Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Clinical Exercise Physiology

Background:

• Hospitalized oldest-old adults often experience functional decline.
• Exercise interventions aim to mitigate this decline but individual responses vary.
• Understanding variability in exercise response is critical for optimizing care.

Purpose of the Study:

• To analyze inter-individual variability in exercise response among acutely hospitalized oldest-old adults.
• To identify factors associated with different response categories (responders, non-responders, adverse responders).
• To examine the short- and middle-term consequences of adverse exercise response.

Main Methods:

• Ancillary analysis of a randomized controlled trial involving 268 oldest-old adults (mean age 88).
• Patients were assigned to usual care or supervised exercise (walking, chair rising).
• Response was categorized based on changes in Activities of Daily Living (ADL) function (Katz index) from admission to discharge.

Main Results:

• Impaired ADL function and poorer nutritional status at admission predicted greater exercise responsiveness.
• Better ADL function at admission, longer hospitalization, and lower comorbidity predicted poorer response.
• Adverse responders showed worse outcomes at discharge and 3-month follow-up, including impaired physical performance and increased falls.

Conclusions:

• Supervised exercise can prevent ADL decline in hospitalized oldest-old individuals.
• Patients with better baseline functional/health status and longer hospital stays are at higher risk for adverse responses.
• Adverse responders face negative short- to middle-term consequences, necessitating tailored exercise strategies.