CoChat
Sign Up
Cited by 59Physical Activity and HealthIntensive Care Unit Cognitive DisordersFrailty in Older Adults

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

Open access
Gallardo-Gómez, Daniel, del Pozo-Cruz, Jesús, Pedder, Hugo, Alfonso-Rosa, Rosa M, Álvarez-Barbosa, Francisco, Noetel, Michael, Jasper, Unyime, Chastin, Sebastien +2 more·2023·British Journal of Sports Medicine
DOI 10.1136/bjsports-2022-106409
Open this paper in CoChat — free accountOpen PDF

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. Trial registration number: PROSPERO CRD42021271999.

Integrity signals

Registry

Crossref · 10.1136/bjsports-2022-106409

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 39 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The ambulation optimal-dose estimate showed high evidential power (87.68%).

    “showing a high evidential power (87.68%)”
    • Also stated in: § Systematic review · plain
      “Power analysis showed that ambulation (150 METs-min/day) and multicomponent treatments (100 and 150 METs-min/day) yielded the highest power values, although only ambulation presented an evidential power over 80%.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.
  • Findingown data

    The optimal dose of physical activity for improving functional capacity in acutely hospitalised older adults was estimated at 159 METs-min/day (SMD 0.41, 95% CrI 0.08 to 0.72).

    “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).”
    • Also stated in: § Dose-response associations · hedged
      “The optimal dose was estimated at 159 METs-min/day (SMD=0.41,95% CrI 0.08 to 0.72).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.
  • Findingown data

    Nineteen randomised controlled trials involving 3842 acutely hospitalised older adults were included in the review.

    “Nineteen studies (3842 participants) met the inclusion criteria.”
    • Also stated in: § RESULTS · plain
      “In total, 19 studies 6 14- 16 38-52 involving 3842 participants were included in the review.”
    Quote in the paperSubstantial claim
  • Findingown data

    For ambulation, the lowest dose producing a significant effect was estimated at 74 METs-min/day (approximately 25 min/day of slow-paced walking; SMD 0.25, 95% CrI 0.01 to 0.41 in the abstract and 0.01 to 0.50 in the results).

    “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).”
    • Also stated in: § Systematic review · hedged
      “For ambulation, the minimal effective dose was estimated at 74 METs-min/ day (SMD=0.25,95% CrI 0.01 to 0.50)”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.
  • Findingown data

    The minimal dose of physical activity associated with significant improvement in functional capacity in acutely hospitalised older adults was approximately 100 METs-min/day (SMD 0.28, 95% CrI 0.01 to 0.55; the results model predicted 99 METs-min/day, SMD 0.26, 95% CrI 0.01 to 0.53).

    “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).”
    • Also stated in: § Dose-response associations · plain
      “The minimal dose associated with significant changes in functional capacity was predicted at 99 METs-min/day (SMD=0.26,95% CrI 0.01 to 0.53).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.
  • May combine two claims. 23
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingown data

    Adverse-event types were distributed similarly across interventions, and falls were the most commonly reported event.

    “The distribution of different types of adverse events was similar across the different interventions, with falls being the main adverse event reported across studies and interventions (online supplemental figure 13).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The adverse-event model assumes a negative binomial distribution for event counts.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The minimal effective physical activity dose for functional capacity is about 100 METs-min/day, equivalent to roughly 40 minutes/day of light effort or 25 minutes/day of moderate effort.

    “The minimal effective dose was estimated at ~100 METs-min/day (~40 min/day of light effort or 25 min/day of moderate effort activities) and the optimal response at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Physical activity dose and functional capacity have a non-linear dose-response relationship.

    “this dose-response meta-analysis highlights a novel non-linear relationship between physical activity dose and functional capacity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Based on existing evidence, the review has shown the optimal type and dose of physical activity needed to prevent functional decline and reduce adverse events in older adults admitted to hospital.

