Effectiveness of exercise intervention on physical and health outcomes in patients admitted to an acute medical ward: A systematic review and meta-analysis

Objective: To evaluate the effectiveness of inpatient medical ward exercise on physical and health outcomes in adults compared with usual care. Data sources: Medline, CINAHL and EMBASE were searched from inception to 20 April 2023. Review methods: Randomised-controlled trials in English that reported physical and health outcomes of adults who received an exercise intervention on an acute medical ward were included. Two reviewers independently extracted data. Methodological quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed the quality of evidence to evaluate the certainty of effect. Meta-analyses were performed where possible. Results: Thirteen studies were included, with 1273 unique participants (mean [SD] age, 75.5 [11] years), which compared exercise intervention with usual care. Low quality evidence demonstrated a significant improvement in aerobic capacity ([MD], 1.39 m [95% CI, 0.23, 2.55], p = 0.02) and maximum isometric strength ([MD], 2.3 kg [95% CI, 2.2, 2.4], p < 0.001) for the exercise intervention compared with usual care. Low quality evidence demonstrated no difference for in-hospital falls count ([OR], 1.93 [95% CI, 0.61, 6.12] p = 0.27) or mortality ([OR], 0.77 [95% CI, 0.48, 1.23], p = 0.27). Moderate quality evidence demonstrated no difference for length of stay ([MD], −0.10 days [95% CI, −0.31, 0.11] p = 0.36). Conclusion: Exercise prescribed during an acute medical ward stay improves aerobic capacity and maximum isometric strength but may not reduce length of stay, in-hospital falls or mortality.