The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials.
OBJECTIVE
To determine the effect of exercise interventions for acutely hospitalized older medical patients on functional status and hospital outcomes.


METHODS
MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PEDro, Current Contents and Sports Discus were searched until February 2006. Additional studies were identified through reference and citation tracking and contacting authors of eligible trials.


METHODS
Eligible studies were prospective randomized or pseudor and omized controlled trials comparing exercise for medical inpatients to alternate or no treatment controls. Of 3138 potentially relevant articles screened by two independent reviewers, seven randomized controlled trials and two pseudorandomized controlled trials were included. Two independent reviewers extracted data relating to patient and hospital outcomes and assessed the method quality.


RESULTS
Pooled analysis of multidisciplinary interventions that included exercise indicated a significant increase in the proportion of patients discharged to home at hospital discharge (relative risk 1.08; 95% confidence interval (CI) 1.03 -1.14) and a small but important reduction in acute hospital length of stay (weighted mean difference - / 1.08 days; 95% CI - / 1.93 to - / 0.22) and total hospital costs (weighted mean difference - / 280 US dollars; 95% CI - / 493 dollars to - / 65 dollars) compared with usual care. Pooled analysis of exercise intervention trials found no effect on the proportion of patients discharged to home or acute hospital length of stay. The effect of exercise on functional outcome measures is unclear. There was no influence of exercise intervention on adverse events.


CONCLUSIONS
Multidisciplinary intervention that includes exercise improves patient and hospital outcomes for acutely hospitalized older medical patients.
de Morton
Natalie A
NA
Physiotherapy, Monash University, Victoria, Australia. natalie.demorton@med.monash.edu.au
Keating
Jennifer L
JL
Jeffs
Kim
K
D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D015444:Exercise; D006760:Hospitalization; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome