Summary of findings 4. Summary of findings table ‐ Progressive resistance exercise interventions compared to usual care with or without sham interventions for acutely hospitalised older medical patients.

Progressive resistance 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: progressive resistance exercise 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 progressive resistance exercise
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 75 to 96 points on the Barthel Indexa	MD 0.14 points on the Barthel Index higher (0.05 lower to 0.32 higher)b	‐	1688 (7 RCTs)	⊕⊕⊝⊝ Lowc,d	The evidence is classified as very uncertain with regard to the effect of progressive resistance exercise on independence with activities of daily living at discharge from hospital (SMD 0.14, 95% CI −0.05 to 0.32). 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 0.24 points on the Short Physical Performance Battery higher (0.09 lower to 0.56 higher)b	‐	978 (5 RCTs)	⊕⊝⊝⊝ Very lowf,g	The evidence is classified as very uncertain with regard to the effect of progressive resistance exercise on functional mobility at discharge from hospital. (SMD 0.63, 95% CI‐0.28, 1.55). A change of 1.0 points on the Short Physical Performance Battery is thought to represent a MCID.
Functional ability: new incidence of delirium during hospitalisation	71 per 1000	68 per 1000 (39 to 119)	RR 0.96 (0.55 to 1.68)	1256 (4 RCTs)	⊕⊕⊝⊝ Lowh,i	The evidence is classified as very uncertain with regard to the effect of progressive resistance exercise on 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 57.5 to 62.4 points on the EQ‐5D VAS	MD 8.9 points on the EQ‐5D VAS higher (2.35 higher to 15.45 higher)	‐	449 (2 RCTs)	⊕⊕⊕⊝ Moderatej	Progressive resistance exercise probably increases quality of life at discharge from hospital slightly. A change of 10 points on the EQ‐5D VAS is thought to represent a MCID.
Falls during hospitalisation	34 per 1000	33 per 1000 (16 to 65)	RR 0.96 (0.48 to 1.91)	995 (5 RCTs)	⊕⊕⊝⊝ Lowk	Progressive resistance exercise may result in little to no difference in falls during hospitalisation.
Medical deterioration during hospitalisation	62 per 1000	61 per 1000 (32 to 115)	RR 0.99 (0.52 to 1.87)	1798 (7 RCTs)	⊕⊝⊝⊝ Very lowl,m,n	The evidence is classified as very uncertain with regard to the effect of progressive resistance exercise on medical deterioration during hospitalisation.
Participant global assessment of success	Not pooled	Not pooled	Not pooled	(0 studies)	‐	This outcome was not measured by any of the included studies.
*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_423057317911555615.

^a Range based on the four studies that measured activities of daily living using a Barthel Index (range of possible scores 0–100).
^b Standardised mean differences (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: 4/7 are classified as high risk of bias. Sensitivity analysis removing studies at high risk of bias provides a larger effect size estimate in favour of progressive resistance exercise (SMD 0.25, 95% CI −0.12 to 0.61). Downgraded one level. 
^d Inconsistency: I² = 68%, 95% prediction interval (PI) for the SMD: −0.29 to 0.57, 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: 3/5 are classified as high risk of bias. Sensitivity analysis removing studies at high risk of bias provides a larger effect size estimate in favour of progressive resistance exercise (SMD 0.53, 95% CI 0.30 to 0.75). Downgraded one level. 
^g Inconsistency: I² = 84%, 95% PI for SMD: −0.50 to 0.98, demonstrating significant uncertainty. Downgraded two levels. 
^h Inconsistency: I² = 37%, 95% PI for the RR: 0.45 to 2.29 demonstrating significant uncertainty. Downgraded one level. 
ⁱ Imprecision: due to only 90 events, a control event rate of approximately 10% an optimal information size (OIS) is unlikely to have been met (Guyatt and colleagues, 2011). The CI includes appreciable benefit and harm (i.e. an RR < 0.75 or > 1.25). Downgraded one level.
^j Inconsistency: I² = 67%, PI of the mean difference: −1.14 to 18.94 demonstrating significant uncertainty regarding the size of the effect. Downgraded one level.
^k Imprecision: due to only 35 events, a control event rate of approximately 6% an OIS has not been met (Guyatt and colleagues, 2011), due to the very small number of events (< 50). Downgraded two levels.
^l Inconsistency: I² = 48%, 95% PI of the RR: 0.29 to 3.34 demonstrating significant uncertainty. Downgraded one level.
^m 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.
ⁿ Imprecision: due to only 121 events, a control event rate of approximately 6% an OIS is unlikely to have been met (Guyatt and colleagues, 2011). The CI for the RR includes no effect and appreciable benefit and harm (i.e. an RR < 0.75 or > 1.25). Downgraded one level.