Design of an Early Exercise Program for Hospitalized Patients: “Let's Move”

ABSTRACT

Background

Hospital‐associated deconditioning (HAD) affects up to 30% of older adults during acute hospitalization, leading to functional and cognitive decline and adverse long‐term outcomes.

Purpose

To develop and pilot “Let's Move,” an implementation‐oriented early exercise program designed to support mobility in hospitalized patients.

Methods

An action‐research study was conducted at a tertiary hospital in two stages: (i) program design based on an electronic health record (EHR) needs assessment and targeted protocol review; and (ii) pilot implementation among clinically stable adults aged ≥ 18 years, hospitalized for ≥ 48 h, without physiotherapy referral. Outcomes included Hopkins Highest Level of Mobility (JH‐HLM) functional status, adherence, and safety, complemented by qualitative interviews and a focus group.

Results

In Stage 1, 1399 adult inpatients without rehabilitation referral were identified (median age, 65 years [IQR, 46–78]; length of stay, 3 days [IQR, 2–4]) with circulatory diseases predominating (57.18%). Among 26 participants enrolled in the pilot, 17 were evaluable for adherence, with 13 (76.5%) classified as adherent. Walking ≥ 75 m was the most frequent JH‐HLM assessment category, no adverse events or in‐hospital deaths occurred, and 25/26 participants (96.2%) achieved individualized goals. Qualitative findings supported relevance and feasibility and informed refinements, including sessions every 2 days and standardized educational materials.

Discussion

“Let's Move” is a structured early‐mobilization program developed through action research that integrates brief patient education with low‐intensity exercise for routine inpatient care. It provides a practical workflow to support early mobility and warrants broader evaluation to assess its effectiveness and scalability.

1. Introduction

Hospital‐associated deconditioning (HAD) is an important complication of hospitalization, characterized by a rapid decline in physical and cognitive function resulting from immobility and prolonged bed rest (Smart et al., 2018; Hoyer et al., 2016). Several studies have reported that this deterioration may begin within the first 24 hours of admission, particularly among older adults with chronic comorbidities such as osteoarthritis, diabetes mellitus, or chronic obstructive pulmonary disease (COPD), which may increase the risk of functional decline through pain, systemic inflammation, hypoxia, and reduced physical activity (Kalisch et al., 2014).

The prevalence of hospital‐associated disability is approximately 30% among older adults admitted to acute care and is associated with poorer functional recovery and adverse long‐term outcomes (Loyd et al., 2020). Despite its clinical relevance, hospital‐based strategies often remain fragmented and predominantly focused on rehabilitation rather than early prevention. Evidence supports early mobilization as a cost‐effective intervention across different hospital settings. In cardiac surgery, early mobilization has been associated with fewer postoperative complications and shorter hospital stays. In intensive care units, structured early‐mobilization programs have shown improvements in muscle strength (mean difference in MRC score: +8.6), a two‐fold higher likelihood of independent walking at discharge (OR: 2.13), and more days alive and out of hospital within 180 days after admission (Schweickert et al., 2011; Burtin et al., 2009). These findings highlight the potential role of early exercise as a secondary prevention strategy to reduce the burden of HAD.

Furthermore, recent evidence emphasizes that HAD is not limited to physical decline but may also involve cognitive and psychosocial domains, influenced by immobility, polypharmacy, malnutrition, delirium, and hospital‐related stress (Chen et al., 2022). Therefore, preventive strategies may benefit from a multidimensional approach that integrates physical, cognitive, and educational interventions from the onset of hospitalization. The implementation of structured early‐mobilization programs is also consistent with the principles of comprehensive, timely, and high‐quality care aimed at reducing the adverse consequences of immobility and promoting patient autonomy (Ley 1751 de 2015).

Based on this rationale and the available evidence, this study aimed to develop “Let's Move,” an early exercise program designed to support mobility among clinically stable hospitalized patients at risk of HAD. Rather than proposing early mobilization as a novel therapeutic concept, this study focuses on the local adaptation and initial implementation of a structured mobility strategy for clinically stable, functionally independent patients who are not referred to physiotherapy but remain at risk of hospital‐associated deconditioning. “Let's Move” was developed as a preventive mobility pathway integrating screening, patient education, low‐intensity exercise, progressive ambulation, and follow‐up within routine ward care. Its contribution lies in providing a pragmatic supporting mobility beyond conventional physiotherapy referral pathways and informing further evaluation, particularly in resource‐constrained settings.

