title: Effects on muscle performance of NSAID treatment with Piroxicam versus placebo in geriatric patients with acute infection-induced inflammation. a double blind randomized controlled trial How inflammation underlies physical and organ function in acutely admitted older medical patients The influence of celecoxib on muscle fatigue resistance and mobility in elderly patients with inflammation. Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Improved Functional Performance in Geriatric Patients During Hospital Stay The underrecognized epidemic of low mobility during hospitalization of older adults. Physical activity interventions are delivered consistently across hospitalized older adults but multimorbidity is associated with poorer rehabilitation outcomes: A population‐based cohort study Handgrip strength shows no improvements in geriatric patients with persistent inflammation during hospitalization Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial. Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Twenty-four-hour mobility during acute hospitalization in older medical patients. Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. Deterioration of muscle function after 21-day forearm immobilization. A pilot study of anabolic steroids in elderly patients with hip fractures. Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Results of a Multimodal Program During Hospitalization in Obese COPD Exacerbated Patients Physical and Functional Impairment During and After Hospitalization in Subjects With Severe COPD Exacerbation
abstract: Background Inflammation is the main cause of disease-associated muscle wasting . In a previous single blind study we have demonstrated improved recovery of muscle endurance following celecoxib treatment in hospitalized geriatric patients with acute infection . Here we further evaluate NSAID treatment with piroxicam in a double blind RCT and investigate the role of cytokines and heat shock proteins ( Hsp ) with respect to muscle performance . We hypothesized that NSAID treatment would preserve muscle performance better than antibiotic treatment alone , by reducing infection-associated inflammation and by increasing expression of cytoprotective Hsp . Methods Consecutive admissions to the geriatric ward were screened . 30 Caucasian patients , median age 84.5 years , with acute infection-induced inflammation and serum levels of CRP > 10 mg/L were included and r and omized to active treatment with 10 mg piroxicam daily or placebo . Assessment comprised general clinical and biochemical parameters , 25 cytokines in serum , intra- and extracellular Hsp27 and Hsp70 , Elderly Mobility Scale ( EMS ) scores , grip strength ( GS ) , fatigue resistance ( FR ) and lean body mass ( LBM ) . Patients were evaluated until discharge with a maximum of 3 weeks after treatment allocation . Results EMS scores , FR and grip work ( GW ) , a measure taking into account GS and FR , significantly improved with piroxicam , but not with placebo . Early decreases in IL-6 serum levels with piroxicam correlated with better muscle performance at week 2 . Basal expression of Hsp27 in monocytes without heat challenge ( WHC ) was positively correlated with FR at baseline and significantly increased by treatment with piroxicam compared to placebo . Profound modifications in the relationships between cytokines or Hsp and changes in muscle parameters were observed in the piroxicam group . Conclusions Piroxicam improves clinical ly relevant measures of muscle performance and mobility in geriatric patients hospitalized with acute infection-induced inflammation . Underlying mechanisms may include modifications in the cytokine network and increases in monocytic expression of cytoprotective Hsp27.Trial registration numberIS RCT N : IS RCT OBJECTIVES To investigate whether systemic inflammation in acutely admitted older medical patients ( age > 65 years ) is associated with physical performance and organ dysfunction . Organ dysfunction´s association with physical performance , and whether these associations are mediated by systemic inflammation , was also investigated . METHODS A cross-sectional study in an Emergency Department . Physical performance was assessed by h and grip strength and de Morton Mobility Index  (  DEMMI  ) , and organ dysfunction by FI-OutRef , the number of st and ard blood tests outside the reference range . Systemic inflammation was assessed by  suPAR , TNFα , and IL-6 . Associations were investigated by regression