Personalized Exercise Programs for Aging-related Functional Decline During Hospitalization

Overseen By Caroline Law

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Université du Québec a Montréal

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: Up to 36 weeks

720 Participants Needed

Trial Summary

What is the purpose of this trial?

Bed rest related to hospitalization contributes to the physical decline in capacities of the elderly, the loss of autonomy accelerated in post-hospitalization and the prevalence of the iatrogenic functional decline is about 20 to 50% for the elderly after an hospitalization. Mobilization through physical activity (PA) programs is strongly suggested to counter this phenomenon, but it is not part of the routine clinical hospital practices.The consequences are the functional incapacities, the mobility loss, the re-hospitalization falls and the important use of the health care and health services. In this regard, the Ministry of Health and Social Services adopted in 2011 a framework making mandatory the set up of interventions to prevent the functional decline of hospitalized elderly in every hospital centres in Quebec. The Geriatric Units (GU) admit elderly around 80 years old that present complex health problems. The scientific literature presents effective mobilisation programs to ensure the maintenance of functional capacities and the mobility of frail elderly. However, even with this knowledge, the prescription of physical exercises by the GU does not seem to be integrated in a natural and systematic way by in the professional practices. Our research team would like to implant the clinical tools : MATCH, PATH and PATH 2.0 that is a unique process of systematic prescriptions of physical activity during hospitalization (MATCH), at discharge (PATH) and during hospitalization and at discharge (PATH 2.0) in the GU, adapted to the profile of these patients. The objective of this project is to evaluate the implementation of the clinical tools MATCH, PATH and PATH 2.0 in different GU and to evaluate the tools efficiency and estimate the benefits-cost ratio on the use of post-hospitalization health services. Finally, the conclusions would help us refine the procedures to use in the short and medium term which clinical tool is likely a standard practice our GU and to improve the health continuum of elderly.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment MATCH, MATCH, PATH, PATH 2.0, PATH, MATCH, PATH 2.0, PATH 2.0, MATCH, PATH for aging-related functional decline during hospitalization?

Research shows that personalized exercise programs can help prevent decline in daily activities for older adults in the hospital. However, some patients, especially those in better health at admission, may not respond as well to these interventions. ^{1 2 3 4 5}

Is the personalized exercise program safe for older adults during hospitalization?

Supervised exercise programs for hospitalized older adults have been shown to be safe and effective in preventing or reducing functional decline. However, some individuals may experience negative outcomes, especially those with better health at admission and longer hospital stays. ^{4 6 7 8 9}

What makes the MATCH, PATH, PATH 2.0 treatment unique for addressing functional decline in hospitalized older adults?

The MATCH, PATH, PATH 2.0 treatment is unique because it offers a personalized exercise program specifically designed to reverse both functional and cognitive decline in older adults during hospitalization, unlike standard care which may not address these declines comprehensively. ^{2 4 10 11 12}

Research Team

Fonseca Raquel, Ph. D

Principal Investigator

Université du Québec a Montréal

Veillette Nathalie, Ph.D

Principal Investigator

Université de Montréal

Mylene Aubertin-Leheudre, Ph. D

Principal Investigator

Université du Québec a Montréal

Marie-Jeanne Kergoat, M.D., FRCPC

Principal Investigator

Centre de recherche de l'institut Universitaire de Gériatrie de Montreal

Eligibility Criteria

This trial is for older adults aged 65 and over who are hospitalized, planning to be discharged home, can communicate in French or English, have self-awareness, and no contraindications to physical activity. There are no specific exclusion criteria.

Inclusion Criteria

You tend to be very hard on yourself or criticize yourself often.

I am 65 years old or older.

I am scheduled to be discharged home after treatment.

Exclusion Criteria

Not applicable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Implementation of the MATCH tool: Prescription of physical exercise programs during hospitalization

Up to 36 weeks

Daily sessions during hospitalization

Post-hospitalization

Implementation of the PATH tool: Prescription of exercise programs at discharge

Up to 36 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

Up to 36 weeks

Treatment Details

Interventions

• MATCH
• PATH
• PATH 2.0

Trial Overview The study tests three personalized exercise programs: MATCH during hospitalization; PATH at discharge; and PATH 2.0 both during hospitalization and after discharge. The goal is to prevent functional decline in elderly patients by integrating these exercises into routine care.

