Role of Exercise in Reversal of Hospitalization-associated Disability in Elderly

The study design includes 2 phases (10 months each) for development and evaluation of the testing and intervention protocol. The last 4 months of the study will be devoted to preparation of a larger randomized controlled clinical trial grant submission. Mixed methods will be used in both phases.

Phase I will focus on developing, testing and refining the measurement protocol and bedside tailored low intensity pedaling exercise (Ex) program using mixed methods. During this 10-month phase, researchers plan to enroll 10 participants who are admitted to a medical surgical (MS) unit and meet study eligibility criteria. Investigators will implement our proposed testing and intervention protocol,obtain feedback and make modifications as necessary. For this purpose the study team will use a process improvement framework with rapid cycle improvements. The outcome for Phase I will be development of a manual of operations for the testing and Ex protocol that will be implemented in Phase II.

Phase II (10 months) will randomly assign 60 patients over the age of 65 years who meet medical criteria and are admitted to a medical surgical (MS) hospital unit at the VA Palo Alto Health care system (VAPA HCS) to one of two groups, 1) low intensity bedside pedaling exercise or 2) usual care. All participants will be asked to complete questionnaires, undergo a Short Physical Performance Battery (SPPB), cognitive testing and a blood draw prior to participation in the Ex program (baseline). All testing and blood draw will be repeated within 24 hours prior to discharge (release from the hospital to home or other facility, indicating that their condition has been resolved or adequately treated or is stabilized during their hospital stay) from the hospital(approximately at 5-6 days). Participants will be followed for the duration of the hospital stay, an expected average length of 5-6 days. Additionally, all participants will be asked to continue to exercise after discharge to home for 4 weeks. All tests will be performed at baseline (prior to intervention), within 24 hours prior to discharge (release from the hospital to home or other facility, indicating that their condition has been resolved or adequately treated or is stabilized during their hospital stay)from the hospital, on average 5-6 days) and again at 4 weeks post discharge. The focus of Phase II is safety and feasibility of the intervention and association with outcome measures. The length of stay (LOS) at VAPA HCS is approximately 6 days. Thus, the study investigators anticipate that each individual will be enrolled approximately 5 days and participate in an average of 8 training sessions. Investigators will also examine the association between physical activity levels at baseline (pre Ex) and myokines and associated changes in myokines after intervention.

A description of the Ex program:

Individually tailored, low intensity bedside pedaling exercise: