Promoting Physical Activity Among Older People in Hospital

  • Anna Barker
  • Sze-Ee Soh


This chapter outlines the issues and strategies for optimising the implementation of physical activity programmes for older people in hospital. It begins with an overview of the hospital environment and a profile of older people admitted to hospital, including how active they are. The research literature relating to the functional consequences of bed rest and factors influencing activity levels of older people in hospital is then reviewed. Barriers to physical activity at the level of the hospital system, staff and the older person are discussed. Following this, strategies to promote physical activity are presented along with learnings from the field of implementation science. Programmes should be tailored to individuals, integrated into existing workflows, and multi-faceted to optimise effectiveness.


  1. Agmon, M., Zisberg, A., Gil, E., Rand, D., Gur-Yaish, N., & Azriel, M. (2017). Association between 900 steps a day and functional decline in older hospitalized patients. JAMA Internal Medicine, 177(2), 272–274.CrossRefGoogle Scholar
  2. Astrand, A., Saxin, C., Sjoholm, A., Skarin, M., Linden, T., Stoker, A., et al. (2016). Poststroke physical activity levels no higher in rehabilitation than in the acute hospital. Journal of Stroke and Cerebrovascular Diseases, 25(4), 938–945. Scholar
  3. Australian Institute of Health and Welfare. (2012). Australian Hospital Statistics 2010–11. Health services series no. 43. Cat. no. HSE 117. Retrieved from Canberra.Google Scholar
  4. Australian Institute of Health and Welfare. (2016). Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW.Google Scholar
  5. Boltz, M., Resnick, B., Capezuti, E., Shuluk, J., & Secic, M. (2012). Functional decline in hospitalized older adults: Can nursing make a difference? Geriatric Nursing, 33(4), 272–279. Scholar
  6. Brown, C. J., Friedkin, R. J., & Inouye, S. K. (2004). Prevalence and outcomes of low mobility in hospitalized older patients. Journal of the American Geriatrics Society, 52(8), 1263–1270. Scholar
  7. Brown, C. J., Williams, B. R., Woodby, L. L., Davis, L. L., & Allman, R. M. (2007). Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians. Journal of Hospital Medicine, 2(5), 305–313. Scholar
  8. Buttery, A. K., & Martin, F. C. (2009). Knowledge, attitudes and intentions about participation in physical activity of older post-acute hospital inpatients. Physiotherapy, 95(3), 192–198. Scholar
  9. Buurman, B. M., Hoogerduijn, J. G., de Haan, R. J., Abu-Hanna, A., Lagaay, A. M., Verhaar, H. J., et al. (2011). Geriatric conditions in acutely hospitalized older patients: Prevalence and one-year survival and functional decline. PLoS One, 6(11), e26951. Scholar
  10. Convertino, V. A. (1997). Cardiovascular consequences of bed rest: Effect on maximal oxygen uptake. Medicine and Science in Sports and Exercise, 29(2), 191.CrossRefGoogle Scholar
  11. Convertino, V., Hung, J., Goldwater, D., & Debusk, R. F. (1982). Cardiovascular responses to exercise in middle-aged men after 10 days of bedrest. Circulation, 65(1), 134.CrossRefGoogle Scholar
  12. Convertino, V. A., Bloomfield, S. A., & Greenleaf, J. E. (1997). An overview of the issues: Physiological effects of bed rest and restricted physical activity. Medicine and Science in Sports and Exercise, 29(2), 187.CrossRefGoogle Scholar
  13. Cosby, J. L. (2006). Improving patient care: The implementation of change in clinical practice. Elsevier: BMJ Publishing Group.Google Scholar
  14. Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., et al. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451–458.CrossRefGoogle Scholar
  15. Davenport, S. J., Arnold, M., Hua, C., Schenck, A., Batten, S., & Taylor, N. F. (2015). Physical activity levels during acute inpatient admission after hip fracture are very low. Physiotherapy Research International, 20(3), 174–181.CrossRefGoogle Scholar
