īy targeting older people with or at risk of mobility disability while inpatient, the vicious circle of inactivity and reduced physical function and HRQOL often experienced after discharge for older people could be counteracted. A recent systematic review on effectiveness of interventions to prevent pre-frailty and frailty progressions in older adults found that the group-setting was crucial to the effect of physical exercise programs. Furthermore, interventions with high intensity has proven somewhat superior to interventions with lower intensity in terms of improving physical function in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity. However, the rehabilitation sessions should be supervised to increase adherence and reduce falls. Nevertheless, a consensus regarding the most effective exercise-program to optimize physical function and HRQOL after discharge from hospital is lacking. Physical activity and exercise therapy after hospitalization of geriatric patients has shown to be feasible and could be an important means to help counteract the challenges associated with an ever-growing older population. Those who are not able to meet the recommendations due to health conditions are encouraged to engage in as much physical activity as their abilities and conditions allow. Further, older adults with poor mobility are recommended to perform physical activity to enhance balance and prevent falls on at least 3 days per week. In addition, muscle-strengthening exercises, involving major muscle groups, should be conducted at least twice a week. A combination of moderate- and vigorous-intensity exercise is just as good, and bouts of aerobic exercise lasting at least 10 min count in the weekly summary. To preserve good health, the World Health Organization (WHO) recommends people aged 65 years and older to engage in cardiorespiratory exercise training of moderate intensity at least 150 min per week, or at least 75 min if the intensity is vigorous. The literature on interventions aiming to preserve physical function and HRQOL in the general population is vast, and interventions should include endurance, strength, balance and flexibility exercises. Hospitalization often exacerbates the effects of ageing on physical function, and many older people suffer from mobility limitations and reduced HRQOL after discharge. Reduced physical function with increasing age can have tremendous negative consequences, both for the older individuals, their families and the society, hence preserving physical function, independence and HRQOL in older adults is central to the global response to population ageing. The study suggests that this population can benefit from systematic group exercise after hospital-initial rehabilitation has ended.
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ConclusionsĪ high intensity multicomponent exercise program significantly improved functional capacity and physical HRQOL in older adults with or at risk of mobility disability after discharge from hospital. No further between group differences in change from baseline to 4 months follow-up were found. Intention-to-treat analysis showed that the intervention group improved their functional capacity (6MWT) and the physical component summary of SF-36 significantly compared to the control group. Between-group differences were assessed using independent samples t-test.
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Data were analysed according to the intention-to-treat principle. Secondary outcomes were 6-min walk test (6MWT), Berg Balance Scale (BBS), grip strength, Body Mass Index (BMI), and HRQOL (the Short-Form 36 Health Survey (SF-36)). The primary outcome, physical performance, was measured by the Short Physical Performance Battery (SPPB).
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Both groups were instructed in a home-based exercise program and were encouraged to exercise according to World Health Organisation’s recommendations for physical activity in older people. The intervention group performed a group-based exercise program led by a physiotherapist twice a week for 4 months. Baseline testing was conducted median 49 (25 percentile, 75 percentile) (26, 116) days after discharge, before randomisation to an intervention group or a control group.
#High intensity health trial
This single blinded parallel group randomised controlled trial recruited eighty-nine home dwelling older people (65–89 years) while inpatient at medical wards at a general hospital in Oslo, Norway. This study investigates the effects of a group-based multicomponent high intensity exercise program on physical function and HRQOL in older adults with or at risk of mobility disability after discharge from hospital. A consensus regarding the most effective exercise-program to optimize physical function and HRQOL after discharge is lacking. Many older people suffer from mobility limitations and reduced health-related quality of life (HRQOL) after discharge from hospital.