Summary of findings 1. Summary of findings table ‐ Exercise interventions compared to usual care with or without sham interventions for acutely hospitalised older medical patients.

Exercise interventions compared to usual care with or without sham interventions for acutely hospitalised older medical patients
Patient or population: acutely hospitalised medical patients Setting: acute hospital wards Intervention: exercise interventions Comparison: usual care ± sham interventions
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with usual care ± sham interventions	Risk with exercise interventions
Functional ability: independence with activities of daily living at discharge from hospital assessed with: Barthel Index (higher scores = greater independence) Scale from: 0 to 100	The mean functional ability: independence with activities of daily living at discharge from hospital ranged from 42 to 96 points on the Barthel Indexa	MD 1.8 points on the Barthel Index higher (0.43 lower to 4.12 higher)b	‐	5174 (16 RCTs)	⊕⊕⊝⊝ Lowc,d	Exercise interventions may result in little to no difference in independence with activities of daily living at discharge from hospital (SMD 0.09, 95% CI −0.02 to 0.19). A change of 11 points on the Barthel Index is thought to represent a minimally clinically important difference (MCID).
Functional ability: functional mobility at discharge from hospital assessed with: Short Physical Performance Battery (higher scores = greater function) Scale from: 0 to 12	The mean functional ability: functional mobility at discharge from hospital ranged from 3.7 to 4.9 points on the Short Physical Performance Battery e	MD 0.78 points on the Short Physical Performance Battery higher (0.02 lower to 1.57 higher)	‐	2369 (8 RCTs)	⊕⊝⊝⊝ Very lowf,g	The evidence is very uncertain about the effect of exercise on functional mobility at discharge from hospital (SMD 0.28, 95% CI −0.01 to 0.56). A change of 1.0 points on the Short Physical Performance Battery is thought to represent an MCID.
Functional ability: new incidence of delirium during hospitalisation	81 per 1000	73 per 1000 (47 to 114)	RR 0.90 (0.58 to 1.41)	2088 (7 RCTs)	⊕⊝⊝⊝ Very lowh,i,j	The evidence suggests that exercise results in little to no difference in incidence of delirium during hospitalisation.
Quality of life at discharge from hospital assessed with: EuroQol 5 Dimensions (EQ‐5D) visual analogue scale (VAS) (higher scores = better quality of life) Scale from: 0 to 100	The mean quality of life at discharge from hospital ranged from 48.7 to 64.7 points on the EQ‐5D VAS	MD 6.04 points on the EQ‐5D VAS higher (0.9 higher to 11.18 higher)	‐	875 (4 RCTs)	⊕⊕⊝⊝ Lowk	Exercise interventions may result in a small clinically unimportant improvement in quality of life at discharge from hospital. A change of 10 points on the EQ‐5D VAS is thought to represent a MCID.
Falls during hospitalisation	34 per 1000	34 per 1000 (20 to 57)	RR 0.99 (0.59 to 1.65)	1787 (9 RCTs)	⊕⊕⊕⊝ Moderatel	Exercise interventions probably result in little to no difference in falls during hospitalisation.
Medical deterioration during hospitalisation	71 per 1000	73 per 1000 (44 to 120)	RR 1.02 (0.62 to 1.68)	2730 (11 RCTs)	⊕⊝⊝⊝ Very lowm,n,o	Exercise interventions may have no effect on medical deterioration during hospitalisation.
Participant global assessment of success	Not pooled	Not pooled	Not pooled	(0 studies)	‐	No studies reported participant global assessment of success.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; OR: odds ratio; RR: risk ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_423027971375700878.

^a Range based on the seven studies that measured activities of daily living using a Barthel Index (range 0–100).
^b Standardised mean difference (SMD) was re‐expressed as the MD, by multiplying the SMD and associated 95% CIs by the estimated standard deviation (SD) of measurements in the intervention group at discharge. This estimate of the SD was obtained by calculating a weighted mean of measurements taken across all intervention groups of all studies that used the instrument. 
^c Risk of bias: sensitivity analysis removing studies at high risk of bias had no important impact on the effect estimate (SMD 0.18, 95% CI −0.08 to 0.43); however, 11/16 studies judged at high risk of bias. Downgraded one level. 
^d Inconsistency: I² = 66%, 95% prediction interval (PI) for the SMD: −0.25 to 0.42, demonstrating significant uncertainty. Downgraded one level.
^e Range based on the three studies that measured mobility using the Short Physical Performance Battery.
^f Risk of bias: 6/8 studies assessed at high risk of bias; sensitivity analysis removing studies judged at high risk of bias had an important impact on the effect estimate (SMD 0.53, 95% CI 0.30 to 0.75), as the estimate of effect represented a clinically important difference. Downgraded one level. 
^g Inconsistency: I² = 90%, 95% PI for the SMD: −0.52 to 1.07, demonstrating significant uncertainty. Downgraded two levels. 
^h Risk of bias: 4/8 studies assessed at high risk of bias; sensitivity analysis removing studies judged at high risk of bias had an important impact on the effect estimate (RR 0.86, 95% CI 0.45 to 1.63). Downgraded one level. 
ⁱ Inconsistency: I² = 39%, 95% PI for the RR: 0.40 to 2.05 demonstrating significant uncertainty. Downgraded one level. 
^j Imprecision: due to < 200 events, a control event rate of approximately 8% an optimal information size (OIS) is unlikely to have been met (Guyatt and colleagues, 2011). The CI included appreciable benefit and harm (i.e. an RR < 0.75 or > 1.25). Downgraded one level. 
^k Inconsistency: I² = 70%, 95% PI for the MD: −3.77 to 15.86, demonstrating significant uncertainty. Downgraded two levels. 
^l Imprecision: due to only 62 events, a control event rate of approximately 2.5% an OIS will not have been met (Guyatt and colleagues, 2011). The CI included appreciable benefit and harm (i.e. an RR < 0.75 or > 1.25). Downgraded one level. 
^m Inconsistency: I² = 51%, 95% PI for the RR: 0.33 to 3.19 representing significant uncertainty. Downgraded one level. 
ⁿ Imprecision: < 150 events, a control rate of approximately 7% an OIS is unlikely to have been met. CIs represent appreciable harm and benefit. Downgraded one level. 
^o Indirectness: outcome varies between studies, i.e. combination of studies that report general medical deterioration (e.g. admission to critical care), studies that report new incidence of delirium and studies that report both. Downgraded one level.