2. Methods

2.1. Study Design

An action‐research study was carried out in a referral institution, comprising (1) program design and (2) pilot testing, to develop and preliminarily evaluate a rehabilitation‐oriented intervention for adult inpatients. The study was framed as an implementation‐oriented feasibility study rather than an effectiveness trial. Stage 1 focused on designing the program through three sequential phases; Stage 2 consisted of a pilot implementation followed by analysis and iterative refinement. Given the single‐group design and absence of a control or comparison group, the quantitative findings were interpreted descriptively and should be considered preliminary Figure 1 summarizes the overall workflow.

FIGURE 1.

Stages of development of the “Let's Move” Program. The action‐research process comprised two stages and six sequential phases, from needs assessment and program design to pilot implementation, evaluation, and refinement of the final version.

2.2. Stage 1: Program Design

This stage comprised three phases designed to ensure that the program addressed the needs of the target population. Phase 1 involved a diagnostic needs assessment to characterize the clinical context and target population; Phase 2 defined the program structure, objectives, and targets; and Phase 3 involved development of the final program proposal. The activities undertaken during each phase are described below.

2.2.1. Phase 1. Diagnostic Needs Assessment

During Phase 1, the research team characterized the clinical context and target population to ensure that the program addressed clinically relevant needs and operational constraints. A structured query of the hospital's electronic health record (EHR) was conducted to identify adult inpatients (≥ 18 years) admitted to general wards between January 1 and June 30, 2025, who did not receive a physiotherapy referral or intervention during the index hospitalization.

A prespecified dataset was extracted, including age (years), length of stay (days), sex (female/male), health insurance scheme (contributory/subsidized/special), and primary admission diagnosis classified according to the International Classification of Diseases, 10th Revision (ICD‐10) chapter (CDC, 2024). Predefined eligibility criteria included complete clinical documentation, at least 48 hours of hospitalization before program enrollment, and absence of an initial rehabilitation referral. Patients with medical contraindications to physical activity, such as cardiovascular instability, severe respiratory failure, or physician‐ordered strict bed rest, as well as those with pre‐existing severe disability precluding participation, were excluded. The resulting EHR‐derived data were used to characterize the target population, quantify unmet rehabilitation needs, and refine the program's objectives, scope, and implementation strategy for subsequent phases.

The research team also developed a problem tree to graphically represent the central problem, the risk of HAD among inpatients without physiotherapy intervention, together with its main contributing factors and downstream consequences. This synthesis tool supported analytical coherence with the objectives of Phase 1 and provided a structured link between the empirical findings and the objectives and design decisions developed in Phase 2

2.2.2. Phase 2: Objectives and Program Structure

During this phase, the research team conducted a focused review of international protocols on early mobilization and therapeutic exercise for hospitalized patients, with particular attention to studies reporting safety outcomes and specifying intervention frequency, duration, and intensity (Liu et al., 2013; McLaughlin et al., 2022). Based on this evidence, the program was conceptualized as an early‐exercise strategy designed to support mobility among hospitalized patients at risk of HAD.

Overall and specific objectives were established together with measurable targets to monitor program implementation and preliminary outcomes in the local context. The intervention was organized into two components. The first consisted of brief health counseling that explained HAD, outlined the risks associated with prolonged bed rest, and introduced the concept and benefits of physical activity during hospitalization, emphasizing the importance of maintaining activity through a basic, structured routine. The second component consisted of the practical exercise module and its delivery parameters, which are detailed in Phase 3.

2.2.3. Phase 3: Program Development

The structured program comprised 5 components: (i) a low‐intensity exercise session involving movements of the neck, head, trunk, and upper and lower limbs; (ii) predefined dosing parameters consisting of 20‐min sessions delivered at 4‐day intervals during the pilot implementation in accordance with recommendations for early rehabilitation, with follow‐up visits every 4 days until referral to physiotherapy or hospital discharge (Lang et al., 2020); (iii) educational counseling for patients and, when feasible, their families, addressing the risks of prolonged bed rest, the benefits of exercise during hospitalization, and strategies to support adherence (Lang et al., 2020; Zhang et al., 2019); (iv) a visual aid (educational poster; Supporting Information S1: Figure S1) outlining the exercise routine, sets and repetitions, posture, and criteria for progressive ambulation when clinically appropriate; and (v) adjustable dosing criteria tailored to patient tolerance, including the number of repetitions, posture, and walking distance, under the supervision of a physiotherapist or trained staff member to ensure safety.

Individualized goals were established by the physiotherapist during the initial assessment based on clinical stability, baseline mobility, activity tolerance, symptoms, and safety considerations. Exercise progression was determined clinically according to patient tolerance, the absence of warning symptoms, hemodynamic stability, and the ability to complete the prescribed routine. Progression could include increasing the number of repetitions, changing posture, or increasing walking distance when clinically appropriate.

2.3. Stage 2: Implementation and Evaluation

Stage 2 built on the preceding design work and comprised three phases: Phase 4 (program implementation), Phase 5 (program evaluation), and Phase 6 (refinement and consolidation of the final version). The activities undertaken during each phase are described below.