analyses adjusted for age , sex , cognitive impairment , CRP , and VitalPAC Modified Early Warning Score . RESULTS A total of 369 patients were evaluated . In adjusted analyses , suPAR and TNFα was associated with both physical performance measures ( p<0.001- p=0.004 ) , and IL-6 with h and grip strength ( p=0.007 ) . All inflammation biomarkers were associated with FI-OutRef ( p<0.001 ) . FI-OutRef was also associated with physical performance ( all p<0.001 ) ; suPAR being the inflammatory biomarker with the highest impact when adjusting for inflammation . CONCLUSION Inflammatory biomarkers are potentially feasible for systematic assessment of vulnerability . Moreover , suPAR may be an important mediator between organ dysfunction and physical performance BACKGROUND Acute inflammation has a negative effect on the muscular system in elderly patients , compromising the outcome of the underlying disease . OBJECTIVE The aim of this study was to evaluate the effect of cyclooxygenase-2 ( COX-2 ) inhibition on muscle performance and mobility in hospitalized elderly patients with acute inflammation of infectious origin . METHODS In this single-blind , controlled trial , consecutively hospitalized elderly patients ( age > or = 70 years ) with inflammation ( C-reactive protein [ CRP ] levels > or = 10 mg/L ) due to acute infection were r and omly assigned to receive 2 weeks of treatment with the COX-2-selective inhibitor celecoxib , acetaminophen , or no supplementary medication ( control ) . The following variables were assessed at baseline and at 1 and 2 weeks ' follow-up : muscle fatigue resistance ( primary outcome measure ) ; grip strength and mobility ( secondary outcome measures ) ; and levels of the acute-phase markers CRP , interleukin (IL)-1beta , IL-6 , IL-10 , tumor necrosis factor-alpha ( TNF-alpha ) , and transforming growth factor-beta ( TGF-beta ) as explanatory variables . RESULTS Forty-three consecutively hospitalized elderly patients ( 31 women , 12 men ; mean [ SD ] age , 84 [ 6 ] years ) were enrolled . Fourteen patients received celecoxib , 14 received acetaminophen , and 15 received no supplementary medication . The change in fatigue resistance was significantly different between groups ( P = 0.021 , Kruskal-Wallis chi-square test ) , with significantly greater improvement in patients receiving celecoxib compared with the acetaminophen and control groups ( 63 % increase from baseline ; P < 0.05 ) . There were no significant between-group differences in changes in grip strength , mobility , IL-1beta , IL-6 , TNF-alpha , or TGF-beta . The changes in levels of IL-10 differed significantly between groups ( P = 0.020 , Kruskal-Wallis chi-square test ) , with greater improvement in the celecoxib group compared with the acetaminophen group ( P = 0.032 ) . CONCLUSION The results of this study suggest that COX-2-selective inhibition has a beneficial effect on muscle fatigue resistance in hospitalized elderly patients with acute inflammation of infectious origin . However , until further trials are conducted , the use of COX-2-selective inhibitors for this indication is not recommended QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 OBJECTIVES To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions . DESIGN Prospect i ve cohort study . SETTING Internal medicine wards in two Israeli medical centers . PARTICIPANTS Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem . MEASUREMENTS Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge .  In-hospital mobility , continence care , sleep medication consumption , satisfaction with hospital environment , and nutrition intake  were assessed using previously tested self-report instruments . RESULTS Two hundred eighty-two participants ( 41.2 % ) reported functional decline at discharge and 317 ( 46.3 % ) at 1 month after discharge . Path analysis indicated that in-hospital mobility ( st and ardized maximum likelihood estimate ( SMLE ) = -0.48 , P < .001 ) , continence care ( SMLE = -0.12 , P < .001 ) , and length of stay ( LOS ) ( SMLE = 0.06 , P < .001 ) were directly related to functional decline at discharge and , together with personal risk factors , explained 64 % of variance . In-hospital mobility , continence care , and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge ( SMLE = 0.45 , P < .001 ) . Nutrition consumption ( SMLE = -0.07 , P < .001 ) was significantly related to functional decline at 1 month after discharge , explaining , together with other risk factors , 