The dose of physical activity to minimise functional decline in older general medical patients receiving 24-hr acute care: a systematic scoping review

AIMS AND OBJECTIVES: To identify evidence for a recommended and feasible activity dose to minimise functional decline in older hospitalised general medical patients. BACKGROUND: Quality 24-hr care of older patients involves balancing activity to minimise functional decline, with rest to aid recovery. However, there is limited guidance regarding an optimal type and dose of activity to minimise functional decline in hospitalised elders receiving acute medical care. DESIGN: A systematic search and scoping review of the literature were conducted following Joanna Briggs methodological guidance. METHODS: The results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Study bias was determined using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Fifteen primary studies of variable design, rigour and potential for bias were included. Study contexts were general medical wards (n = 11, 73.3%), Acute care of the elderly unit (n = 3, 20%) and a nursing unit (n = 1, 6.7%) located in tertiary referral acute hospitals. Most participants were aged 75-84 years (n = 10, 66%), had variable medical diagnoses and samples were either physically capable (n = 4, 26.7%) of limited physical capability (n = 1, 6.7%) or of mixed capability to mobilise independently (n = 10, 66.7%). Walking at least twice a day for approximately 20 min in total appeared to be associated with less functional decline in older patients of variable physical capabilities, and the overall efficacy of twice-daily exercise to reduce functional decline was supported. CONCLUSION: The evidence tentatively supported walking for hospitalised elders, irrespective of physical capability, and based on one RCT, suggested likely benefits of graduated exercise in dependent elders. Insufficient evidence limits prescription of optimal doses of physical activity to minimise functional decline. RELEVANCE TO CLINICAL PRACTICE: This review could provide evidence for nurses to promote function in older patients by specifying a dose of physical activity to be undertaken in hospital.