title: Exergames versus self-regulated exercises with instruction leaflets to improve adherence during geriatric rehabilitation: a randomized controlled trial Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial. Physiotherapy based on PNF concept for elderly people after conventional colon surgery. Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial The underrecognized epidemic of low mobility during hospitalization of older adults. Effects of the Horse Riding Simulator and Ball Exercises on Balance of the Elderly Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. Enhancing physical activity in older adults receiving hospital based rehabilitation: a phase II feasibility study The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. A Controlled Trial of the Efficacy of a Training Walking Program in Patients Recovering from Abdominal Aortic Aneurysm Surgery. Prevalence and outcomes of low mobility in hospitalized older patients. Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients. Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial
abstract: Background Improving mobility in elderly persons is a primary goal in geriatric rehabilitation . Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low . Exergames may improve adherence . This study therefore compared exergames with self-regulated exercise using instruction leaflets . The primary outcome was adherence . Secondary outcomes were enjoyment , motivation and balance during walking . Methods Design : single center parallel group non-blinded r and omized controlled trial with central stratified r and omization . Setting : center for geriatric inpatient rehabilitation . Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise . Patients were assigned to self-regulated exercise using a ) exergames on Windows Kinect ® ( exergame group EG ) or b ) instruction leaflets ( conventional group CG ) . During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days . Patients reported adherence ( primary outcome ) , enjoyment and motivation daily . Balance during walking was measured blind before and after the treatment phase with an accelerometer . Analysis was by intention to treat . Repeated measures mixed models and Cohen ’s d effect sizes ( ES , moderate if > 0.5 , large if > 0.8 ) with 95 % CIs were used to evaluate between-group effects over time . Alpha was set at 0.05 . Results From June 2014 to December 2015 217 patients were evaluated and 54 included , 26 in the EG and 28 in the CG . Adverse effects were observed in two patients in the EG who stopped because of pain during exercising . Adherence was comparable at day one ( 38 min . in the EG and 42 min . in the CG ) and significantly higher in the CG at day 10 ( 54 min . in the CG while decreasing to 28 min . in the EG , p = 0.007 , ES 0.94 , 0.39–0.151 ) . Benefits favoring the CG were also observed for enjoyment ( p = 0.001 , ES 0.88 , 0.32 – 1.44 ) and motivation ( p = 0.046 , ES 0.59 , 0.05–1.14 ) ) . There was no between-group effect in balance during walking . Conclusions Self-regulated exercise using instruction leaflets is superior to exergames  regarding adherence , enjoyment and motivation in a geriatric inpatient rehabilitation setting . Effects were moderate to large . There was no between group difference in balance during walking . Trial registration Clinical Trials.gov , NCT02077049 , 6 February 2014 BACKGROUND Several studies on the effect of physical exercise on activities of daily living ( ADL ) for people with dementia exist ; yet , data concerning the specific context of acute psychiatric hospitals remain scant . This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward . METHODS A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals . Participants were r and omly allocated to either an experimental group ( EG ) or a control group ( CG ) . Members of the EG received 20 physical exercise sessions ( strengthening , balance , and walking ) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency , but without physical exercise . The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention , and two weeks later . RESULTS Hundred and sixty patients completed the program . Characteristics of participants of both groups were similar at the inception of the study . The mean ADL score of EG decreased slightly over time , whereas that of the CG significantly decreased compared to initial scores . Overall differences between groups were not significant ; however , significant differences were found for mobility-related items . CONCLUSIONS ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization . An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores UNLABELLED Aging population , increases the number of  major abdominal surgery ( MAS ) performed in the elderly . Main goal of physiotherapy after that surgery is prevention postoperative complications and reduction of functional