32 % of variance . CONCLUSION In-hospital low mobility , suboptimal continence care , and poor nutrition account for immediate and 1-month posthospitalization functional decline . These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake Objective The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients . Design This was a prospect i ve observational study in elderly medical patients of age 65 years or older at a geriatric department . Measurements were obtained on days 2 to 4 , day 5 to 8 , and days 9 to 13 . Functional performance was measured with  De Morton Mobility Index ( DEMMI ) test  and a 30-second chair st and test ( 30-s CST ) . Muscular strength was measured with h and grip strength . Activity level was determined with  accelerometry ( ActivPAL ) . Results Results in DEMMI and 30-s CST gradually improved ( P < 0.05 ) , whereas h and grip strength remained unchanged ( P > 0.05 ) . Larger functional improvements were observed in patients with “ high ” compared to “ low ” and “ moderate ” activity level ( P < 0.05 ) . Changes in DEMMI score correlated with changes in 30-s CST ( P < 0.05 ) ; however , changes in DEMMI score and 30-s CST were more likely to occur in patients with a low versus high functional level , respectively . Conclusions Functional performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay of less than 14 days , with larger improvements in patients with high activity level . The DEMMI test and the 30-s CST seem to be complementary to each other when evaluating functional changes in a geriatric hospital population . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to ( 1 ) describe changes in mobility and muscle strength of geriatric patients during a hospital stay of less than 14 days , ( 2 ) underst and the significance of physical activity during hospital admission in geriatric patients , and ( 3 ) discuss the potential limitations of measures for assessing mobility and lower extremity strength status and change during a hospital admission . Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians . The Association of Academic Physiatrists design ates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s) ™ . Physicians should only cl aim credit commensurate with the extent of their participation in the activity OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently BACKGROUND Older adults live with multimorbidity including frailty and cognitive impairment often requiring hospitalization . While physical activity interventions ( PAIs ) are a normal rehabilitative treatment , their clinical effect in hospitalized older adults is uncertain . OBJECTIVE To observe PAI dosing characteristics and determine their impact on clinical performance parameters . DESIGN A single-site prospect i ve observational cohort study in an older persons ' unit . SUBJECTS Seventy-five older persons ' unit patients ≥65 years . INTERVENTION PAI ; therapeutic contact between physiotherapy clinician and patient . MEASUREMENTS Parameters included changes in activities-of-daily-living ( Barthel Index ) , h and grip strength , balance confidence , and gait velocity , measured between admission and discharge ( episode ) . Dosing characteristics were PAI temporal initiation , frequency , and duration . Frailty/cognition status was dichotomized independently per participant yielding 4 subgroups : frail/nonfrail and cognitively-impaired/cognitively-unimpaired . RESULTS Median ( interquartile range ) PAI initiation occurred after 2 days ( 1 - 4 ) , frequency was 0.4 PAIs per day ( 0.3 - 0.5 ) , and PAI duration per episode was 3.75 hours ( 1.8 - 7.2 ) . All clinical parameters improved significantly across episodes : grip strength median ( interquartile range ) change , 2.0 kg ( 0.0 - 2.3 ) ( P < .01 ) ; Barthel Index , 5 ( 3 - 8 ) ( P < .01 ) ; gait velocity , 0.06 m.