Department of Systems Biology, University of Alcalá, Madrid, Spain.
Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.
Ageing Res Rev. 2020 Aug;61:101076. doi: 10.1016/j.arr.2020.101076. Epub 2020 Apr 21.
Acute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.
Relevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19 March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.
Fifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19-1.08) and 1-3 months post-discharge (SMD = 0.29, 95%CI = 0.13-0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18-0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).
In-hospital supervised exercise interventions seem overall safe and effective for improving - or attenuating the decline of - functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.
急性住院治疗可能对老年人产生不良影响，特别是功能下降。我们旨在总结急性住院老年患者运动干预效果的证据。
系统检索（PubMed、Web of Science、康复与运动医学资源和 EMBASE）截至 2020 年 3 月 19 日的相关文献。纳入了针对因急性内科疾病住院的老年患者（＞60 岁）进行院内运动干预与常规护理的随机对照试验（RCT）。使用 PEDro 量表评估研究的方法学质量。主要结局包括功能独立性和身体表现。还评估了干预对其他主要结局（住院时间、再入院率和死亡率）的影响。当≥3 项研究分析相同结局时，进行了荟萃分析。
纳入了来自 12 项 RCT 的 15 项研究（n = 1748）。研究的方法学质量总体较高。没有研究报告与干预相关的任何不良事件。运动干预可改善出院时（标准化均数差 [SMD] = 0.64，95%置信区间 = 0.19-1.08）和出院后 1-3 个月（SMD = 0.29，95%CI = 0.13-0.43）的功能独立性，以及身体表现（SMD = 0.57，95%CI = 0.18-0.95）。住院时间、再入院率或死亡率的组间差异无统计学意义（均 p＞0.05）。
院内监督运动干预总体上安全且有效，可改善或减缓急性住院老年患者的功能独立性和身体表现下降。这些发现的临床意义仍需在未来研究中得到证实。