limitation . The aim of the study was to asses functional status elderly people after MAS  during early postoperative physiotherapy . MATERIAL AND METHODS In a prospect i ve r and omized study involved 34 patients scheduled for elective MAS , aged 65 + . Patients were r and omly assigned to receive PNF or conventional physiotherapy . The study included  forced spirometry ( FVC , FEV1 , PEF )  and  functional tests ( gait speed , up&go ) . Measurements were performed before surgery and the fourth day after surgery . Also analyzed age , sex , BMI and the level of postoperative independence ( postoperative independence scale SAP ) . Kolmogorow- Smirnow test was used to check normal distribution , t-Student was used to check whether two sets of data differ significantly , and r-Pearsons for correlations testing . p values < 0.05 were considered significant . RESULTS After surgery the time of gait speed test and up and go test was significant longer in comparison to preoperative value . FVC% , FEV1 % , PEF% values was decrease . In the PNF group was found significantly higher postoperative independence(SAP ) and shorter length of stay in hospital compared to conventional physiotherapy group . Results of SAP and functional tests were significantly positive correlated . CONCLUSIONS Major abdominal surgery decrees efficiency of walking and lung ventilation after 65 year old in early postoperative period . Some techniques of the PNF concept used in improving older patients after the MAS may favourably affect the postoperative increase independence and reduce the time of hospitalization Objective : To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients . Design : A single-blinded r and omized controlled trial . Setting : Department of Geriatric Rehabilitation in university hospital . Participants : A sample of 71 patients were successively included and r and omized either to the treatment group ( TG ) ( n = 36 ) or the control group ( CG ) ( n = 35 ) . Fifteen participants dropped out ( TG n = 7 ; CG n = 8) , leaving 56 participants with a mean age of 79 ( SD 7 ) . Intervention : Participants in the treatment group were treated in groups with progressive resistance strength training in addition to st and ard care . Progressive resistance strength training of the lower extremities was performed in three sets of 12–15 repetitions , intensity 60–70 % of one repetition maximum , in four 50-minute sessions per week . Main measures : The effect was evaluated by timed up & go test , 30-second chair-st and test , 10-m walk test , three tasks ( transfer , walking , stairs ) of the Barthel Index , and use of walking aids . Results : Significant improvements in the 10-m walk test ( P < 0.01 ) and Barthel Index ( walking ) ( P = 0.01 ) were demonstrated within the treatment group but not in the control group . Both groups had significant improvements in timed up & go , 30-second chair-st and ( modified ) and Barthel Index ( transfer and walking ) . No significant difference was found between groups except for the Barthel Index ( stairs ) ( P = 0.05 ) . Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables . Conclusion : The results indicate that for older hospitalized patients  progressive resistance strength training as additional training may have an effect compared to st and ard care , but no statistically significant effects were demonstrated when measured by functional outcomes 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 [ Purpose ] The aim of this study was to examine the effects of horse riding exercise using a horse riding simulator ( HRS ) and a ball on static and dynamic balance of elderly people . [ Methods ] Thirty-two elderly people hospitalized in geriatric hospitals were r and omly assigned to the HRS exercise group or the ball exercise groups , and they performed exercise for eight weeks . [ Results ] The length of postural sway during quite st and ing with and without eyes closed significantly decreased in both groups after the exercises and there was no significant difference between both groups in the Romberg test . In the functional reach test ( FRT ) , there were significant increases in distance in both groups after the exercises , and the distance of the HRS exercise group was significantly greater than that of the ball exercise group . In the Timed Up & Go test ( TUG ) and Timed 10-meter walk test ( 10MWT ) , the time significantly decreased in both groups , and there was a more significant decrease in the HRS exercise group than in the ball exercise group . [ Conclusion ] The results of this study indicate that HRS and ball exercises may improve the balance and gait ability of elderly people hospitalized in nursing homes or geriatric hospitals QUESTION What are the effects of additional exercise on hospital and patient outcomes for acutely-hospitalised older medical patients ? DESIGN Controlled clinical