∙s-1 ( 0.06 - 0.16 ) ( P < .01 ) ; and balance confidence , -3 ( -6 to -1 ) ( P < .01 )  . Physical activity  intervention dosing remained consistent within subgroups . While several moderate to large associations between amount of PAIs and change in clinical parameters were observed , most were within unimpaired subgroups . CONCLUSIONS PAI dosing is consistent . However , while clinical changes during hospital episodes are positive , more favourable responses to PAIs occur if patients are nonfrail/cognitively-unimpaired . Therefore , to deliver a personalized rehabilitation approach , adaptation of PAI dose based on patient presentation is desirable Purpose : Hospital‐associated deconditioning due to a combination of illness and inactivity is a serious problem for elderly adults . Here we investigate whether persistence in inflammatory status affects changes in physical function during short‐term hospitalization . Methods : This was a prospect i ve observational study in elderly medical patients at a geriatric department . Measurements were obtained at admission and one week after admission and included  de Morton Mobility Index ( DEMMI ) test , 30‐second chair st and test ( 30‐s CST ) , 4‐m gait speed ( 4‐m GST ) test , h and grip strength , activity levels determined with ActivPALs  , and concentrations of circulating C‐reactive protein ( CRP ) from blood sample s. Only patients with inflammation ( C‐reactive protein levels ≥ 10 mg·L− 1 ) at admission were included in this study . They were divided into those with continued inflammation ( CI : CRP remained ≥ 10 mg·L− 1 ) and those that became non‐inflammatory ( BN : CRP decreased to < 10 mg·L− 1 ) after one week of admission . Results : On admission 214 patients ( 67 % female ) with a median ( IQR ) age of 86 ( 81–91 ) years were categorized as inflammatory . There were no baseline differences in physical function between CI ( n = 138 , 67 % female ) and BN ( n = 76 , 68 % female ) . DEMMI‐score increased similarly in both groups ( P < 0.05 ) . When normalized to days between tests , only changes in h and grip strength were significantly different between the CI‐ and BN‐group ( − 0.05 [ − 0.27–0.28 ] vs. 0.16 [ − 0.10–0.41 ] kg·day− 1 , respectively , P < 0.01 ) . There was a positive association between changes in CRP and length of hospital stay ( rs = 0.30 , P < 0.001 ) . Conclusion : Hospitalized geriatric patients admitted with inflammation  showed only moderate improvement of general mobility during hospital stay , regardless of changes in their inflammatory status . However , h and grip strength increased only in those patients who became non‐inflammatory during hospitalization . HighlightsHospital‐associated deconditioning is a serious problem for elderly adults . We examined changes in physical function and inflammation in geriatric patients .We included 214 patients with inflammation on admission . H and grip strength improved only in the patients that became non‐inflammatory . Continuous inflammation may attenuate recovery of muscle strength BACKGROUND & AIMS Previous studies reported a severely impaired energy balance in COPD patients during the first days of an acute exacerbation , mainly due to a decreased energy and protein intake . The aim of the study was to investigate the feasibility and effectiveness of energy- and protein-rich nutritional supplements during hospitalization for an acute exacerbation in nutritionally depleted COPD patients . METHODS In a r and omized double-blind , placebo-controlled two-center trial , 56 COPD patients were r and omized and 47 patients completed the study .  Nutritional intervention consisted of 3 x 125 ml ( 2.38 MJ/day ) and the placebo group received similar amounts of a non-caloric fluid . Medical therapy and dietetic consultation were st and ardized and dietary intake was measured daily . Body composition , respiratory and skeletal muscle strength , lung function and symptoms were measured on admission and on days 4 and 8 of hospitalization . RESULTS Forty-seven percent of the patients had experienced recent involuntary weight loss prior to admission . The degree of weight loss was inversely related to resting arterial oxygen tension ( r = 0.31 ; P < 0.05 ) . Nutritional intervention result ed in a significant increase in energy ( 16 % vs. placebo ) and protein intake ( 38 % vs. placebo ) . Mean duration of hospitalization was 9 + /- 2 days . Relative to usual care , no additional improvements in lung function or muscle strength were seen after nutritional intervention . CONCLUSIONS Oral nutritional supplementation during hospitalization for an acute exacerbation is feasible in nutritionally depleted COPD patients and does not interfere with normal dietary intake ABSTRACT The objective of this study was to determine whether an exercise intervention using a pedal exerciser is able to reduce disability in frail older patients with chronic obstructive pulmonary disease ( COPD ) during hospitalization due to an acute exacerbation . This study was a r and omized , single-blind clinical trial . Fifty-eight frail older patients admitted to hospital due to an acute exacerbation of COPD ( AE