Participant Groups

Group I: Group 3 Experimental Treatment 1 Intervention

MATCH tool: Prescription of physical exercise programs during hospitalization

Group II: Group 2 Experimental Treatment 1 Intervention

PATH 2.0 Tool : Prescription of exercise programs during hospitalization and discharge

Group III: Group 1 Experimental Treatment 1 Intervention

PATH Tool : Prescription of exercise programs at discharge

Group IV: Group 4 Active Control 1 Intervention

Control group: Usual care by the clinical teams

Who Is Running the Clinical Trial?

Université du Québec a Montréal

Lead Sponsor

Trials

28

Recruited

5,600+

Findings from Research

The SPRINT physical activity program significantly improved walking speed, balance, and functional mobility in hospitalized older patients, demonstrating its efficacy in enhancing functional capacities during hospitalization.

Patients participating in the SPRINT program had a much shorter length of stay in the hospital (5 days) compared to those who did not participate (36 days), suggesting that this unsupervised and pragmatic approach can effectively reduce hospitalization time and improve discharge outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study. Peyrusqué, E., Buckinx, F., Bolduc, A., et al.[2021]

An individualized multicomponent exercise program significantly improves both cognitive and physical function in acutely hospitalized older patients, as shown in a randomized clinical trial with 370 participants over 5 to 7 days.

Improvements in cognitive function, particularly in global cognition and verbal fluency, were found to mediate the enhancements in physical function, indicating that exercise not only benefits physical health but also cognitive abilities in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Function Improvements Mediate Exercise Intervention Effects on Physical Performance in Acutely Hospitalized Older Adults. Sáez de Asteasu, ML., Martínez-Velilla, N., Zambom-Ferraresi, F., et al.[2021]

Structured exercise programs, particularly aerobic walking, were evaluated in older adults (≥60 years) hospitalized for acute medical illness, but the results across various health outcomes were mixed, indicating variability in effectiveness.

The review highlighted the need for larger, well-designed randomized controlled trials to better assess the impact of exercise on health outcomes, emphasizing the importance of measuring premorbid function and ensuring adherence to exercise protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review. Kanach, FA., Pastva, AM., Hall, KS., et al.[2019]

In a study of 268 hospitalized patients aged 88 on average, supervised exercise significantly helped prevent declines in daily living activities, but responses varied widely among individuals.

Patients with better functional status at admission and longer hospital stays were more likely to be adverse responders, experiencing negative outcomes like impaired physical performance and increased falls, highlighting the need for tailored exercise interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults. Valenzuela, PL., Ortiz-Alonso, J., Bustamante-Ara, N., et al.[2020]

In a controlled trial involving 236 older patients hospitalized for medical illnesses, an additional exercise program did not significantly improve outcomes such as discharge destination or activity limitations compared to usual care alone.

The study found no significant differences in adverse events, including readmission rates and patient mortality, suggesting that the additional exercise intervention did not enhance safety or efficacy during hospitalization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. de Morton, NA., Keating, JL., Berlowitz, DJ., et al.[2019]

A systematic review of 19 studies involving 3842 older adults showed that as little as 25 minutes of slow-paced walking per day can significantly improve functional capacity and reduce adverse events for acutely hospitalized individuals.

The optimal dose for improving functional capacity was found to be around 159 METs-min/day, equivalent to approximately 70 minutes of light effort or 40 minutes of moderate effort activities, with ambulation being the most effective intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials. Gallardo-Gómez, D., Del Pozo-Cruz, J., Pedder, H., et al.[2023]

Supervised exercise interventions for hospitalized older adults (aged ≥75 years) have been shown to be safe and effective in preventing declines in physical function and cognitive abilities.