2.3.1. Phase 4: Program Implementation

In August 2025, the “Let's Move” program was implemented in adult general wards of the same institution. Consecutive inpatients were enrolled if they met the following criteria: age ≥ 18 years; at least 48 hours of hospitalization before program enrollment; clinical stability allowing supervised mobilization, defined as hemodynamic stability without signs of acute cardiorespiratory decompensation; functional independence, defined as the ability to sit, stand, or ambulate with minimal or no physical assistance according to the physiotherapist's initial assessment; and no physiotherapy referral at admission. Follow‐up assessments were scheduled every 4 days from enrollment in the program rather than from hospital admission.

Patients were excluded if they had severe pain, a physician‐documented contraindication to mobilization, major neurological impairment limiting participation, or declined to participate. Participants remained in the program during their eligible hospitalization period until hospital discharge, referral to standard physiotherapy, development of clinical instability, withdrawal of consent, or inability to complete the prescribed activity because of symptoms or functional limitations. Thus, intervention duration was not fixed but corresponded to the period from the initial intervention until hospital discharge, referral to standard physiotherapy, development of clinical instability, withdrawal, or inability to continue.

Accordingly, program completion was pragmatically defined as participation in the scheduled program activities during the eligible hospitalization period rather than completion of a predetermined number of sessions. Individuals who did not meet eligibility criteria at screening or who subsequently developed clinical instability were referred to the treating team for consideration of standard physiotherapy.

A team of physiotherapists received structured training to standardize program implementation. The training included briefing meetings, lectures, and hands‐on educational sessions covering eligibility and exclusion criteria, hemodynamic safety checks, supervised mobilization techniques, documentation procedures, and escalation pathways for clinical instability. In parallel, the program was formally introduced to medical and nursing teams through continuing‐education activities to align workflows, reinforce referral criteria, and clarify roles during ward‐based mobilization. Implementation fidelity was monitored through standardized eligibility verification, hemodynamic safety checks, symptom surveillance, adherence recording, JH‐HLM assessment, and documentation of adverse events at each recorded encounter. These procedures were used to promote consistency in intervention delivery across participants. However, not all scheduled follow‐up sessions were completed, primarily because participants could become unavailable during hospitalization according to the predefined program discontinuation criteria.

All intervention encounters were documented in REDCap through the project “REHAEVAL Fisioterapia” (Harris et al., 2009; Harris et al., 2019). The dataset included age (years), time from program enrollment to hospital discharge (days), sex (female/male), primary diagnosis, adherence (yes/no), Johns Hopkins Highest Level of Mobility (JH‐HLM) category (walk ≥ 75 m, walk ≥ 7.5 m, walk ≥ 10 steps, stand ≥ 1 minute, or sit at bedside) (Hoyer et al., 2018), reported adverse events, in‐hospital mortality, and achievement of individualized goals (yes/no). Individual mobilization goals were established by the physiotherapist following the initial assessment and tailored to each patient's clinical and functional status.

2.3.2. Phase 5: Impact Evaluation

The “Let's Move” program was evaluated using a mixed‐method approach combining quantitative and qualitative components conducted in parallel. The quantitative evaluation focused on three domains: (i) functional status, assessed using the Johns Hopkins Highest Level of Mobility (JH‐HLM) scale at the initial session and each follow‐up assessment; (ii) adherence, defined at the participant level as completion of the prescribed exercise plan among participants evaluable at the scheduled follow‐up; and (iii) safety, assessed through systematic recording of adverse events during the intervention and throughout hospitalization.

Quantitative variables were summarized using medians and interquartile ranges (IQRs) or frequencies and proportions, as appropriate. Analyses were performed using Stata version 16 (FAQ). Given the pilot feasibility design, small sample size, and absence of a comparison group, no inferential pre‐post testing, effect‐size estimation, or longitudinal modeling was performed. JH‐HLM results were summarized descriptively across all assessments conducted during implementation and interpreted as preliminary indicators of mobility performance during the program rather than evidence of clinical effectiveness.

The qualitative component explored the perceived relevance, feasibility, clinical applicability, and implementation requirements of the program among healthcare professionals directly involved in its implementation: two physiotherapists, one nurse, one general practitioner, and the physiotherapy service coordinator. Data were collected through semi‐structured interviews (Supporting Information S1: Figure S2) and a focus group guided by questions addressing the program's potential preventive value against HAD, its most useful components, barriers and facilitators to implementation, adequacy of supporting materials, and recommendations for sustainable integration into clinical practice.

