Rehabilitation of older medical patients: the role of progressive strength training

PhD-project

Principal investigator: Mette Merete Pedersen

Principal supervisor: Thomas Bandholm

Co-supervisors: Janne Petersen, and Nina Beyer

Research initiative: Optimized Senior Patient Programme (OPTIMED), Clinical Research Centre, Copenhagen University Hospital, Hvidovre, and PMR-C.

Time frame: 2012-2015

Background: In Denmark in 2009, older medical patients (+65 years) accounted for more than 66 % of all in-hospital days. Low mobility and periods of complete bed rest are common during hospitalization in older adults and can lead to functional decline and a loss of independency in everyday activities. In theory, functional decline can be prevented by strength training. We expect that the implementation of a simple but intensive strength training program during hospitalization and after discharge can help older medical patients maintain function while hospitalized and after discharge.

Purpose: The purpose of the PhD-project is (1) to quantify 24-h mobility during hospitalization in a group of acutely admitted older medical patients and to develop and validate an algorithm to quantify in-hospital mobility using accelerometers, (2) to test the feasibility of simple strength exercises for acutely admitted older medical patients. The exercises will be tested during hospitalization and in the patients’ own homes, (3) and to investigate if in-hospital training (including the above mentioned exercises) with continuation of training 3 times per week for 12 weeks in the patients’ own homes can improve mobility level, muscle strength, and activity level of older medical patients one month and ½ a year post dischargeefter, compared to usual care.

The hypotheses are (1) that older medical patients spend most of their in-hospital time in bed and the in-hospital mobility can be quantified using accelerometers, (2) that older medical patients can cooperate in performing simple strength training during hospitalization and after discharge, (3) and that in-hospital strength training, compared to usual care, improves mobility, muscle strength, and activity level of older medical patients.

Experimental approach: Study 1: A prospective cohort study conducted from December 2010 until June 2011 at Hvidovre Hospital. 60 acutely admitted older medical patients (+65) were included. We validated and developed an algorithm to quantify in-hospital mobility in older medical patients using accelerometers. The accelerometers were found valid in quantifying mobility in these patients and the patients were found to spend a mean of 17 hours per day in bed.

Study 2: A feasibility study aimed at testing a few strength training exercises in hospital and in the patients’ own home. Our focus will be on exercises aimed at improving the ability to perform basic mobility, e.g. sit-to-stand. We will include 24 older medical patients, admitted from their own home. We will ask the patients to perform 3 sets of 8-12 RM and will register the intensity of the performed exercises (RM) as well as pain and motivation related to the exercises.  

Study 3: A randomized controlled trial on 80 acutely admitted older medical patients (+65). The patients will be randomized to (1) training or (2) usual care. The patients in the intervention group will be asked to perform supervised simple strength training every day during hospitalization and 3 times per week for 4 weeks after discharge. The strength training exercises will be chosen based on the results of study 2. The primary outcome measure will be functional level measured by the de Morton Mobility Index (DEMMI) at admission, at discharge, 4 weeks after discharge and 6 months after discharge. Secondary outcome measure will be the 30 second sit-to-stand test and 24-hour mobility measures by accelerometers.

Contact: mette.merete.pedersen@hvh.regionh.dk, Mette Merete Pedersen


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