| Participants |
Inclusion criteria: irrespective of ward allocation, medical inpatients aged ≥ 65 years, needing an aid or assistance to walk (or both) on admission, and admitted from and planned for discharge home (rather than for institutional care), with an anticipated hospital stay ≥ 3 days were recruited
Exclusion criteria: inpatients admitted for > 48 hours prior to screening; unable to follow simple commands in the English language; admitted with an acute psychiatric condition, or requiring end‐of‐life or critical care; ordered bedrest, or contraindications to walking (e.g. hip fracture or high ventricular rate atrial fibrillation); baseline Short Physical Performance Battery score 0/1; participated in the trial within the previous 12 months
Exercise arm
Control arm
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| Interventions |
Exercise arm
TIDieR item 1: (brief name: provide the name or a phrase that describes the intervention): augmented prescribed exercise programme + usual care. TIDieR item 2: (why: describe any rationale, theory or goal of the elements essential to the intervention): it was hypothesised that a simple exercise programme could be easy to implement but effective in preventing acute sarcopenia, health and hospital outcomes. TIDieR item 3: (what (materials): describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers): the exercise intervention did not require specialist equipment and weights were not used due to infection control regulations. TIDieR item 4: (what (procedures): describe each of the procedures, activities or processes (or a combination) used in the intervention, including any enabling or support activities): the intervention group were assisted or supervised in complete strengthening, balance and gait exercises. Exercises were designed to improve the participant's transfer ability, balance and walking endurance. Strengthening and balance exercises were completed at the bedside. They were lower limb strengthening exercises completed in sitting, sit to stand exercises, transfer training (bed to chair, chair to chair) and balance exercises. The initial treatment was kept simple and straightforward to maintain participant compliance and the intensity was increased as tolerated in the subsequent sessions. Those able to walk safely and independently were strongly encouraged to walk ≥ 3 times daily independently. Family members were encouraged to "go for a walk" with the participants during visits. Advice and education about walking, general physical fitness and performance was given to the participants and their carers as required. TIDieR item 5: (who provided: for each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given): a senior physiotherapist who specialised in geriatric care prescribed the tailored exercise programme. The exercises were prescribed and assisted by her only. TIDieR item 6: (how: describe the modes of delivery (such as face‐to‐face or by some other mechanism, such as Internet or telephone) of the intervention and whether it was provided individually or in a group): face‐to‐face, individual sessions, as well as in some cases encouragement to walk independently or with family members. TIDieR item 7: (where: describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features): all wards admitting older medical patients in a 350‐bed general teaching hospital. Most of the exercise programme occurred on the participant's ward; however, participants could carry out the strengthening and balance exercises off the ward, in a quiet open area of the hospital. TIDieR item 8: (when and how much: describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose): the sessions occurred twice daily, Monday to Friday, with session duration 20–40 minutes (depending upon the participant's exercise tolerance). TIDieR item 9: (tailoring: if the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how): the initial treatment was kept simple and straightforward to maintain participant compliance and the intensity was increased as tolerated in the subsequent sessions. Exercises were progressed by increasing the number of repetitions, increasing the speed and the challenge of the exercises. TIDieR item 10: (modifications: if the intervention was modified during the course of the study, describe the changes (what, why, when and how)): no protocol deviations relating to the intervention. TIDieR item 11: (how well (planned): if intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them): the research physiotherapist kept a register of the exercises completed as well as the total number of sessions that the participants could have possibly completed, number that were actually completed and the reason for missed sessions such as absence from ward, refusal, medical status or care in isolation. TIDieR item 12: (how well (actual): if intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned): 63/95 participants completed ≥ 75% of possible exercise sessions; 16/95 participants completed 50–74% of possible exercise sessions. 13/95 participants completed 25–49% of possible exercise sessions. 3/95 participants completed < 25% of possible exercise sessions.
Control arm
TIDieR item 1: sham exercises + usual care. TIDieR item 2: to act as a control intervention. TIDieR item 3: not specified. TIDieR item 4: the control group completed sham exercises that mainly consisted of stretching and relaxation exercises. They were completed either in the lying or sitting position only. While the participants were encouraged to talk about their condition and exercise, none were given education, encouragement or were assisted to exercise or walk more. The exercises were not progressed but rather repeated at each session. Session duration 20–30 minutes depending on the participants' ability. TIDieR item 5: a senior physiotherapist who specialised in geriatric care prescribed the tailored exercise programme. The exercises were prescribed and assisted by her only. TIDieR item 6: face‐to‐face, individual sessions. TIDieR item 7: all wards admitting older medical patients in a 350‐bed general teaching hospital. TIDieR item 8: the sessions occurred twice daily, Monday to Friday, with session duration 20–30 minutes (depending upon the participant's exercise tolerance). TIDieR item 9: the exercises were not progressed but rather repeated at each session. TIDieR item 10: no protocol deviations relating to the intervention. TIDieR item 11: the research physiotherapist kept a register of the exercises completed as well as the total number of sessions that the participants could have possibly completed, number that were actually completed and the reason for missed sessions such as absence from ward, refusal, medical status or care in isolation. TIDieR item 12: 57/95 participants completed ≥ 75% of possible exercise sessions; 18/95 participants completed 50–74% of possible exercise sessions. 14/95 participants completed 25–49% of possible exercise sessions. 5 participants completed < 25% of possible exercise sessions, 1 participant dropped out and did not receive the sham intervention.
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