COPD ) were included in this study . All patients received st and ard medical and pharmacological care . Patients assigned to the intervention group also received an exercise intervention . The main outcome measures were balance , muscle strength , and exercise capacity . Significant between-group differences were found in muscle strength ( p = 0.028 ) and balance ( p = 0.013 ) after the intervention . All the variables improved significantly ( p < 0.05 ) in the exercise intervention group . In the intervention group , the mean difference in muscle strength between baseline and discharge was 10.47 N. Balance also improved , showing a mean difference of 7.56 seconds on the right leg and 6.57 seconds on the left leg . Exercise capacity improved as well , with a difference of 4.97 st and s between baseline and discharge . All the variables showed impairment in the control group . In conclusion , an exercise intervention using a pedal exerciser during the hospital stay of frail elderly patients with an AE COPD improves muscle strength , balance , and exercise capacity OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Inactivity during hospitalization in older medical patients may lead to functional decline . This study quantified 24-hour mobility , vali date d the accelerometers used , and assessed the daily level of basic mobility in acutely admitted older medical patients during their hospitalization . METHODS This is a prospect i ve cohort study in older medical patients able to walk independently ( ambulatory patients ) and those not able to walk independently ( nonambulatory patients ) on admission . The 24-hour mobility level during hospitalization was assessed by measuring the time in lying , sitting , and st and ing and /or walking , by two accelerometers .  Basic mobility  was quantified within 48 hours of admission and repeated daily throughout hospitalization . RESULTS Forty-three ambulatory patients and six nonambulatory patients were included . The ambulatory patients tended to be hospitalized for fewer days than the nonambulatory patients ( 7 vs 16 , p = .13 ) . The ambulatory patients were lying median 17 hours , ( interquartile range [ IQR ] : 14.4 - 19.1 ) , sitting 5.1 hours ( IQR : 2.9 - 7.1 ) , and st and ing and /or walking 1.1 hours ( IQR : 0.6 - 1.7 ) per day . On days with independency in basic mobility , the ambulatory patients were lying 4.1 hours less compared with days with dependency in basic mobility ( p < .0001 ) , sitting 2.4 hours more ( p = .0004 ) , and st and ing 0.9 hours more ( p < .0001 ) . The algorithm identification for  lying , sitting , and st and ing and /or walking  of the accelerometers , corresponded by 89%-100 % with positions performed by older medical patients . CONCLUSIONS Older acutely hospitalized medical patients with walking ability spent 17h/d of their in-hospital time in bed , and the level of in-hospital mobility seemed to depend on the patients ' level of basic mobility . The accelerometers were valid in assessing mobility in older medical patients RATIONALE Exacerbations of chronic obstructive pulmonary disease ( COPD ) acutely reduce skeletal muscle strength and result in long-term loss of functional capacity . OBJECTIVES To investigate whether resistance training is feasible and safe and can prevent deteriorating muscle function during exacerbations of COPD . METHODS Forty patients ( FEV(1 ) 49 + /- 17 % predicted ) hospitalized with a severe COPD exacerbation were r and omized to receive usual care or an additional resistance training program during the hospital admission . Patients were followed up for 1 month after discharge . Primary outcomes were quadriceps force and systemic inflammation . A muscle biopsy was taken in a subgroup of patients to assess anabolic and catabolic pathways . MEASUREMENTS AND MAIN RESULTS Resistance training did not yield higher systemic inflammation as indicated by C-reactive protein levels and could be completed uneventfully . Enhanced quadriceps force was seen at discharge ( + 9.7 + /- 16 % in the training group ; -1 + /- 13 % in control subjects ; P = 0.05 ) and at 1 month follow-up in the patients who trained . The 6-minute walking distance improved after discharge only in the group who received resistance training ( median 34 ; interquartile range , 14 - 61 m ; P = 0.002 ) . In a subgroup of patients a muscle biopsy showed a more anabolic status of skeletal muscle in patients who followed training . Myostatin was lower ( P = 0.03 ) and the myogenin/MyoD ratio tended to be higher ( P = 0.08 ) in the training group compared with control subjects . CONCLUSIONS Resistance training is safe , successfully counteracts skeletal muscle dysfunction during acute exacerbations of COPD , and may up-regulate the anabolic milieu in the skeletal muscle . Clinical trial registered with www . clinical trials.gov ( NCT00877084 ) PURPOSE Although it is well known that immobilization causes muscle atrophy , most immobilization models have examined lower limbs , and little is known about the forearm . The purpose of this study was to determine whether forearm immobilization produces changes in muscle morphology and function . METHODS Six healthy males ( age : 21.5 + /- 1.4 , mean + /- SD ) participated in this study . The nondominant arm was immobilized with a cast ( CAST ) for 21 d , and the dominant arm was measured as the control ( CONT ) . The forearm cross-sectional area ( CSA ) and circumference were measured as muscle morphology . Maximum grip strength , forearm muscle oxidative capacity , and dynamic grip endurance were measured as muscle function . Magnetic resonance ( MR ) imaging was used to measure CSA , and 31phosphorus MR spectroscopy was used to measure time constant ( Tc ) for phosphocreatine ( PCr ) recovery after submaximal exercise ( PCr-Tc ) . Grip endurance was expressed by the number of h and grip contractions at 30 % maximum grip strength load . All measurements were taken before and after the immobilization . RESULTS After the 21-d forearm immobilization , no changes were seen for each measurement in CONT . CSA and the circumference showed no significant changes in CAST . However , maximum grip strength decreased by 18 % ( P < 0.05 ) , PCr-Tc was prolonged by 45 % ( P < 0.05 ) , and the grip endurance at the absolute load was reduced by 19 % ( P < 0.05 ) for CAST . CONCLUSION In this model , 21-d forearm immobilization caused no significant changes in forearm muscle morphology , but the muscle function showed remarkable deterioration ranging from 18 to 45 % OBJECTIVE To determine the safety and efficacy of the anabolic steroid n and rolone in elderly patients with hip fractures . DESIGN A r and omized double-blind placebo-controlled trial . SETTING The orthopedic ward of a university teaching hospital . PARTICIPANTS 29 frail elderly females with hip fractures . INTERVENTION Subjects received n and rolone 2 mg/kg ( n = 15 ) or placebo ( n = 14 ) by weekly injection for 4 weeks or until discharge . MEASURES Baseline functional status was assessed by the Lawton-Brody ADL and IADL . Hemoglobin , transferrin , thyroid-binding prealbumin , albumin , liver function tests , creatinine , weight , MAMC , bioelectric impedance , st and ard anthropometrics and grip strength were measured at baseline and weekly intervals . Rehabilitation parameters and length of stay were recorded . RESULTS The placebo and n and rolone groups were similar in age , although the control group had slightly higher baseline ADL scores . There was no difference between groups in biochemical parameters , anthropometrics , body composition , grip strength , rehabilitation end points or length of stay . One subject in the n and rolone group had a doubling of AST and was withdrawn from the study . CONCLUSIONS N and rolone can be given safely to frail elderly subjects with hip fractures but is likely to be of minimal benefit at the doses we employed OBJECTIVE To evaluate the effects of whole-body resistance training on exercise capacity , health-related quality of life ( HRQOL ) , and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease . DESIGN R and omized controlled trial . SETTING University hospital . PARTICIPANTS Patients ( N=46 ) were r and omized to either a control group ( CG ) or training group ( TG ) , and 29 patients completed the study . INTERVENTION Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs ( 2 sets of 8 repetitions each ) , and the initial load was set at 80 % of the 1-repetition maximum load . MAIN OUTCOME MEASURES Patients were evaluated on the second day of hospitalization , at hospital discharge , and 30 days postdischarge . Patients were evaluated on the basis of the 6-minute walking distance ( 6MWD ) , HRQOL , muscle strength , systemic inflammatory markers , and level of physical activity in daily life ( PADL ) . RESULTS The CG showed a reduction in the strength of lower-limb muscles ( P<.05 ) but not in the 6MWD ( P>.05 ) . In contrast , patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization ( P<.05 ) . The TG also improved the impact domain in HRQOL after hospitalization . No improvement in PADL was observed in the TG . Finally , a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization . CONCLUSIONS Our results suggest that resistance training during hospitalization improves the 6MWD , HRQOL , and lower-limb muscle strength , without altering the levels of systemic inflammation . However , future research should explore this intervention in larger r and omized trials The objective of this study was to analyze the results of a multimodal therapeutic program during hospitalization in obese AE COPD patients . This was a r and omized , single-blind clinical trial conducted at two university hospitals in Granada , Spain . Forty-nine patients hospitalized due to AE COPD were r and omly allocated to a control group ( CG ) , in which patients received st and ard care , or to an intervention group ( IG ) , in which patients were included in a multimodal therapeutic program , added to the st and ard care . The main outcome measures were pulmonary , physical ( strength and exercise capacity ) and perceived ( dyspnea , quality of life and psychological distress ) variables . Within-group significant improvements ( p < 0.05 ) were found in physical and perceived variables in the IG after the treatment . In the CG , a significant decrease was found in lower limb strength and a significant improvement in dyspnea and in three subscales of the EuroQol-5D question naire . The between-groups analysis showed significant differences after the treatment on lower limb strength and exercise capacity values ( p < 0.05 ) , in three of the EuroQol-5D subscales , and in the total score and the depression subscale of the Hospital Anxiety and Depression Scale . A multimodal therapeutic program has a beneficial effect on physical functioning and perceived variables in hospitalized obese patients with AE COPD BACKGROUND : COPD exacerbations are frequent events that have a negative impact on the lives of patients . The aims of this study were to analyze physical and functional impairment during hospital stay in subjects hospitalized due to COPD exacerbation and to assess the physical and functional impact of hospitalization at a 1-month follow-up in patients with severe COPD . METHODS : This was a prospect i ve observational study on a sample of 52 subjects hospitalized due to COPD exacerbation . The assessment s were performed at baseline , discharge , and 1-month follow-up . The outcome measures were dyspnea , muscle strength , functional capacity , and postural steadiness . RESULTS : Quadriceps strength [ 1.036 ( P = .043 ) kg mean difference ] and the one-leg stance test [ 1.04 ( P = .02 ) and 0.73 ( P = .032 ) s mean difference right and left leg ] showed significant impairment during hospitalization . Dyspnea perception improved significantly ( P = .004 ) during hospitalization . Additionally , strength in the upper and lower limbs [ 4.04 ( P = .002 ) and 1.23 ( P = .038 ) kg mean difference ] , functional capacity [ 3.0 number of steps mean difference ( P = .032 ) ] , and the one-leg stance test [ 2.12 ( P = .006 ) and 0.53 ( P = .047 ) s mean difference right and left leg ] showed significant impairment 1-month follow-up . CONCLUSIONS : Hospitalization due to COPD exacerbation leads to physical and functional impairment in patients ; impairment is greater at 1-month follow-up . It would be interesting to conduct physical therapy interventions to prevent the impairment
target: Inflammation appeared to be associated with greater loss of muscle strength .
  There was inconclusive evidence that the level of physical activity affects change in skeletal muscle .
  In regard to the effect of interventions , only exercise interventions were consistently associated with improved skeletal muscle outcomes .
  CONCLUSIONS Adult patients who undergo an unplanned hospital admission may experience a small reduction in knee extension strength and mid-arm muscle mass .
background: OBJECTIVES The primary objective of the review was to describe change that occurs in skeletal muscle during periods of unplanned hospitalisation in adult patients .
  The secondary objective was to examine the relationship between both physical activity and inflammation with the change in skeletal muscle .
  A further objective was to investigate the effect of interventions on change in skeletal muscle during periods of unplanned hospitalisation .