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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if personalized exercise programs can help elderly patients maintain mobility and independence during and after a hospital stay. Researchers will test three exercise plans: one during hospitalization, one at discharge, and one that combines both. These plans will be compared to usual care to identify the most effective approach. Individuals aged 65 and over, planning to return home after their hospital stay, who can provide feedback and speak English or French, might be suitable candidates. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance recovery strategies for future patients.

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 prior data suggests that these exercise programs are safe for elderly patients?

Studies have shown that exercise programs like MATCH, PATH, and PATH 2.0 are generally safe for older adults in hospitals. Research indicates these programs help prevent physical decline without causing harm. In a previous study, MATCH proved both practical and well-received in geriatric units, demonstrating that older adults can manage the exercises well. Another study found that exercise programs like PATH can safely improve the physical abilities of hospitalized older patients. Research supports that PATH 2.0 exercises can prevent physical decline during and after a hospital stay. Overall, these exercise programs are well-tolerated and have not shown significant negative effects in the studies available. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these personalized exercise programs because they offer a tailored approach to managing aging-related functional decline during hospitalization, a condition traditionally managed with general physical therapy and routine care. The MATCH, PATH, and PATH 2.0 tools stand out because they prescribe specific exercise regimens tailored to individual needs, either during hospitalization or at discharge, potentially enhancing recovery speed and functional outcomes. Unlike standard care, which often applies a one-size-fits-all approach, these tools aim to provide customized interventions that could lead to more effective and efficient patient recovery. By targeting individual patient needs, these programs may revolutionize how functional decline is managed in older adults, offering hope for improved quality of life during and after hospital stays.

What evidence suggests that the MATCH, PATH, and PATH 2.0 programs are effective for preventing functional decline in hospitalized elderly?

Research has shown that exercise programs can help prevent the loss of physical abilities often experienced by older adults in the hospital. This trial will evaluate different tools for prescribing exercise programs. Participants in Group 1 will use the PATH tool, which provides exercise plans at discharge. Group 2 will use the PATH 2.0 tool, offering exercise programs during hospitalization and at discharge. Group 3 will use the MATCH tool, focusing on exercise during hospitalization. Studies have found that tools like MATCH, PATH, and PATH 2.0 effectively help elderly patients maintain mobility and strength. For instance, one study found that patients who followed an exercise program like MATCH experienced less physical decline while in the hospital. Another study noted that about 35% of patients aged 70 or older experience a decline in function during hospitalization, but personalized exercise programs can help prevent this. These findings suggest that including regular physical activity in hospital routines can help older adults stay stronger and more independent. ^{3 6 7 8 9}

Who Is on the 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

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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 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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT04078334

Personalized Exercises Program Prescription to Prevent ... 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 ...

2. researchgate.net researchgate.net/publication/389514657_Effect_of_a_Pragmatic_Exercise_Intervention_Pilot_Study_on_Preventing_Functional_and_Physical_Decline_in_Hospitalized_Older_Adults

Effect of a Pragmatic Exercise Intervention Pilot Study on ... We evaluated whether MATCH, a pragmatic unsupervised exercise intervention, could help prevent physical and functional decline in hospitalized ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3368750/

Integrated approach to prevent functional decline in ... Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional ...

4. nature.com nature.com/articles/s41598-024-56606-0

Exploring trajectories of functional decline and recovery ... Aging is an important factor contributing to the loss of ADL abilities, and our study focuses on investigating the trajectories of functional decline and ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8343083/

Value-based chronic care model approach for vulnerable ... Vulnerable older adults suffer from multiple chronic conditions (MCCs) in addition to cognitive and physical decline during the process of aging resulting in an ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10138309/

Implementation, Feasibility, and Acceptability of MATCH to ... MATCH, a pragmatic, specific, adapted, and unsupervised PA program, was feasible and acceptable in a geriatric assessment unit (GAU) and a COVID-19 geriatric ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12541298/

Physical exercises to prevent and rehabilitate hospital ... During hospitalisation, older adults are at risk of developing functional decline unrelated to the condition for which they were admitted.

8. sciencedirect.com sciencedirect.com/science/article/pii/S1279770723025952

Study Protocol Tailored Prevention of Functional Decline ... A multicomponent, individualized and progressive exercise program is an effective therapy for improving the capacity of acutely hospitalized older patients.

9. bjsm.bmj.com bjsm.bmj.com/content/57/19/1272

Optimal dose and type of physical activity to improve ... Recent meta-analytical evidence5 has demonstrated the effectiveness of active interventions to prevent functional declines in older adults admitted to hospital.