All interviews were transcribed verbatim and analyzed using an inductive thematic approach in ATLAS.ti (ATLAS, 2025), allowing identification of emergent categories and cross‐cutting patterns. Transcripts were read repeatedly, codes were generated inductively, and categories were refined through team discussion. Discrepancies were resolved by consensus, and illustrative quotations were retained to support thematic interpretation. As a complementary descriptive analysis, word frequencies were examined after transcripts were cleaned to remove redundancies and noninformative terms. A word cloud was then generated with the size of each term reflecting its relative frequency in the participants' narratives.

2.3.3. Phase 6. Refinement and Final Version

Based on the analysis of the pilot findings, targeted refinements were made, and the program was consolidated into the final version of the “Let's Move” early‐mobilization intervention for hospitalized patients.

2.4. Ethical Statement

The study was conducted in accordance with applicable clinical research regulations and was approved by the Institution's Ethics Committee. Written informed consent was obtained from all participants in accordance with Resolution 008430 of 1993 of the Colombian Ministry of Health and the principles of the Declaration of Helsinki as amended in October 2013. Participant confidentiality was protected through data coding and restricted access to study information. The program was designed to minimize potential risks, and any adverse events were managed according to institutional protocols.

3. Results

3.1. Stage 1: Program Design

The EHR review identified 1399 hospitalized patients admitted between January 1 and June 30, 2025, who had not received rehabilitation referral or intervention (Table 1). The median age was 65 years (IQR, 46–78), and the median length of hospital stay was 3 days (IQR, 2–4). Women accounted for 53.68% of the population. Regarding health insurance coverage, 45.18% of patients were enrolled in the contributory scheme, 30.37% in the subsidized scheme, and 24.45% in a special scheme. Diseases of the circulatory system were the most frequent primary admission diagnoses (57.18%), followed by pregnancy, childbirth, and the puerperium (11.29%), diseases of the digestive system (5.93%), diseases of the respiratory system (3.93%), and infectious and parasitic diseases (3.65%).

TABLE 1.

Characteristics of the target population.

Variable	Total n (%) N = 1399
Age (years) a	65 (46–78)
Length of stay (days) a	3 (2–4)
Sex
Male	648 (46.32)
Female	751 (53.68)
Health insurance scheme
Contributory	632 (45.18)
Subsidized	425 (30.37)
Special	342 (24.45)
Primary diagnosis
Infectious and parasitic diseases	51 (3.65)
Malignant tumors	29 (2.07)
Autoimmune diseases	8 (0.57)
Endocrine and metabolic diseases	31 (2.22)
Mental and behavioral disorders	4 (0.29)
Diseases of the nervous system	19 (1.36)
Diseases of the circulatory system	800 (57.18)
Diseases of the respiratory system	55 (3.93)
Diseases of the digestive system	83 (5.93)
Diseases of the skin and subcutaneous tissue	35 (2.50)
Diseases of the musculoskeletal system and connective tissue	14 (1.0)
Diseases of the genitourinary system	50 (3.57)
Pregnancy, childbirth, and puerperium	158 (11.29)
Congenital malformations, deformations, and chromosomal abnormalities	10 (0.71)
Trauma	26 (1.86)
Other (symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified)	26 (1.86)

Note: Characteristics of adult inpatients without physiotherapy referral identified during the diagnostic needs assessment. Data are presented as n (%) unless otherwise specified. Age and length of stay are reported as median (interquartile range). Primary diagnoses were grouped according to ICD‐10 chapters. IQR: interquartile range.

^a Median (IQR).

The problem tree analysis identified the absence of a structured secondary prevention program based on health education and physical exercise as a central problem. It also highlighted the need to strengthen healthcare professionals' knowledge of the importance of physical activity during hospitalization (Figure S3).

The structured flow of the “Let's Move” program is summarized in Figure 2. Hospitalized patients were initially assessed according to predefined eligibility criteria, including hemodynamic stability, a minimum hospital stay of 2 days, functional independence, and no prior rehabilitation referral. Patients who met these criteria initiated the intervention. The program comprised two main components: an educational session addressing hospital‐associated deconditioning, the risks of prolonged immobility, and the benefits of maintaining physical activity during hospitalization; and a practical component incorporating visual mobility aids, guided stretching, and walking when clinically appropriate.

FIGURE 2.

Structured Flow of the “Let's Move” program. The diagram summarizes patient screening, educational and exercise components, eligibility reassessment, follow‐up every 4 days, referral to physiotherapy, and hospital discharge.

Patients who did not initially meet the eligibility criteria were reassessed according to their hemodynamic stability and functional independence. Those who remained ineligible were referred to physiotherapy when clinically indicated or discharged as appropriate. Patients who continued in the program received systematic follow‐up every 4 days, including functional assessment, adherence monitoring, and adjustment of exercise prescriptions. This workflow supported standardized patient selection, early education regarding physical activity, and continued monitoring throughout hospitalization (Figure 2).