    “Based on the existing evidence to date, this review has shown the optimal type and dose of physical activity necessary to prevent functional decline and reduce adverse events in older adults admitted to hospital.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    If ambulation is provided, the beneficial effects of in-hospital supervised physical activity programmes can be maximised with as little as about 25 minutes/day of slow-paced walking, which is an achievable target for most hospitalised older adults.

    “If the most potent intervention is provided (ie, ambulation), the beneficial effects of in-hospital supervised physical activity programmes can be maximised with as little as ~25 min/day of slow-paced walking, an achievable target for most hospitalised older adults.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    A dose as low as about 25 minutes per day of slow walking may be enough to enhance function and reduce adverse events 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.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The adverse-event model assumes a negative binomial distribution for event counts.
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.

  • May combine two claims.

    Study design and conductown data

    Overall risk-of-bias judgements were low for seven trials, unclear for two, and high for ten.

    “At the overall level, seven studies were classified as low risk of bias, 15 39 40 44 45 50 51 two studies as unclear risk of bias 14 52 and 10 studies as high risk of bias.6 16 38 41-43 46-49”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Estimates remained robust across alternative model forms, including fixed-treatment natural splines and quadratic functions, though those forms fitted the data less well.

    “The results were also robust to different modelling strategies (ie, natural spline assuming fixed- treatment effects, and quadratic functions; online supplemental file 7), although these were a poorer fit to the data.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.

  • May combine two claims.

    Premisecitation

    Without management, this increasingly vulnerable period can result in readmission, disability, nursing-home admission, morbidity, and death.

    “If not managed, this period of increasing vulnerability may lead to hospital readmission, disability, nursing home placement, morbidity and mortality.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Further studies indicate that increasing mobilisation in older inpatients is feasible and can improve functioning.

    “Other studies have shown the feasibility of increasing mobilisation in hospitalised older adults, with positive outcomes such as improved functionality.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Greysen, 2016, Activating hospitalized older patients to confront the epidemic of low mobility, JAMA Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Certainty for functional-capacity outcomes was low to moderate; six treatment estimates were rated low certainty because of imprecision and risk of bias.

    “The evidence presented in this meta-analysis for functional capacity outcomes was classified as low to moderate.Six treatment estimates were deemed of low certainty of evidence due to imprecision (ie, 95% CrIs cross zero or are wide, suggesting uncertainty in the estimate) and risk of biased estimates.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The functional-capacity model assumes a normal likelihood and identity link.

  • May combine two claims.

    Premisecitation

    Most hospital time for older inpatients, even those able to walk unaided, is sedentary and usually spent in bed.

    “Hospitalised older adults, including those who can walk independently, spend most of their hospital time sedentary, usually in bed. 1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Baldwin, 2017, Accelerometry shows inpatients with acute medical or surgical conditions spend little time upright and are highly sedentary: systematic review, Phys Ther source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Doses were calculated using the validated method of Ainsworth et al.

    “We followed the validated approach by Ainsworth et al 20 to calculate the different doses associated with each of the included interventions in this meta-analysis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data extraction was performed independently by two authors, and disagreements were settled by consensus among all authors.

    “Two authors independently extracted data from the included studies (DG-G and JdP-C) and disagreements were resolved by consensus between all authors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Expert and stakeholder consensus guidance advises older inpatients to be as active as their abilities and clinical condition permit.

    “The world-first consensus-based statements from expert and stakeholder consultation recommend that hospitalised older adults should”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Baldwin, 2020, Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review protocol was registered in PROSPERO (CRD42021271999).

    “This pre-registered systematic review and meta-analysis (PROS-PERO CRD42021271999)”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The best dose for older inpatients is still unknown and may differ by activity type.

    “Second, the optimal dosage, which may be physical activity type-dependent, remains unknown.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Baldwin, 2020, Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Methods development was guided by NICE Decision Support Unit technical documents.