trial . PARTICIPANTS 236 Patients aged 65 or older admitted to an acute care hospital with a medical illness between October 2002 and July 2003 . INTERVENTION The experimental group received usual care plus an individually tailored exercise program administered twice daily from hospital admission to discharge . The control group received usual care only . OUTCOME MEASURES The primary outcome was discharge destination . Secondary outcomes were measures of activity limitation ( Barthel Index , Timed Up and Go , Functional Ambulation Classification ) , length of stay , and adverse events . RESULTS There was no significant effect of the additional exercise program on any outcome . There were no significant differences between groups for the proportion of the patients discharged to home ( RR 0.99 , 95 % CI 0.86 to 1.14 ) or inpatient rehabilitation ( RR 0.76 , 95 % CI 0.30 to 1.51 ) or for measures of activity limitation at hospital discharge . A one day difference in length of stay was identified between groups but this difference was not significant ( p = 0.45 ) . There were no significant differences between groups for adverse events : 28-day readmission ( RR 1.10 , 95 % CI 0.65 to 1.86 ) , patient mortality ( RR 1.15 , 95 % CI 0.16 to 8.0 ) , intensive care admission ( RR 0.16 , 95 % CI 0.01 to 3.13 ) and falls ( RR 0.69 , 95 % CI 0.17 to 2.81 ) . CONCLUSION Additional physiotherapy intervention during hospitalisation did not significantly improve hospital or patient outcomes Background Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes . Increased physical activity may improve mobility . The objective of this Phase II study was to evaluate the feasibility of a r and omized controlled trial ( RCT ) of enhanced physical activity in older adults receiving rehabilitation . Methods Patients admitted to aged care rehabilitation with reduced mobility were r and omized to receive usual care or usual care plus additional physical activity  , which was delivered by a physiotherapist or physiotherapy assistant . The feasibility and safety of the proposed RCT protocol was evaluated . The primary clinical outcome was mobility , which was assessed on hospital admission and discharge by an assessor blinded to group assignment . To determine the most appropriate measure of mobility , three measures were trialled ; the Timed Up and Go , the Elderly Mobility Scale and the de Morton Mobility Index . Results The protocol was feasible . Thirty-four percent of people admitted to the ward were recruited , with 47 participants r and omised to a control ( n = 25 ) or intervention group ( n = 22 ) . The rates of adverse events ( death , falls and readmission to an acute service ) did not differ between the groups . Usual care therapists remained blind to group allocation , with no change in usual practice . Physical activity targets were met on weekdays but not weekends and the intervention was acceptable to participants . The de Morton Mobility Index was the most appropriate measure of mobility . Conclusions The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible . A larger multi-centre RCT to establish whether this intervention is cost effective and improves mobility is warranted . Trial registration The trial was registered with the ANZTCR ( ACTRN12608000427370 ) QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis BACKGROUND The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities ( low-moderate and high ) of the knee extensor ( KE ) muscles on muscle function , functional limitations , and self-reported disability . METHODS The authors conducted a single-blinded , r and omized , placebo-controlled trial . Twenty-two institutionalized elders ( mean age , 81.5 years ) were assigned to either high-intensity strength training ( HI ; n = 8) , low-moderate intensity strength training ( LI ; n = 6 ) , or weight-free placebo-control training ( PC ; n = 8) . The HI group trained at 80 % of their 1-repetition maximum and the LI group trained at 40 % . All groups performed 3 sets of 8 repetitions , 3 times per week for 10 weeks . Outcome measures included KE maximal strength , KE endurance , and functional performance as assessed by 6-minute walking , chair-rising , and stair-climbing tests , and by self-reported disability . RESULTS KE strength and endurance , stair-climbing power , and chair-rising time improved significantly in the HI and LI groups compared with the PC group . Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group . Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test , with a trend in the same direction for chair-rising and stair-climbing . Changes in strength were significantly related to changes in functional outcomes , explaining 37 % to 61 % of the variance . CONCLUSIONS These results show strong dose-response relationships between resistance training intensity and strength gains , and between strength gains and functional improvements after resistance training . Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance . Supervised HI , free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally OBJECTIVES To describe the changes in activities of daily living ( ADL ) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function . DESIGN Prospect i ve observational study . SETTING The general medical service of two hospitals . PARTICIPANTS Two thous and two hundred ninety-three patients aged 70 and older ( mean age 80 , 64 % women , 24 % nonwhite ) . MEASUREMENTS At the time of hospital admission , patients or their surrogates were interviewed about their independence in five ADLs ( bathing , dressing , eating , transferring , and toileting ) 2 weeks before admission ( baseline ) and at admission . Subjects were interviewed about  ADL function  at discharge . Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge . RESULTS Thirty-five percent of patients declined in ADL function between baseline and discharge . This included the 23 % of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12 % of patients who did not decline between baseline and admission but declined between hospital admission and discharge . Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge . The frequency of ADL decline between baseline and discharge varied markedly with age ( 23 % , 28 % , 38 % , 50 % , and 63 % in patients aged 70 - 74 , 75 - 79 , 80 - 84 , 85 - 89 , and > or = 90 , respectively , P < .001 ) . After adjustment for potential confounders , age was not associated with ADL decline before hospitalization ( odds ratio ( OR ) for patients aged > or = 90 compared with patients aged 70 - 74 = 1.26 , 95 % confidence interval ( CI ) = 0.88 - 1.82 ) . In contrast , age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission ( OR for patients aged > or = 90 compared with patients aged 70 - 74 = 2.09 , 95 % CI = 1.20 - 3.65 ) and with new losses of ADL function during hospitalization in patients who did not decline before admission ( OR for patients aged > or = 90 compared with patients aged 70 - 74 = 3.43 , 95 % CI = 1.92 - 6.12 ) . CONCLUSION Many hospitalized older people are discharged with ADL function that is worse than their baseline function . The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during 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 ) BACKGROUND Major surgical procedures as well as general anesthesia contribute to muscle weakness and posture instability and may result in increased postoperative complications and functional disorders result ing from an elective operation . OBJECTIVES We aim to state the significance of backward walking as a form of interval march training with patients after abdominal aortic aneurysm surgery . MATERIAL AND METHODS Sixty-five patients were r and omly divided into three subgroups and three various models of physiotherapy were applied . The participants were males , aged 65 - 75 years , with stable cardiologic status , absence of neurological disorders , and non-symptomatic aneurysm - non-ruptured , no pain complaints and no motor system impairments . The control group had only routine physiotherapy , since therapeutic groups I and II also had walking exercises , forward in group II and backward in group I. Both experimental groups were applied interval training . The patient data analyzed was as follows : hospitalization period-days ; 6-min walking test-distance ( m ) , training heart rate ( 1/min ) , mean speed ( km/h ) , MET ; spirometry test-FVC(L ) , FEV1(L ) , FEV1/FVC and PEF(L/s ) . RESULTS The hospital stay period in all groups did not vary significantly . Statistical analysis showed that patients with backward walking had a statistically significantly lower reduction of walking distance in the corridor test when compared to the control group ( p < 0.05 ) . After the operation , a significant reduction of mean speed in the control group was noted in comparison with both the forward and backward walking groups ( p < 0.05 ) . No significant differences were noted between the experimental groups in average walking speed as well as in heart rate in all observed groups . CONCLUSIONS Physical training applied to patients after major abdominal aortic aneurysm surgery influences sustaining the level of exercise tolerance to a small extent . Both backward and forward walking seem to be alternative methods when compared to classic post-surgery physiotherapy OBJECTIVES To estimate the prevalence of different levels of mobility in a hospitalized older cohort , to measure the degree and rate of adverse outcomes associated with different mobility levels , and to examine the physician activity orders and documented reasons for bedrest in the lowest mobility group . DESIGN A prospect i ve cohort study . SETTING An 800-bed university teaching hospital . PARTICIPANTS Four hundred