3.2. Stage 2: Implementation and Evaluation

A total of 26 patients participated in the pilot phase of the “Let's Move” program. The median age was 52.5 years (IQR, 43.3–62.8), and 57.7% were male. The most frequent admission diagnoses were decompensated heart failure (26.9%), urinary tract infection (11.5%), pleural effusion (11.5%), and liver cirrhosis (11.5%). The median time from program enrollment to hospital discharge was 5.5 days (IQR, 1.5–11.75).

Of the 26 participants enrolled in the pilot, 17 (65.4%) remained hospitalized and clinically eligible to receive at least one follow‐up assessment 4 days after program enrollment. Among these participants, 13 (76.5%) adhered to the prescribed exercise plan, whereas 4 (23.5%) were classified as non‐adherent. Nine participants did not reach the scheduled follow‐up assessment: eight participants were discharged within 4 days of program enrollment and one was referred to standard physiotherapy because of pain. These participants were excluded from the adherence denominator because adherence could not be assessed. Functional status was summarized descriptively across all recorded JH‐HLM assessments, including the baseline evaluation; therefore, percentages represent assessment‐level distributions rather than patient‐level pre‐post changes. Walking ≥ 75 m was the most frequently recorded category, accounting for 74.4% of assessments, whereas lower mobility categories were less frequent. Participant progression through the pilot implementation is summarized in Figure 3.

FIGURE 3.

Participant Flow During the Pilot Implementation of the “Let's Move” Program. Participant flow from enrollment through follow‐up and adherence assessment. Of 26 enrolled participants, 17 remained hospitalized and clinically eligible for the planned day‐4 follow‐up, whereas 8 were discharged before day 4 and 1 was referred to standard physiotherapy because of pain. Adherence was assessed among participants with at least one follow‐up evaluation (n = 17). Values are presented as n (%).

No adverse events or in‐hospital deaths were recorded. Overall, 96.2% of participants achieved their individualized program goals. One patient did not achieve the planned goal because of radiating pain and edema in the left lower limb, with a reported pain score of 10/10, and was subsequently referred to standard physiotherapy. Across the 43 JH‐HLM assessments (26 baseline and 17 follow‐up assessments), walking ≥ 75 m was the most frequently recorded mobility level (32/43, 74.4%), followed by walking ≥ 7.5 m (7/43, 16.3%). The remaining assessments corresponded to walking ≥ 10 steps (1/43, 2.3%), standing for ≥ 1 minute (2/43, 4.7%), and sitting at the bedside (1/43, 2.3%). Adherence was assessed only among participants who remained hospitalized and clinically eligible to receive at least one follow‐up assessment on day 4 (n = 17). Of these, 13 (76.5%) were adherent to the prescribed exercise plan and 4 (23.5%) were non‐adherent. The remaining 9 participants did not reach the scheduled follow‐up assessment: 8 were discharged before the scheduled day‐4 follow‐up and 1 was referred to standard physiotherapy because of pain. These participants were therefore not included in the adherence denominator, as adherence could not be assessed (Table 2).

TABLE 2.

Clinical characteristics, participant‐level adherence, assessment‐based functional outcomes, and safety of patients enrolled in the “Let's Move” program.

Variable	Total n (%) N = 26
Age (years) a	52.5 (43.3–62.8)
Sex
Female	11 (42.3)
Male	15 (57.7)
Diagnosis
Decompensated heart failure	7 (26.9)
Urinary tract infection	3 (11.5)
Pleural effusion	3 (11.5)
Liver cirrhosis	3 (11.5)
Cardiogenic syncope	2 (7.7)
Gastroenteritis	2 (7.7)
Myocarditis	2 (7.7)
Soft tissue infection	2 (7.7)
Pneumonia	1 (3.8)
Hypertensive crisis	1 (3.8)
Time from program enrollment to hospital discharge, days, median	5.5 (1.5–11.75)
Adherence at scheduled follow‐up b
Adherent	13 (76.5)
Non‐adherent	4 (23.5)
Johns hopkins highest level of mobility scale c n = 43
Walk ≥ 75 m	32 (74.4)
Walk ≥ 7.5 m	7 (16.3)
Walk ≥ 10 steps	1 (2.3)
Stand ≥ 1 minute	2 (4.7)
Sit at bedside	1 (2.3)
Reported adverse events	0 (0)
In‐hospital mortality	0 (0)
Goal achievement
Yes	25 (96.2)
No	1 (3.8)

^a Median (IQR).

^b Adherence was assessed at the participant level among participants evaluable at the scheduled day‐4 follow‐up (n = 17). Nine participants who did not reach the scheduled follow‐up were excluded from the adherence denominator.