    “The methodological development of this work was guided by the technical support documents provided by the Decision Support Unit (DSU) of the National Institute for Health and Care Excellence (NICE).11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Dias S , Welton NJ , Sutton AJ , et al . NICE DSU technical support document 1: Introduction to evidence synthesis for decision making. University of Sheffield, Decision Support Unit, 2011: 1–24.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Reporting followed the PRISMA extension for network meta-analyses of healthcare interventions.

    “was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for network meta-analyses of healthcare interventions.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Lee SW , Koo MJ . PRISMA 2020 statement and guidelines for systematic review and meta-analysis articles, and their underlying mathematics: life cycle committee recommendations. Life Cycle 2022;2. doi:10.54724/lc.2022.e9 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Four databases-PubMed, Web of Science, Scopus, and Embase-were searched from inception to June 2022.

    “A systematic search was conducted in PubMed, Web of Science, Scopus and Embase databases from inception to June 2022.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Sensitivity analyses tested robustness by restricting to low-risk-of-bias trials and by using alternative dose-response functions.

    “To assess the robustness of our estimates, we also conducted dose-response meta-analytical models (1) including only studies with a low risk of bias, and (2) using other dose-response functions that also fitted the data well as sensitivity analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Screening of titles, abstracts, and full texts was done independently by two reviewers, with a third adjudicating disagreements.

    “Two reviewers (DG-G and BdPC) independently screened the title/abstract and full texts, with disagreements resolved by discussion or adjudication by a third author (JdP-C).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Which type of activity intervention is most efficient for older inpatients remains unidentified.

    “First, the most efficient type of physical activity intervention has not yet been identified.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Baldwin, 2020, Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A widespread belief holds that in-hospital activity raises the risk of falls and other harms, encouraging bed rest.

    “Finally, there is a common perception that physical activity may increase falls and other negative events (fostering the culture of 'bed rest' while in hospital).7 9”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Greysen, 2016, Activating hospitalized older patients to confront the epidemic of low mobility, JAMA Intern Med source

      Not checked in the free run.

    • cites [9] Flaherty, 2022, Changing hospital care for older adults: the case for geriatric hospitals in the United States, Gerontol Geriatr Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Certainty of network meta-analysis estimates was rated using GRADE.

    “The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to rate the certainty in estimates from our network meta-analysis.37”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Three reviewers rated risk of bias with the Cochrane Risk of Bias tool.

    “Three reviewers (DG-G, JR-M and FA-B) assessed and rated the risk of bias in the included studies according to the Cochrane Risk of Bias tool criteria (Cochrane ROB tool).36”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Higgins, 2011, The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The network meta-analysis assumptions of connectivity, consistency, transitivity, and homogeneity showed no indication of violation.

    “No indication of violation of key assumptions for network meta-analysis (ie, connectivity, 23 consistency in the data, transitivity and homogeneity 24 25 ) was found (see online supplemental file 2).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] source

      Not checked in the free run.

    • cites [24] Wheeler, 2010, Assessing local model adequacy in Bayesian hierarchical models using the partitioned deviance information criterion, Comput Stat Data Anal source

      Not checked in the free run.

    • cites [25] White, 2012, Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression, Res Synth Methods source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The review by Scheerman et al could not confirm benefits of physical interventions, including exercise, for improving physical performance in older adults admitted to hospital.

    “the review by Scheerman et al 53 could not confirm the benefits of physical interventions, including exercise, to improve physical performance in older adults admitted to hospital.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Scheerman, 2018, Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review, BMC Geriatr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Former research has indicated that multicomponent interventions have superior effects.

    “Former research has also indicated the superior effects of multicomponent interventions.5 6 15 48”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Valenzuela, 2020, Effects of exercise interventions on the functional status of acutely hospitalised older adults: a systematic review and meta-analysis, Ageing Res Rev source

      Not checked in the free run.

    • cites [6] Martínez-Velilla, 2019, Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial, JAMA Intern Med source

      Not checked in the free run.

    • cites [15] Siebens, 2000, A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults, J Am Geriatr Soc source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The study included a relatively large sample of acutely hospitalised older adults, giving adequate statistical power for its aims.

