A program of personalized physical exercise implemented over a three-year period and involving 370 people over the age of 75 admitted to the Geriatric Service of the Hospital Complex of Navarre (CHN) has turned out to be "safe and effective" in reversing the functional deterioration associated with hospitalization to which patients in this age group are subjected. Other aspects such as cognitive status and life quality also benefited.
This is the conclusion of a research project coordinated by Nicolás Martínez-Velilla and Mikel Izquierdo-Redín, researchers at Navarrabiomed, the biomedical research centre of the Government of Navarre and the Public University of Navarre (NUP/UPNA); its results have just been published in the Journal of the American Medical Association (JAMA Internal Medicine).
These findings open up the possibility of medical hospitalization units changing their traditional paradigm, which focuses mainly on disease, to another that recognizes the person's functional status as a clinical sign that may be negatively affected by this traditional hospitalization (classically based on bed rest).
Program of physical exercise involving strength, balance and walking
The people participating in this research participated in a controlled, personalized program of strength, balance and walking exercises adapted to their possibilities, even during the acute phase of their diseases. Depending on the status of each patient, training intensity ranging between 30% and 60% of their muscular capacity was specified, so they did leg and arm exercises. These sessions lasted twenty minutes twice a day (morning and afternoon), over between five and seven consecutive days (including weekends and public holidays) under the individual supervision of experts in the field of physical exercise for the elderly.
The program of physical activity adapted from the VIVIfrail training program (already successfully tried out on nearly a thousand people with problems of frailty and residing in seven European countries) was adapted at all times to the clinical circumstances of each patient; far from leading to complications in their initial state of health, it was found to be "a significant support in preventing frailty, a factor in eliminating complications linked to passive stay in hospital and a means of motivation for overcoming disease", as Nicolás Martínez-Velilla and Mikel Izquierdo pointed out.
"Our study shows that intervention involving, innovative, personalized multicomponent physical exercise that includes moderate intensity endurance training over a very short period of time, five days on average, has a significant benefit on routine care and may help to reverse the functional and cognitive deterioration associated with the hospitalization of the elderly," said the NUP/UPNA professor.
The results of the study show that when discharged from hospital, the group that had participated in the prescribed program of exercise achieved, in comparison with those who had not done it, a total of 2.2 points above the average on a maximum score of 12 in the SPPB (Short Physical Performance Battery) functional assessment tool, which measures balance, walking speed and leg strength, and 6.9 points above the average score in the Barthel Functional Index for Activities of Daily Living, which has a maximum score of 100 points. These results are particularly important, as there is scientific consensus that regards a one-point increase on the SPPB scale and five on the Barthel scale as clinically significant.
In comparison with the interventions carried out so far with patients that fit this profile, this is new and constitutes significant progress in dealing with functional aspects when abandoning hospitalization models that encourage the bed rest and sendentarism of the patient. "Until now, no one had suggested that patients of this type (elderly people with a range of diseases) could benefit in just five days from a personalized exercise program far removed from the usual message of 'get up and walk along the corridor a little' or 'rest in bed or in an armchair´," explained the head of the Geriatric Service at the CHN.
Significant benefits of the intervention from the cognitive and life quality perspective were also found. The above-mentioned improvements were achieved without any side effects or increase in hospital stay, as the researchers point out in their article.
"Nevertheless, this intervention did not change the rate of re-admittance or mortality three months later. In such an elderly population as those in the study and with a theoretically short life expectancy following hospitalization, the aim of our intervention was not to increase the quantity but the quality of life," said Nicolás Martínez-Velilla.
"Sometimes we believe that improvements in technologies or the latest innovative treatment can provide all the solutions for our problems, but we are not aware that disability generated by hospitalization may exert a greater impact than the very disease that prompted admittance in the first place. In this respect the hugely positive effect that physical exercise can have on disease prevention and treatment is reiterated," added Mikel Izquierdo.
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