^c JH‐HLM categories represent all 43 recorded assessments: 26 baseline assessments, one for each enrolled patient, and 17 follow‐up assessments. Percentages were calculated using the total number of assessments (n = 43) as the denominator.

Abbreviation: JH‐HLM: Johns Hopkins Highest Level of Mobility.

The qualitative findings highlighted participants' perceptions of the program's relevance and usefulness, particularly its potential role in preventing physical deconditioning and providing comprehensive patient support. Participants also perceived potential benefits extending beyond the physical domain to mental and social well‐being. The most valued elements included education on physical activity, active patient involvement, and the practicality of adapted exercises.

Several barriers to implementation were identified, including insufficient staffing, difficulties in the timely identification of eligible patients, and variability in patient willingness to participate. Key facilitators included institutional support, systematic clinical assessment, multidisciplinary collaboration, and perceived patient acceptance. Factors considered important for adherence included professional support, continuous feedback, and motivation related to preventing deconditioning.

Regarding educational materials, participants emphasized the need for greater clarity and visibility within hospital rooms and suggested incorporating additional formats, such as videos and infographics. Recommendations to support program sustainability included increasing staff availability, optimizing patient recruitment processes, and providing more visible and accessible educational materials. Given the small number of participants and their direct involvement in program implementation, these qualitative findings should be interpreted as exploratory insights into feasibility, acceptability, and implementation barriers rather than as a comprehensive qualitative evaluation (Table 3).

TABLE 3.

Qualitative findings: Relevance, implementation barriers, facilitators, and sustainability of the program.

Selective category	Axial categories	Open codes (textual examples)
Relevance and usefulness of the program	–Prevention of deconditioning –Comprehensive patient support –Mental and social benefits	“Prevents physical deconditioning” “supports transition back home or to work” “it is useful even for mental health because it changes the routine”
Valuable elements of the program	–Exercise education –Inclusion and active participation –Practical and adapted exercises	“Education on physical activity” “feeling less limited despite hospitalization” “ease and practicality of the exercises”
Implementation barriers	–Insufficient human resources –Difficulty in patient identification/recruitment –Patient’s condition/disposition	“Lack of staff” “adequate identification of eligible patients” “patient willingness”
Implementation facilitators	–Institutional and organizational support –Clinical evaluation –Multidisciplinary teamwork –Good patient acceptance	“Institutional support” “clinical evaluation of patients” “support from physiotherapy service and multidisciplinary team” “good patient engagement”
Adherence factors	–Professional support –Continuous feedback –Prevention of deconditioning –Patient’s physical and mental status	“Assistance from staff and home exercise plan” “Continuous feedback” “Prevention of deconditioning” “Physical background, condition, and mental status”
Educational material and communication	–Clarity and sufficiency –Visibility in patient rooms –New proposed formats (videos, infographics)	“The current material is insufficient and unclear” “it is clear but not very visible” “create a video as support material”
Program sustainability	–Increased staffing –Adjustment of schedules and recruitment –More visible educational materials	“More staff” “recruitment days” “infographic more visible in the patient’s room”

Note: Qualitative findings derived from interviews and a focus group with healthcare professionals involved in program implementation. Selective and axial categories were generated through inductive thematic analysis, and open codes are presented as illustrative textual examples. Findings should be interpreted as exploratory implementation insights.

As a complementary descriptive resource, word frequency analysis was used to visually summarize recurrent terms in participants' narratives. The resulting word cloud was not intended to represent an independent qualitative finding but rather to complement the thematic description by illustrating frequently mentioned terms such as “program,” “patient,” and “deconditioning” (Supporting Information S1: Figure S4).

As part of the final refinement phase, program modifications were made in direct response to the pilot findings. During the pilot, the 4‐day interval limited opportunities for repeated patient contact and reassessment within relatively short hospital stays. Based on this implementation experience and feedback from the healthcare professionals involved, the final program frequency was increased to every 2 days to improve continuity, allow more frequent reassessment of mobility and exercise tolerance, and reinforce patient education and exercise recommendations.

Given the limited availability of printed educational materials, a poster was developed as the primary supporting resource to communicate key content clearly and accessibly. The final version of the poster incorporated content and design refinements aimed at improving comprehension and patient safety. Technical terminology was simplified; for example, “upper/lower limbs” was replaced with “arms/legs.” The trunk exercise section was modified to advise patients to perform movements while seated if they felt unsafe, and a safety note instructed patients to contact nursing staff if symptoms developed during activity. The program title, “Let's Move,” was also made more prominent. These modifications were intended to make the educational material clearer, safer, and easier for patients to follow. To facilitate dissemination, the inclusion of a QR code linking to the program materials was proposed (Supporting Information S1: Figure S5).