    “this study comprised a relatively large sample size of acute hospitalised older adults, which provided adequate statistical power for the study aims.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Multicomponent interventions require qualified personnel and multiple resources, which are considered important barriers to implementing physical activity programmes in acutely hospitalised older adults.

    “Multicomponent interventions require qualified personnel and multiple resources for their application, both of which are considered important barriers to the implementation of physical activity programmes in acutely hospitalised older adults. 56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Geelen, 2021, Barriers and enablers to physical activity in patients during hospital stay: a scoping review, Syst Rev source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The study used current state-of-the-art meta-analytical techniques to pool data and examine the dose-response between physical activity dose and functional capacity.

    “we applied current state of the art metaanalytical techniques 19 for pooling data from different studies to investigate the dose-response between physical activity dose and functional capacity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Gallardo-Gómez, 2022, Optimal dose and type of exercise to improve cognitive function in older adults: a systematic review and Bayesian model-based network meta-analysis of RCTs, Ageing Res Rev source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The available aggregated data did not permit modelling of covariate-specific dose-response patterns or determining dose at the individual level.

    “the currently available aggregated data did not allow the modelling of covariate-specific doseresponse patterns or ascertainment of the dose at the individual level.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Valenzuela et al stated that in-hospital physical activity interventions are safe.

    “Descriptively, the same review by Valenzuela et al 5 stated that in-hospital physical activity interventions are safe.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Valenzuela, 2020, Effects of exercise interventions on the functional status of acutely hospitalised older adults: a systematic review and meta-analysis, Ageing Res Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ambulatory activities may be easier and simpler to implement in hospital settings.

    “ambulatory activities may be easier and simpler to implement in hospital settings, 57 58”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] Holst, 2015, Physical activity in hospitalized old medical patients; how active are they, and what, J Aging Res Clin Pract

      Not checked in the free run.

    • cites [58] Gill, 2022, Preserving community mobility in vulnerable older people, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Using direct, indirect and network estimates, the study compared the relative efficacy of different active interventions and identified ambulation as the most effective in-hospital intervention for improving functional capacity in older adults.

    “through direct, indirect and network estimates, we were able to compare the relative efficacy of different active interventions, which led to the identification of ambulation as the most effective in-hospital intervention to improve the functional capacity of older adults.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Valenzuela et al concluded that inpatient supervised physical activity is effective for improving functional capacity in older adults and reported effect sizes (SMD 0.57) comparable to the current meta-analysis.

    “more recent work by Valenzuela et al 5 concluded that inpatient supervised physical activity is effective in improving functional capacity in older adults and showed comparable effect sizes (SMD 0.57) to those reported in the current meta-analysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Valenzuela, 2020, Effects of exercise interventions on the functional status of acutely hospitalised older adults: a systematic review and meta-analysis, Ageing Res Rev source

      Not checked in the free run.

37 of 37

  • The authors state this as an assumption.

    The exploratory arm-based analysis treats prognostic factors and effect modifiers as identical across studies.

    “Compared with contrast-based MBNMA, arm-based analyses such as this assume that prognostic factors and effect modifiers are the same across studies, and the results may therefore be affected by differences in prognostic factors between studies.32”

  • The authors state this as an assumption.

    The adverse-event model assumes a negative binomial distribution for event counts.

    “Adverse event counts were assumed to be negatively binomially distributed and were modelled using a log link.”

  • The authors state this as an assumption.

    The functional-capacity model assumes a normal likelihood and identity link.

    “Functional capacity was modelled using a normal likelihood with an identity link function.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Extended sessions of multicomponent training (approximately 20 min/day resistance band exercises and 20 min/day aerobic activities) could offer additional benefits in acutely hospitalized older patients.

    “It was also highlighted that extended sessions of multicomponent training, such as approximately 20 min/day of resistance band exercises and approximately 20 min/day of aerobic activities, could offer additional benefits [533].”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [533]

  • A recent dose-response meta-analysis reported effective ranges of physical activity doses for improving functional capacity and reducing adverse events in acutely hospitalized older patients.

