Summary of findings 3. Summary of findings table ‐ Structured exercise interventions compared to usual care with or without sham interventions for acutely hospitalised older medical patients.

Structured exercise interventions compared to usual care with or without sham interventions for acutely hospitalised older medical patients
Patient or population: acutely hospitalised older medical patients Setting: acute hospital wards Intervention: structured 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 structured 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 55 to 56 points on the Barthel Indexa	MD 2.6 points on the Barthel Index higher (4.45 lower to 9.64 higher)b	‐	648 (5 RCTs)	⊕⊕⊝⊝ Lowc,d	Structured exercise may result in little to no difference in independence with activities of daily living at discharge from hospital (standardised mean difference (SMD) 0.12, 95% CI −0.21 to 0.45). 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: Elderly Mobility Scale (higher scores = greater function) Scale from: 0 to 20	The mean functional ability: functional mobility at discharge from hospital was 14.13 units on the Elderly Mobility Scalee	MD 1.79 units on the Elderly Mobility Scale higher (3.44 lower to 7.02 higher)b	‐	416 (2 RCTs)	⊕⊝⊝⊝ Very lowf,g,h	The evidence was very uncertain with regard to the effect of structured exercise programmes on functional mobility at discharge from hospital (SMD 0.30 95% CI, ‐0.96, 1.57). A change of 2 points on the Elderly Mobility Scale is thought to represent an MCID.
Functional ability: new incidence of delirium during hospitalisation	Only 1 study reported the outcome. The study found only 1 incidence of delirium in the intervention group and 0 in the control group.			100 (1 study)	‐	Included only 1 study categorised as delivering a structured exercise intervention. The effect of structured exercise on the incidence of new delirium during hospitalisation was very uncertain.
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 was 64.74 points on the EQ‐5D VAS	MD 3.74 points on the EQ‐5D VAS higher (6.32 lower to 13.8 higher)	‐	76 (1 study)	‐	Only 1 study reported a quality‐of‐life outcome at hospital discharge. The effect of structured exercise interventions on quality of life at discharge from hospital was very uncertain.
Falls during hospitalisation	40 per 1000	31 per 1000 (9 to 102)	RR 0.76 (0.23 to 2.53)	542 (3 RCTs)	⊕⊕⊝⊝ Lowi	Structured exercise interventions may result in little to no difference in falls during hospitalisation.
Medical deterioration during hospitalisation	20 per 1000	51 per 1000 (10 to 271)	RR 2.56 (0.48 to 13.54)	200 (2 RCTs)	⊕⊝⊝⊝ Very lowj,k	The evidence was very uncertain with regard to the effect of structured exercise programmes 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_423064120727928815.

^a Range based on the two studies that measured activities of daily living using a Barthel Index (range of possible scores 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: 4/5 were assessed at high risk of bias, sensitivity analysis not possible. Downgraded one level. 
^d Inconsistency: I² = 71%, 95% prediction interval (PI) for the SMD: 0.57 to 0.582 demonstrating uncertainty as upper CI represented meaningful effect. Downgraded one level. 
^e Mean based on the one study that measured functional mobility using the Elderly Mobility Scale. 
^f Risk of bias: 2/2 studies were at high risk of bias due to lack of assessor blinding. Downgraded one level. 
^g Inconsistency: I² = 93%, 95% PI for the SMD: −1.54 to 2.32, demonstrating significant uncertainty. Downgraded one level.
^h Imprecision: the 95% CIs for the estimate of the effect overlapped 0 and represented both appreciable benefit and harm. The optimal information size (OIS) was sufficient, based on an MCID of 2 points on the Short Physical Performance Battery and SD of 2.8 (pooled SD from main analyses) corresponding to a sample size of 32 per arm. Downgraded one level. 
ⁱ Imprecision: due to only 20 events, a control event rate of approximately 2.5% an OIS was not met (Guyatt and colleagues, 2011). The CIs included no effect and appreciable benefit and harm (i.e. an RR < 0.75 or > 1.25). Downgraded two levels for imprecision due to < 50 events. 
^j Indirectness: outcome varied between studies, one study reported incidence of delirium and incidence of admission to critical care, the other study only reported incidence of admissions to critical care. Downgraded one level. 
^k Imprecision: due to only 10 events, a control event rate of approximately 2% an OIS was not met (Guyatt and colleagues, 2011), due to the very small number of events (< 50). Downgraded two levels.