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Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial
Open accessAbstract
Importance: Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. Objective: To assess the effects of an innovative multicomponent exercise intervention on the functional status of this patient population. Design, Setting, and Participants: A single-center, single-blind randomized clinical trial was conducted from February 1, 2015, to August 30, 2017, in an acute care unit in a tertiary public hospital in Navarra, Spain. A total of 370 very elderly patients undergoing acute-care hospitalization were randomly assigned to an exercise or control (usual-care) intervention. Intention-to-treat analysis was conducted. Interventions: The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises (2 daily sessions). Main Outcomes and Measures: The primary end point was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB). Secondary end points were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge. Results: Of the 370 patients included in the analyses, 209 were women (56.5%); mean (SD) age was 87.3 (4.9) years. The median length of hospital stay was 8 days in both groups (interquartile range, 4 and 4 days, respectively). Median duration of the intervention was 5 days (interquartile range, 0); there was a mean (SD) of 5 (1) morning and 4 (1) evening sessions per patient. No adverse effects were observed with the intervention. The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points (95% CI, 1.7-2.6 points) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5 points) on the Barthel Index over the usual-care group. Hospitalization led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of -5.0 points (95% CI, -6.8 to -3.2 points) in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points; 95% CI, 0.2-3.7 points). The intervention also improved the SPPB score (2.4 points; 95% CI, 2.1-2.7 points) vs 0.2 points; 95% CI, -0.1 to 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points (95% CI, 1.3-2.3 points) over the usual-care group. Conclusions and Relevance: The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients. Trial Registration: ClinicalTrials.gov identifier: NCT02300896.
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In the citing paper
“Although evidence indicates benefits for individuals ranging from robust to frail, including hospitalized older persons, power training remains underused in clinical practice [8,15,203].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Although evidence indicates benefits for individuals ranging from robust to frail, including hospitalized older persons, power training remains underused in clinical practice [8,15,203].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Martínez-Velilla et al. [203] and Saez de Asteasu et al. [522] showed that individualized multicomponent exercise training programs can significantly enhance the functional capacity and cognition in older patients with frailty during acute hospitalization compared to usual care.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Exercise is essential in preventing functional and cognitive decline associated with hospitalization in older adults.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“These include functional capacity, cognition, mood, and muscle function (i.e., muscle strength and power), all of which commonly deteriorate during hospital stays, especially among the oldest old [203,518,521,522].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“An individualized multicomponent physical exercise intervention incorporating moderate-intensity PRT represents an effective therapeutic measure to counteract muscle strength/power and mass losses frequently observed during hospitalization [203,522,526].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Although evidence indicates benefits for individuals ranging from robust to frail, including hospitalized older persons, power training remains underused in clinical practice [8,15,203].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Exercise is essential in preventing functional and cognitive decline associated with hospitalization in older adults. The advantages of exercise have been clinically, biologically, and economically confirmed [203,521]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Martínez-Velilla et al. [203] and Saez de Asteasu et al. [522] showed that individualized multicomponent exercise training programs can significantly enhance the functional capacity and cognition in older patients with frailty during acute hospitalization compared to usual care.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“An individualized multicomponent physical exercise intervention incorporating moderate-intensity PRT represents an effective therapeutic measure to counteract muscle strength/power and mass losses frequently observed during hospitalization [203,522,526].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“These include functional capacity, cognition, mood, and muscle function (i.e., muscle strength and power), all of which commonly deteriorate during hospital stays, especially among the oldest old [203,518,521,522].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [203]
In the citing paper
“Martinez-Velilla et al 6 showed the benefits of an individualised multicomponent intervention to reverse the functional decline associated with acute hospitalisation in very elderly patients.”
In the citing paper
“Physical activity interventions often report no 6 or few adverse events.7”
In the citing paper
“Former research has also indicated the superior effects of multicomponent interventions.5 6 15 48”
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Metadata
- Authors
- Martínez-Velilla, N., Casas-Herrero, A., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Lucia, A., Galbete, A., García-Baztán, A., Alonso-Renedo, J., González-Glaría, B., Gonzalo-Lázaro, M., Apezteguía Iráizoz, I., Gutiérrez-Valencia, M., Rodríguez-Mañas, L., & Izquierdo, M.
- Affiliations
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Navarre Institute of Health Research (ES)
- Complejo Hospitalario de Navarra (ES)
- Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2019-01-01
- Volume
- 179
- Issue
- 1
- Pages
- 28
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6583412
- OpenAlex
- W2900563116
- Cited by
- 481
- References
- 52
- Citations by year
- 2026: 38 · 2025: 51 · 2024: 75 · 2023: 65 · 2022: 71 · 2021: 80 · 2020: 66 · 2019: 32
- FWCI
- 25.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Academica-e (Universidad Pública de Navarra) (acceptedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- Gobierno de Navarra
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Keywords
- functional decline, very elderly patients, resistance training, balance training, walking exercise, inpatient rehabilitation, Barthel Index, Short Physical Performance Battery, grip strength, delirium, falls, hospital readmission, mortality, quality of life, cognitive function, mood, length of hospital stay, multimorbidity
- MeSH terms
- Activities of Daily Living, Aged, 80 and over, Exercise Therapy, Female, Hospitalization, Humans, Male, Quality of Life, Spain, Geriatric Assessment, Single-Blind Method, Treatment Outcome, Intention to Treat Analysis, Cognitive Dysfunction
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