Recognizing the importance of sustained capacity building in the context of staff turnover, continuing education was provided to healthcare personnel to standardize eligibility screening, mobilization procedures, and documentation practices. This training was intended to support implementation fidelity across staff rotations and promote consistent delivery of the early‐mobilization program.

4. Discussion

Prolonged bed rest and inactivity during hospitalization can lead to rapid functional decline, particularly among older adults and patients with multimorbidity. Approximately 30% of older adults admitted to acute care develop hospital‐associated disability (HAD), which has been associated with poorer functional recovery and adverse long‐term outcomes (Smart et al., 2018; Yang et al., 2022). To address this clinical and implementation gap, we developed and piloted “Let's Move,” a structured early‐mobility program for hospitalized patients. In this initial feasibility study, the program showed acceptable adherence, high achievement of individualized mobility goals, and no recorded adverse events. Given the small sample size and absence of a comparison group, these findings should be interpreted as preliminary evidence regarding feasibility, adherence, and safety rather than clinical effectiveness or prevention of HAD.

The main contribution of this study lies not in presenting early mobilization as a new therapeutic concept but in addressing a population that may be overlooked by conventional rehabilitation pathways: clinically stable, functionally independent hospitalized adults who do not have an indication for formal physiotherapy. Unlike rehabilitation programs primarily directed toward patients with established functional impairment, “Let's Move” was designed as a structured mobility pathway intended to support physical activity among patients at risk of hospital‐associated deconditioning. Its structured combination of eligibility screening, patient education, low‐intensity exercise, progressive ambulation, safety monitoring, and follow‐up provides a pragmatic model that may facilitate the extension of mobility‐oriented care beyond the patients who traditionally receive physiotherapy. This may be particularly relevant in resource‐limited settings, where rehabilitation personnel cannot provide individualized intervention to all hospitalized patients. Furthermore, its development through needs assessment, evidence‐informed design, pilot implementation, stakeholder feedback, and iterative refinement provides a reproducible framework that can be adapted and formally evaluated in other institutions. This approach is consistent with evidence supporting early mobilization as a strategy to preserve function and reduce complications associated with prolonged inactivity during hospitalization (Goldsworthy, 2016; Flaatten et al., 2022; Sahetya et al., 2024).

A distinctive feature of the program is its integration of brief educational counseling with a low‐intensity exercise routine. Patient education may help address uncertainty regarding mobility during hospitalization and encourage active participation in maintaining functional capacity. Previous studies suggest that clear information about the consequences of prolonged bed rest and the benefits of physical activity can support engagement with mobility interventions (Liu et al., 2013; Brown et al., 2016). In “Let's Move,” visual educational materials and supervised exercise were incorporated to facilitate understanding, reinforce patient participation, and provide a simple mobility strategy that may be particularly relevant in settings with limited rehabilitation resources. In the Colombian context, this preventive approach is also consistent with the principles of comprehensive health care established under the national statutory health framework ().

Our qualitative findings provided complementary insights into the program's acceptability and implementation requirements. Participants perceived the intervention as practical and compatible with routine clinical care, while identifying limited staffing and difficulties in timely patient identification as the main implementation barriers. Importantly, this feedback directly informed iterative modifications to the program, including increasing session frequency and improving the visibility and clarity of educational materials. This process is consistent with implementation‐oriented approaches in which interventions are progressively adapted to local workflows, available resources, and stakeholder feedback (McLaughlin et al., 2022; Hoyer et al., 2018).

Beyond physical decline, HAD is increasingly recognized as a multidimensional syndrome involving cognitive impairment, malnutrition, delirium, and hospital‐related stress (Chen et al., 2022). Although this pilot focused primarily on mobility, future iterations could consider complementary components such as cognitive stimulation, nutritional assessment, and psychosocial support. The Acute Care for Elders (ACE) model illustrates the potential value of multidimensional hospital‐based approaches by integrating adapted environments, interdisciplinary care, discharge planning, and early mobility (Palmer et al., 1994). Incorporating selected elements of such frameworks may broaden the scope of “Let's Move” and support a more comprehensive approach to immobility‐related risk.

Taken together, these findings suggest that a structured program combining patient education, low‐intensity exercise, safety screening, and follow‐up by trained personnel can be integrated into routine care for clinically stable hospitalized adults. The absence of recorded adverse events and the high proportion of individualized goals achieved provide preliminary support for program delivery under supervised conditions. However, the small sample size, single‐group design, and short follow‐up preclude conclusions regarding clinical effectiveness. Larger comparative studies with longer follow‐up are needed to determine whether the program improves functional outcomes and whether it can be sustainably implemented across different inpatient settings.

