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

Question: What are the effects of additional exercise on hospital and patient outcomes for acutely-hospital ised older medical patients? Design: Controlled clinical trial. Participants: 236 patients aged 65 or older admitted to an acute care hospital with a medical illness between October 2002 and July 2003. Intervention: The experimental group received usual care plus an individually tailored exercise program administered twice daily from hospital admission to discharge. The control group received usual care only. Outcome measures: The primary outcome was discharge destination. Secondary outcomes were measures of activity limitation (Barthel Index, Timed Up and Go, Functional Ambulation Classification), length of stay, and adverse events. Results: There was no significant effect of the additional exercise program on any outcome. There were no significant differences between groups for the proportion of the patients discharged to home (RR 0.99, 95% CI 0.86 to 1.14) or inpatient rehabilitation (RR 0.76, 95% CI 0.30 to 1.51) or for measures of activity limitation at hospital discharge. A one day difference in length of stay was identified between groups but this difference was not significant (p = 0.45). There were no significant differences between groups for adverse events: 28-day readmission (FR 1.10, 95% CI 0.65 to 1.86), patient mortality (FIR 1.15, 95% Cl 0.16 to 8.0), intensive care admission (FIR 0.16, 95% Cl 0.01 to 3.13) and falls (FR 0.69, 95% Cl 0.17 to 2.81). Conclusion: Additional physiotherapy intervention during hospitalisation did not significantly improve hospital or patient outcomes.