There is a critical need to integrate tailored physical activity guidelines and physical trainers into healthcare systems to ensure that frail older adults receive appropriate exercise prescriptions, promoting healthier aging.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity guidelines for older people: knowledge gaps and future directions. Izquierdo, M., Duque, G., Morley, JE.[2022]

The MATCH physical activity program was found to be feasible and acceptable for implementation in various geriatric care settings, including a geriatric assessment unit, a geriatric rehabilitation unit, and a post-acute care unit, with high adherence rates across all units.

Despite differences in patient eligibility among the units, the implementation time and patient satisfaction were consistent, indicating that MATCH could effectively counteract functional decline in older adults and should be further evaluated in randomized controlled trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation, Feasibility, and Acceptability of MATCH to Prevent Iatrogenic Disability in Hospitalized Older Adults: A Question of Geriatric Care Program? Peyrusqué, E., Kergoat, MJ., Sirois, MJ., et al.[2023]

In a study of 2153 hypertensive men aged 70 and older, higher exercise capacity was linked to a significant reduction in mortality risk, with a 11% lower risk for each 1-MET increase in exercise capacity.

Men categorized as moderate-fit and high-fit had mortality risks reduced by 36% and 48%, respectively, compared to those with very low fitness levels, highlighting the importance of physical activity in improving longevity among older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise capacity and all-cause mortality in male veterans with hypertension aged ≥70 years. Faselis, C., Doumas, M., Pittaras, A., et al.[2016]

Exercise-based rehabilitation that begins during hospital stays and continues after discharge can significantly improve functional ability in older adults who experience emergency admissions, based on a meta-analysis of 1602 participants from nine studies.

In-hospital-only exercise interventions did not show clear benefits for functional gains, indicating that ongoing support after discharge is crucial for effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving the rehabilitation of older people after emergency hospital admission. McKelvie, S., Hall, AM., Richmond, HR., et al.[2018]

The study aimed to implement an inpatient followed by an in-home exercise program for older adults with limited mobility, but only 10 out of 76 eligible patients were recruited, highlighting significant barriers such as illness severity and short hospital stays.

While most patients recognized the benefits of exercise, adherence to the program was low, with only 1 patient completing the full 24-week program, indicating that while the concept is promising, the execution needs improvement to enhance feasibility and patient engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise program implementation proves not feasible during acute care hospitalization. Brown, CJ., Peel, C., Bamman, MM., et al.[2019]

In a study of 95 overweight and obese older adults (ages 65-79) undergoing 5 months of either aerobic or resistance training, both exercise types significantly improved physical function, but individual responses varied widely.

While aerobic training led to an average 7.9% increase in peak aerobic capacity, and resistance training improved knee extensor strength by 8.1%, a notable percentage of participants (13% for aerobic and 30% for resistance training) showed no improvement or even a decrease in their physical function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Heterogeneity of physical function responses to exercise training in older adults. Chmelo, EA., Crotts, CI., Newman, JC., et al.[2022]

References

1. France pubmed.ncbi.nlm.nih.gov

Potential Efficacy of Pragmatic Exercise Program (SPRINT) during Hospitalization in Older Adults on Health Care and Physical Performance: A Pilot Study. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Cognitive Function Improvements Mediate Exercise Intervention Effects on Physical Performance in Acutely Hospitalized Older Adults. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review. [2019]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults. [2020]

5. Australia pubmed.ncbi.nlm.nih.gov

Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Physical activity guidelines for older people: knowledge gaps and future directions. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Implementation, Feasibility, and Acceptability of MATCH to Prevent Iatrogenic Disability in Hospitalized Older Adults: A Question of Geriatric Care Program? [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Exercise capacity and all-cause mortality in male veterans with hypertension aged ≥70 years. [2016]

10. Ireland pubmed.ncbi.nlm.nih.gov

Improving the rehabilitation of older people after emergency hospital admission. [2018]

11. United States pubmed.ncbi.nlm.nih.gov

Exercise program implementation proves not feasible during acute care hospitalization. [2019]

12. United States pubmed.ncbi.nlm.nih.gov

Heterogeneity of physical function responses to exercise training in older adults. [2022]