hospitalization of older adults.
        J Am Geriatr Soc. 2009; 57: 1660-1665
        • Callen B.L.
        • Mahoney J.E.
        • Grieves C.B.
        • et al.
        Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital.
        Geriatr Nurs. 2004; 25: 212-217
        • Valenzuela P.L.
        • Morales J.S.
        • Pareja-Galeano H.
        • et al.
        Physical strategies to prevent disuse-induced functional decline in the elderly.
        Ageing Res Rev. 2018; 47: 80-88
        • Valenzuela P.
        • Castillo-García A.
        • Morales J.
        • et al.
        Physical exercise in the oldest old.
        Compr Physiol. 2019; 9: 1281-1304
        • Martínez-Velilla N.
        • Cadore E.L.
        • Casas-Herrero
        • et al.
        Physical activity and early rehabilitation in hospitalized elderly medical patients: Systematic review of randomized clinical trials.
        J Nutr Heal Aging. 2016; 20: 738-751
        • Bachmann S.
        • Finger C.
        • Huss A.
        • et al.
        Inpatient rehabilitation specifically designed for geriatric patients: Systematic review and meta-analysis of randomised controlled trials.
        BMJ. 2010; 340: 1230
        • Kosse N.M.
        • Dutmer A.L.
        • Dasenbrock L.
        • et al.
        Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: A systematic review.
        BMC Geriatr. 2013; 13: 1
        • Fleck S.J.
        • Bustamante-Ara N.
        • Ortiz J.
        • et al.
        Activity in GEriatric acute CARe (AGECAR): Rationale, design and methods.
        BMC Geriatr. 2012; 12: 12-28
        • Martínez de la Iglesia J.
        • Herrero R.D.
        • Vilches M.C.O.
        • et al.
        Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores de 65 años.
        Med Clin (Barc). 2001; 117: 129-134
        • Vidán M.T.
        • Sánchez E.
        • Alonso M.
        • et al.
        An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients.
        J Am Geriatr Soc. 2009; 57: 2029-2036
        • Katz S.
        • Ford A.
        • Moskowitz R.
        • et al.
        Studies of illnes in the aged. The index of ADL: A standardized measure of biological and pshychological function.
        JAMA. 1963; 185: 914-918
        • Holden M.K.
        • Gill K.M.
        • Magliozzi M.R.
        • et al.
        Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness.
        Phys Ther. 1984; 64: 35-40
        • Rosanna Chau M.W.
        • Chan S.P.
        • Wong Y.W.
        • Lau M.Y.P.
        Reliability and validity of the modified functional ambulation classification in patients with hip fracture.
        Hong Kong Physiother J. 2013; 31: 41-44
        • Park C.S.
        • An S.H.
        Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis.
        J Phys Ther Sci. 2016; 28: 2264-2267
        • Tsang R.
        • Chau R.
        • Cheuk T.
        • et al.
        The measurement properties of modified Rivermead mobility index and modified functional ambulation classification as outcome measures for Chinese stroke patients.
        Physiother Theory Pract. 2014; 30: 353-359
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physcial performance battery assessing lower extremity function: Assocation with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol Med Sci. 1994; 49: M85-M94
        • Vickers A.J.
        • Altman D.G.
        Analysing controlled trials with baseline and follow up measurements.
        Br Med J. 2001; 323: 1123-1124
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: Evidence for a phenotype.
        J Gerontol Ser A Biol Sci Med Sci. 2001; 56: M146-M157
        • Brown C.J.
        • Foley K.T.
        • Lowman J.D.
        • et al.
        Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients a randomized clinical trial.
        JAMA Intern Med. 2016; 176: 921-927
        • Padula C.A.
        • Hughes C.
        • Baumhover L.
        Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults.
        J Nurs Care Qual. 2009; 24: 325-331
        • Siebens H.
        • Aronow H.
        • Edwards D.
        • Ghasemi Z.
        A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults.
        J Am Geriatr Soc. 2000; 48: 1545-1546
        • Martínez-Velilla N.
        • Casas-Herrero N.
        • Zambon-Ferraresi F.
        • et al.
        Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: A randomized clinical trial.
        JAMA Intern Med. 2019; 179: 28-36
        • Saez de Asteasu M.L.
        • Martinez-Velilla N.
        • Zambom-Ferraresi F.
        • et al.
        Physical exercise improves function in acutely hospitalized older patients: Secondary analysis of a randomized clinical trial.
        J Am Med Dir Assoc. 2019; 20: 866-873
        • Sáez de Asteasu M.L.
        • Martínez-Velilla N.
        • Zambom-Ferraresi F.
        • et al.
        Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: Secondary analysis of a randomized trial.
        PLOS Med. 2019; 16: e1002852
        • Mañas A.
        • Pozo-Cruz B.
        • Rodríguez-Gómez I.
        • et al.
        Can physical activity offset the detrimental consequences of sedentary time on frailty? A moderation analysis in 749 older adults measured with accelerometers.
        J Am Med Dir Assoc. 2019; 20: 634-638.e1
        • Harvey J.A.
        • Chastin S.F.M.
        • Skelton D.A.
        Breaking sedentary behaviour has the potential to increase/maintain function in frail older adults.
        J Frailty Sarcopenia Falls. 2018; 03: 26-34
        • Borde R.
        • Hortobágyi T.
        • Granacher U.
        Dose–response relationships of resistance training in healthy old adults: A systematic review and meta-analysis.
        Sport Med. 2015; 45: 1693-1720