ninety-eight hospitalized medical patients , aged 70 and older . MEASUREMENTS Using average mobility level , scored from 0 to 12 , the low-mobility group was defined as having a score of 4 or less , intermediate as a score of higher than 4 to 8 , and high as higher than 8 . Outcomes were functional decline , new institutionalization , death , and death or new institutionalization . RESULTS Low and intermediate levels of mobility were common , accounting for 80 ( 16 % ) and 157 ( 32 % ) study patients , respectively . Overall , any activity of daily living ( ADL ) decline occurred in 29 % , new institutionalization in 13 % , death in 7 % , and death or new institutionalization in 22 % of patients in this cohort . When compared with the high mobility group , the low and intermediate groups were associated with the adverse outcomes in a grade d fashion , even after controlling for multiple confounders . The low-mobility group had an adjusted odds ratio ( OR ) of 5.6 ( 95 % confidence interval (CI)=2.9 - 11.0 ) for ADL decline , 6.0 ( 95 % CI=2.5 - 14.8 ) for new institutionalization , 34.3 ( 95 % CI=6.3 - 185.9 ) for death , and 7.2 ( 95 % CI=3.6 - 14.4 ) for death or new institutionalization . The intermediate group had adjusted ORs of 2.5 ( 95 % CI=1.5 - 4.1 ) , 2.9 ( 95 % CI=1.4 - 6.0 ) , 10.1 ( 95 % CI=1.9 - 52.9 ) , and 3.3 ( 95 % CI=1.8 - 5.9 ) for ADL decline , new institutionalization , death , and death or new institutionalization , respectively . Bedrest was ordered at some point during hospitalization in 165 ( 33 % ) patients . For most patients , mobility was limited involuntarily ( bedrest orders ) , and almost 60 % of bedrest episodes in the lowest mobility group had no documented medical indication . CONCLUSION Low mobility and bedrest are common in hospitalized older patients and are important predictors of adverse outcomes . This study demonstrated that the adverse outcomes associated with low mobility and bedrest may be viewed as iatrogenic events leading to complications , such as functional decline 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 OBJECTIVE An acute disease is regularly associated with inflammation , decreased food intake , and low physical activity ; the consequence is loss of muscle mass . However , the restoration of muscle tissue is problematic , especially in older patients . Loss of muscle mass leads to further decrease of physical activity which leads , together with recurring disease , to the progressive muscle mass loss accompanied by loss of self-sufficiency . Early nutrition support and physical activity could reverse this situation . Therefore , the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness . METHODS Two hundred patients > 78 y were admitted to a hospital internal medicine department and participated in a prospect i ve , r and omized controlled study . The patients were r and omized to a control group receiving st and ard treatment ( n = 100 ) or to an intervention group ( n = 100 ) . The intervention consisted of nutritional supplements ( 600 kcal , 20 g/d protein ) added to a st and ard diet and a simultaneous intensive rehabilitation program . The tolerance of supplements and their influence on spontaneous food intake , self-sufficiency , muscle strength , and body composition were evaluated during the study period . The patients were then regularly monitored for 1 y post-discharge . RESULTS The provision of nutritional supplements together with early rehabilitation led to increased total energy and protein intake while the intake of st and ard hospital food was not reduced . The loss of lean body mass and a decrease in self-sufficiency were apparent at discharge from the hospital and 3 mo thereafter in the control group . Nutritional supplementation and the rehabilitation program in the study group prevented these alterations . A positive effect of nutritional intervention and exercise during the hospital stay was apparent at 6 mo post-discharge . CONCLUSIONS The early nutritional intervention together with early rehabilitation preserves muscle mass and independence in ill older patients hospitalized because of acute disease Abstract Purpose : To determine the effect of Vibration Training ( VT ) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zeal and . Method : A r and omized controlled trial of 56 participants ( mean 82.01 years in the intervention group and 81.76 years in the control group ) .  VT targeting lower limb muscles with a frequency 30–50 Hz occurred three times per week until discharge . Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant . The control group received usual care physiotherapy sessions . Outcome measures were : Physiological profile assessment ( PPA ) ; and Functional Independence measure ( FIM ) and Modified Falls Efficacy Scale ( MFES ) . Results : There was a statistically significant difference observed between the two groups in terms of FIM score ( F = 5.09 , p = 0.03 ) and MFES ( F = 3.52 , p = 0.007 ) but no difference was observed in terms of PPA scores ( F = 0.96 , p = 0.36 ) . Conclusions : Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability . The study design and the small dosage of VT provided may have precluded any change in falls risk among participants . Implication s for Rehabilitation Vibration training ( VT ) may assist in reducing the risk of falling among at risk older people . Current pressures on health systems ( ageing population , reduced hospital length of stay ) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people . Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability Objective : To evaluate the clinical effectiveness and implementation of a falls prevention exercise programme for preventing falls in the subacute hospital setting . Design : R and omized controlled trial , subgroup analysis . Participants : Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a falls prevention exercise programme when enrolled in a larger r and omized controlled trial of a falls prevention programme . Methods : Participants in both the control and intervention groups who were recommended for the exercise programme intervention were followed for the duration of their hospital stay to determine if falls occurred . Participants had their balance , strength and mobility assessed upon referral for the exercise programme and then again prior to discharge . Participation rates in the exercise programme were also recorded . Results : Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts ( control : 16.0 falls/1000 participant-days , intervention : 8.2 falls/1000 participant-days , log-rank test : P = 0.007 ) . However few differences in secondary balance , strength and mobility outcomes were evident . Conclusion : This exercise programme provided in addition to usual care may assist in the prevention of falls in the subacute hospital setting Purpose : To assess the feasibility of a physiotherapy intervention using an interactive gaming program compared with conventional physiotherapy for hospitalised older people . Methods : R and omised controlled pilot study in a geriatric rehabilitation unit within an acute public hospital . Participants were r and omly allocated to  physiotherapy using an interactive gaming program ( n = 22 ) or conventional physiotherapy in a ward-based gym ( n = 22 ) . Feasibility was assessed by comparing the effects of the intervention on clinical outcome measures ( primary outcome : mobility as assessed by the Timed Up and Go test , secondary outcomes : safety , adherence levels , eligibility and consent rates ) . Results : Participants ( n = 44 ) had a mean age of 85 years ( SD 4.5 ) and the majority ( 80 % ) were women . Univariable analyses showed no significant difference between groups following intervention . However , multivariable analyses suggested that participants using the interactive gaming program improved more on the Timed Up and Go test ( p = 0.048 ) than participants receiving conventional physiotherapy . There were no serious adverse events and high levels of adherence to therapy were evident in both groups . Only a small proportion of patients screened were recruited to the study . Conclusions : In this feasibility study , the use of a commercially available interactive gaming program by physiotherapists with older people in a hospital setting was safe and adherence levels were comparable with conventional therapy . Preliminary results suggest that further exploration of approaches using games as therapy for older people could include commonly used measures of balance and function . Implication s for Rehabilitation The use of an interactive gaming program by physiotherapists with hospitalised older people appeared to be safe and result ed in improvements in balance and mobility . Use of these programs may be limited to a relatively small proportion of older people , only those able to use and interested in this technological approach to therapy
target: Overall , the effect of physical interventions on physical performance was inconsistent .
  Patient tailored interventions , i.e. continuously adapted to the capabilities of the patient were not found to be superior over interventions that were not .
  Conclusions Evidence for the effect of physical interventions on physical performance in older patients during hospitalization was found uncertain .
background: Background To counteract decline in physical performance and physical activity in older patients during hospitalization , multiple physical interventions were developed .
  However , it is unknown whether these are effective in this particular population .
  This systematic review aim ed to identify the effect of physical interventions on physical performance and physical activity in older patients during hospitalization .