  16. de Morton, N. A., Nolan, J., O’Brien, M., Thomas, S., Govier, A., Sherwell, K., et al. (2015). A head-to-head comparison of the de Morton mobility index (DEMMI) and elderly mobility scale (EMS) in an older acute medical population. Disability and Rehabilitation, 37(20), 1881. Scholar
  17. Despond, O., Buchser, E., Sprunger, A. L., & Sloutkis, D. (1999). Influence of patient’s dressing on spontaneous physical activity and length of hospital stay in surgical patients. Sozial-und Präventivmedizin, 44(1), 8–13.CrossRefGoogle Scholar
  18. Dewing, J. (2001). Care for older people with a dementia in acute hospital settings. Nursing Older People, 13(3), 18–20. PubMed PMID: 12008241.CrossRefGoogle Scholar
  19. Fisher, S. R., Graham, J. E., Ottenbacher, K. J., Deer, R., & Ostir, G. V. (2016). Inpatient walking activity to predict readmission in older adults. Archives of Physical Medicine and Rehabilitation, 97(9 Suppl), S226–S231. Scholar
  20. Gasior, K. (2012). In R. Rodrigues, M. Huber, & G. Lamura (Eds.), Facts and figures on healthy ageing and long-term care, Europe and North America, Occasional reports series 8. Vienna: European Centre.Google Scholar
  21. Gill, T. M., Allore, H. G., Gahbauer, E. A., & Murphy, T. E. (2010). Change in disability after hospitalization or restricted activity in older persons. JAMA, 304(17), 1919–1928. Scholar
  22. Gorgon, E., Said, C., & Galea, M. (2007). Mobility on discharge from an aged care unit. Physiotherapy Research International, 12(2), 72.CrossRefGoogle Scholar
  23. Hall, M. J., DeFrances, C. J., Williams, S. N., Golosinskiy, A., & Schwartzman, A. (2010). National Hospital Discharge Survey: 2007 summary. National Health Statistics Reports, 29(1–20), 24.Google Scholar
  24. Hastings, S. N., Sloane, R., Morey, M. C., Pavon, J. M., & Hoenig, H. (2014). Assisted early mobility for hospitalized older veterans: Preliminary data from the STRIDE program. Journal of the American Geriatrics Society, 62(11), 2180–2184. Scholar
  25. Hirsch, C. H., Sommers, L., Olsen, A., Mullen, L., & Winograd, C. H. (1990). The natural history of functional morbidity in hospitalized older patients. Journal of the American Geriatrics Society, 38(12), 1296–1303. Scholar
  26. Hirshon, J. M., Risko, N., Calvello, E. J. B., de Ramirez, S. S., Narayan, M., Theodosis, C., & Oneill, J. (2013). Health systems and services: The role of acute care. (Perspectives). Bulletin of the World Health Organization, 91(5), 386.CrossRefGoogle Scholar
  27. Holst, M., Hansen, P. L., Pedersen, L. A., Paulsen, S., Valentinsen, C. D., & Kohler, M. (2015). Physical activity in hospitalised elderly medical patients: How active are they, and what motivates to physical activity. Journal of Aging Research and Clinical Practice, 4(2), 116–123.Google Scholar
  28. Izawa, K. P., Watanabe, S., Oka, K., Osada, N., Omiya, K., Brubaker, P. H., & Shimizu, H. (2014). Differences in daily in-hospital physical activity and geriatric nutritional risk index in older cardiac inpatients: Preliminary results. Aging Clinical and Experimental Research, 26(6), 599–605. Scholar
  29. Kortebein, P., Symons, T. B., Ferrando, A., Paddon-Jones, D., Ronsen, O., Protas, E., et al. (2008). Functional impact of 10 days of bed rest in healthy older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(10), 1076–1081.CrossRefGoogle Scholar
  30. Kuys, S. S., Dolecka, U. E., & Morrison, C. A. (2011). Appropriate seating for medical patients: An audit. Australian Health Review, 35(3), 316–319. Scholar
  31. Lafreniere, S., Folch, N., Dubois, S., Bedard, L., & Ducharme, F. (2015). Strategies used by older patients to prevent functional decline during hospitalization. Clinical Nursing Research.