5. Limitations

Conducted in a single tertiary hospital, the findings from this initial implementation experience may not generalize to settings with different organizational structures, staffing models, or patient profiles. The initial implementation phase included only 26 patients, which limits generalizability and the strength of interpretation regarding implementation potential or clinical impact. In addition, the study did not include a control or comparison group; therefore, it was not designed to determine clinical effectiveness or to establish whether the intervention prevents hospital‐associated deconditioning. Furthermore, JH‐HLM findings were summarized as assessment‐level distributions across all recorded evaluations rather than as within‐patient changes from baseline over time. Consequently, these data describe mobility performance observed during the program but do not demonstrate improvement in functional status attributable to the intervention. Potential selection bias should also be considered, as the program included clinically stable adults without an initial physiotherapy referral, which may limit its applicability to patients with greater clinical complexity, poorer baseline mobility, or contraindications to mobilization. In particular, patients who were clinically unstable, functionally dependent, or already referred for physiotherapy were not represented in the pilot population. Therefore, the feasibility findings should primarily be interpreted in relation to clinically stable and functionally independent hospitalized adults and should not be generalized to patients at higher risk of functional decline without further evaluation. Feasibility was also shaped by resource constraints, particularly limited staffing, which may have influenced adherence and the consistency of intervention delivery.

The qualitative component was limited by the small number of healthcare professionals included and by their direct involvement in program implementation. This may have introduced both selection and response bias and restricted the diversity of perspectives represented. Accordingly, these findings should be interpreted as exploratory insights into feasibility, acceptability, implementation barriers, and facilitators rather than as a comprehensive qualitative evaluation. In addition, the thematic findings were primarily descriptive, and the word cloud was used only as a complementary visual summary rather than as an independent analytic result. Finally, the short in‐hospital follow‐up limited the assessment of sustained mobility, post‐discharge functional recovery, readmissions, and longer‐term adherence to exercise recommendations. Despite these limitations, the study provides preliminary implementation insights that may inform further refinement and future comparative evaluation of early‐mobilization programs in hospitalized patients.

6. Conclusion

Through an action‐research process, we developed “Let's Move,” a structured early‐mobilization program integrating brief patient education with low‐intensity exercise for routine inpatient care. The program was locally adapted and implemented in a resource‐limited inpatient setting, targeting clinically stable hospitalized adults who were not initially referred to physiotherapy. The implementation phase showed preliminary feasibility, acceptable adherence, and no recorded adverse events although these findings should not be interpreted as evidence of clinical effectiveness. “Let's Move” provides a practical framework for supporting mobility‐oriented care within routine hospital workflows. Further comparative studies with larger samples and longer follow‐up are needed to evaluate its effectiveness, sustainability, and scalability.

6.1. Implications for the Practice of Physiotherapy

This study highlights the need to incorporate preventive, mobility‐focused strategies into routine inpatient care, even for patients who are not formally referred to physiotherapy. The “Let's Move” program provides preliminary implementation experience suggesting that low‐intensity, structured exercise sessions, combined with brief educational counseling, may be feasible for clinically stable hospitalized adults under supervised conditions, supporting physiotherapists' expanding role in secondary prevention.

For physiotherapists, these findings reinforce the importance of early identification of individuals at risk of hospital‐associated deconditioning and the value of implementing simple, standardized mobility routines to maintain functional capacity. The adherence observed in this pilot suggests that patients may respond positively to clear visual instructions, regular follow‐up, and active participation in their own recovery.

The intervention also provides preliminary evidence that early‐mobilization workflows may be integrated into existing ward dynamics in this setting, even in resource‐limited settings. Collaboration with nursing and medical teams is essential for safe screening, timely mobilization, and continuity of care. Strengthening educational materials and staff training further enhance sustainability.

Overall, this program provides an initial implementation model that may inform future physiotherapy‐led mobility strategies to reduce functional decline during hospitalization, promote patient autonomy, and support a culture of mobility‐centered care. Further comparative studies are needed before conclusions regarding effectiveness, safety, or broader implementation can be established.

Funding

The authors have nothing to report.

Ethics Statement

The study was conducted in compliance with current clinical research regulations and approved by the Institution's Ethics Committee (CEI‐2024‐07724). Written informed consent was obtained from all participants (R‐MA102‐05) in accordance with Resolution 008430 of 1993 from the Ministry of Health and the principles outlined in the Declaration of Helsinki (1964) as amended in October 2013. Confidentiality was safeguarded through data coding and restricted access. The program was designed to minimize potential risks, and any adverse events were managed in accordance with institutional protocols.

Consent

The requirement for informed consent for the retrospective electronic health record review was waived by the institutional Ethics Committee because the analysis used routinely collected, coded clinical data.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information S1

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.