Stephen Lim is a Clinical Research Fellow and a Specialist Registrar in Geriatric Medicine in Academic Geriatric Medicine at the University of Southampton. His research interest is in physical activity and deconditioning in hospital. He will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @StephenERLim
Hospital-associated deconditioning is high on the agenda across hospitals in the UK and many hospital trusts have jumped on the ‘endPJparalysis’ bandwagon to encourage patients to get up and get moving, – and rightly so! It is encouraging to see that healthcare professionals and non-clinical staff members are increasingly aware that prolonged bedrest and immobility is bad medicine.
During an acute illness, older people are at risk of worsening sarcopenia and consequently a decline in physical function. The hospital environment, altered mental state, physiological stresses and poor nutrition (as a sequelae of the acute illness), are some of the important risk factors contributing to a loss of function. Sedentary behaviour during the acute illness phase has profound effects on skeletal muscle and contributes significantly to the loss of muscle mass and strength.
In the acute care setting, patients are often discharged below their prehospitalisation level of function, which results in poorer quality of life and increased dependence in activities of daily living. This also increases the burden placed on social care and increases their risk of readmission to hospital, both of which have cost implications.
For many of us who work in the acute care setting, we witness this decline on a daily basis. Questions must go through our minds about the things that can be done to prevent this decline. Several studies have shown that increased inpatient physical activity, through mobility or exercise interventions, can improve patient health outcomes, with a trend towards functional improvement and reduction in hospital length of stay. However, other studies have shown mixed results.
So, what is the current evidence behind exercise in the acute care setting? Are there specific exercises that may be more beneficial? How often should it be done? Does it matter who delivers the intervention? These are all valid questions that need answers. If changes were to be implemented, we need to know what to prescribe and how often.
If you wish to find out more about the evidence for exercise in the acute care setting, join us at the upcoming BGS Autumn Meeting in London. We will also be presenting our findings from the SoMoVe study, which explored the feasibility and acceptability of using trained volunteers to encourage older inpatients to stay active. We look forward to seeing you on the 22 of November when these findings will be discussed.