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. Data sources: 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. Review methods: Eligible studies were prospective randomized or pseudo-randomized 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 pseudo-randomized 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 -US$280; 95% CI -$493 to -$65) 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.