    “A recent dose-response meta-analysis reported effective ranges of PA doses for improving functional capacity and reducing adverse events in acutely hospitalized older patients [533].”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [533]

  • Brief daily sessions of multicomponent exercise interventions (approximately 15 min/day resistance band exercises and 10 min/day aerobic training) can yield functional improvements in acutely hospitalized older patients.

    “These findings suggest that brief daily sessions of multicomponent exercise interventions, for instance, approximately 15 min per day of resistance band exercises and about 10 min per day of aerobic training, can yield functional improvements.”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [533]

  • Extended sessions of multicomponent training (approximately 20 min/day resistance band and 20 min/day aerobic) could offer additional benefits in acutely hospitalized older patients.

    “It was also highlighted that extended sessions of multicomponent training, such as approximately 20 min/day of resistance band exercises and approximately 20 min/day of aerobic activities, could offer additional benefits [533].”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [533]

  • Brief daily sessions of multicomponent exercise (approximately 15 min/day resistance band and 10 min/day aerobic) can yield functional improvements in acutely hospitalized older patients.

    “These findings suggest that brief daily sessions of multicomponent exercise interventions, for instance, approximately 15 min per day of resistance band exercises and about 10 min per day of aerobic training, can yield functional improvements.”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [533]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • ICU admission percentage uses an inconsistent denominator

    Minor

    The paper says 3783 participants were analysed, but 758 of 3783 is 20.04%, not the reported 21.67%.

    Reported 21.67 · recomputed 20.037008

  • Credible interval differs for the minimum ambulation dose

    Minor

    For the same 74 METs-min/day ambulation estimate and SMD of 0.25, the abstract gives an upper credible limit of 0.41, while the results give 0.50.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Pedder H . MBNMAdose: an R package for incorporating dose-response information into network meta-analysis. In: Evidence synthesis and meta-analysis in R Conference 2021. 2021. Available: https://research-information.bris.ac.uk/en/publications/mbnmadose-an-r-package-for-incorporating-dose-response-informatio

Cited by

Sorted by citations

Related

Authors
Gallardo-Gómez, D., del Pozo-Cruz, J., Pedder, H., Alfonso-Rosa, R. M., Álvarez-Barbosa, F., Noetel, M., Jasper, U., Chastin, S., Ramos-Munell, J., & del Pozo Cruz, B.
Affiliations
  • University of Bristol (GB)
  • Australian Catholic University (AU)
  • The University of Adelaide (AU)
  • Glasgow Caledonian University (GB)
  • Universidad de Sevilla (ES)
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2023-08-03
Volume
57
Issue
19
Pages
1272-1278
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2022-106409
OpenAlex
W4385516425
Semantic Scholar
942647584725c9936c03b6851f9e7cb6b2c2befb
Cited by
59
References
59
Citations by year
2026: 19 · 2025: 23 · 2024: 14 · 2023: 3
FWCI
2.10
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • British Journal of Sports Medicine (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Explore Bristol Research (submittedVersion, cc-by)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
  • ResearchOnline (submittedVersion)
Funders
  • National Institute for Health
  • University of Adelaide
  • Spanish government (FPU20/0067)
  • PAIDI (P20_1181)
  • NICE Technical Support Unit
  • Research Program of the University of Seville, Spain
  • Development, and Innovation Programme
  • Medical Research Council (MR/R025223/1)
  • Research Talent Recruitment Programme (EMERGIA 2020/00158)
  • Bristol Technology Assessment Group
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
physical activity, older adults, acute hospitalization, functional capacity, dose-response relationship, ambulation, walking, adverse events, inpatient rehabilitation, exercise intervention, minimum effective dose, hospital discharge, frailty, falls, delirium, length of hospital stay, quality of life, walking speed, muscle strength
MeSH terms
Aged, Bayes Theorem, Exercise Therapy, Hospitalization, Humans, Middle Aged, Exercise, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review