  32. Lamarche, K., & Vallance, J. (2013). Prescription for physical activity a survey of Canadian nurse practitioners. The Canadian Nurse, 109(8), 22–26.Google Scholar
  33. Landefeld, C. S., Palmer, R. M., Kresevic, D. M., Fortinsky, R. H., & Kowal, J. (1995). A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. New England Journal of Medicine, 332(20), 1338–1344. Scholar
  34. Levit, K., Wier, L., Stranges, E., Ryan, K., & Elixhauser, A. (2009). HCUP facts and figures: Statistics on hospital-based Care in the United States, 2007. Retrieved from
  35. Lindgren, M., Unosson, M., Fredrikson, M., & Ek, A. C. (2004). Immobility – A major risk factor for development of pressure ulcers among adult hospitalized patients: A prospective study. Scandinavian Journal of Caring Sciences, 18(1), 57–64. Scholar
  36. Matsuo, T., Sakaguchi, T., Ishida, A., Yuguchi, S., Saito, K., Nakajima, M., et al. (2015). Effect of in-hospital physical activity on cardiovascular prognosis in lower extremity bypass for claudication. Journal of Physical Therapy Science, 27(6), 1855–1859. Scholar
  37. McCullagh, R., Brady, N. M., Dillon, C., Horgan, N. F., & Timmons, S. (2016). A review of the accuracy and utility of motion sensors to measure physical activity of frail, older hospitalized patients. Journal of Aging and Physical Activity, 24(3), 465–475. Scholar
  38. McDonald, E. G., Dounaevskaia, V., & Lee, T. C. (2014). Inpatient attire: An opportunity to improve the patient experience. JAMA Internal Medicine, 174(11), 1865. Scholar
  39. Mortimer, J., & Green, M. (2015, October). The health and care of older people in England 2015. Age UK.Google Scholar
  40. Mudge, A. M., Giebel, A. J., Mgt, M. A., & Cutler, A. J. (2008). Exercising body and mind: An integrated approach to functional independence in hospitalized older people. Journal of the American Geriatrics Society, 56(4), 630–635. Scholar
  41. Naylor, M., & Keating, S. A. (2008). Transitional care: Moving patients from one care setting to another. The American Journal of Nursing, 108(9 Suppl), 58–63. Scholar
  42. Nitz, J. C., & Low Choy, N. (2008). Falling is not just for older women: Support for pre-emptive prevention intervention before 60. Climacteric, 11(6), 461–466.
  43. Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine, 26(4), 645–692. Scholar
  44. Ong, T., Anand, V., Tan, W., Watson, A., & Sahota, O. (2016). Physical activity study of older people in hospital: A cross-sectional analysis using accelerometers. European Geriatric Medicine, 7(1), 55–56. Scholar
  45. Ottenbacher, K. J., Smith, P. M., Illig, S. B., Linn, R. T., Ostir, G. V., & Granger, C. V. (2004). Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA, 292(14), 1687.CrossRefGoogle Scholar
  46. Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 24(4), 325–331. Scholar
  47. Peiris, C. L., Taylor, N. F., & Shields, N. (2012). Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopedic conditions: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 93(8), 1365–1370. Scholar
  48. So, C., & Pierluissi, E. (2012). Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: A qualitative study. Journal of the American Geriatrics Society, 60(4), 713–718. Scholar
  49. Tolson, D., Smith, M., & Knight, P. (1999). An investigation of the components of best nursing practice in the care of acutely ill hospitalized older patients with coincidental dementia: A multi-method design. Journal of Advanced Nursing, 30(5), 1127–1136. PubMed PMID: 10564412.CrossRefGoogle Scholar
  50. Toots, A., Littbrand, H., Lindelöf, N., Wiklund, R., Holmberg, H., Nordström, P., et al. (2016). Effects of a high-intensity functional exercise program on dependence in activities of daily living and balance in older adults with dementia. Journal of the American Geriatrics Society, 64(1), 55–64. Scholar
  51. Tudor-Locke, C., Craig, C. L., Aoyagi, Y., Bell, R. C., Croteau, K. A., De Bourdeaudhuij, I., et al. (2011). How many steps/day are enough? For older adults and special populations. The International Journal of Behavioral Nutrition and Physical Activity, 8, 80–80. Scholar
  52. Turner-Stokes, L. (2007). Cost-efficiency of longer-stay rehabilitation programmes: Can they provide value for money. Brain Injury, 21(10), 1015–1021. Scholar
  53. VanWormer, J. J., Pronk, N. P., & Kroeninger, G. J. (2009). Clinical counseling for physical activity: Translation of a systematic review into care recommendations. Diabetes Spectrum, 22(1), 48–55.CrossRefGoogle Scholar
  54. Villumsen, M., Jorgensen, M. G., Andreasen, J., Rathleff, M. S., & Molgaard, C. M. (2015). Very low levels of physical activity in older patients during hospitalization at an acute geriatric Ward: A prospective cohort study. Journal of Aging and Physical Activity, 23(4), 542–549. Scholar
  55. Zisberg, A., Shadmi, E., Sinoff, G., Gur-Yaish, N., Srulovici, E., & Admi, H. (2011). Low mobility during hospitalization and functional decline in older adults. Journal of the American Geriatrics Society, 59(2), 266–273. Scholar
  56. Zisberg, A., Shadmi, E., Gur-Yaish, N., Tonkikh, O., & Sinoff, G. (2015). Hospital-associated functional decline: The role of hospitalization processes beyond individual risk factors. Journal of the American Geriatrics Society, 63(1), 55–62. Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Anna Barker
    • 1
  • Sze-Ee Soh
    • 1
  1. 1.School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia

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