Effect of a Pragmatic Exercise Intervention Pilot Study on Preventing Functional and Physical Decline in Hospitalized Older Adults.

Abstract

Purpose: Although physical activity (PA) has the potential to prevent iatrogenic disability, it is rarely integrated into usual care. We evaluated whether MATCH, a pragmatic unsupervised exercise intervention, could help prevent physical and functional decline in hospitalized older adults.

Methods: A quasi-randomized trial (ClinicalTrials #NCT04078334) was conducted involving 100 hospitalized patients, who were allocated to either the usual care + MATCH group (MG; n = 62) or the usual care only group (CG; n = 38). MATCH is an unsupervised PA program guided by a decision tree (3 exercises/session; 3x/day). Outcomes were assessed at admission and discharge: 1) primary outcome: functional capacities (Short Physical Performance Battery (SPPB)); 2) secondary outcomes: handgrip strength, walking speed, functional mobility (3-metre Timed-Up-and-Go (TUG)), leg muscle power (30-second chair-test), need for home care support, and functional autonomy in both instrumental and basic activities of daily living (ADL).

Results: At admission, groups were similar, except for nutritional status (p = 0.047). There were no significant differences between groups for the primary outcome (SPPB: MG:+1.5 ± 1.9 vs. CG:+1.0 ± 1.4/12pts, p = 0.25). However, the MG showed greater improvements in handgrip strength (MG:+1.7 ± 3.9 vs. CG:-0.15 ± 3.0 kg, p = 0.02) and had a lower need for home care support at discharge (MG:44.3% vs. CG:65.8%, p = 0.041). A higher proportion of MG participants improved to being at no risk of falling (TUG<14 sec), achieved good functional capacity (SPPB ≥10/12: +6.6%), increased leg muscle power (Women:<2.1/Men:<2.6(W/kgBW): -15.1%), and improved walking speed (<0.6 m/s: -30.6%) compared to the CG. Clinically meaningful improvements in ADL (+82.7%) were observed only in the MG.

Conclusions: Combining usual care with the MATCH intervention appears more effective that usual care alone in preventing physical and functional decline and reducing the need for home care support at discharge. Larger-scale efficacy studies are needed to confirm these promising results.