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Geelen SJG1, Engelbert RHH1,2, Giele BM1, Veenhof C3,4, Nollet F1, van der Schaaf M1,2
1Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands, 2ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands, 3Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 4Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
Background: Hospitalization is often associated with functional decline, as can be observed in decrease in muscle strength, independent mobility and ability to perform activities of daily living. Multiple studies show that increasing physical activity and encouraging early mobility improves patients' length of stay, independence in their activities of daily living and likelihood of returning home. Still, an increasing amount of studies illustrate that patients continue to spend a significant amount of their hospital stay in bed with decreased ambulation. Therefore, the innovation project of the Amsterdam UMC aims to better understand the physical activity patterns in hospitalized patients, before targeted interventions to increase physical activity will be implemented.
Purpose: To describe the physical activity patterns in hospitalized patients on the gastrointestinal surgery and internal medicine wards and investigate which factors influence the amount of physical activity.
Methods: Forty-seven randomly selected patients on the gastrointestinal surgery and 27 patients on the internal medicine ward were observed throughout a random, 12-hour daytime period. The location, position and activity was registered for 10-minute intervals. In addition, wireless accelerometers (Atris-PAM) measuring the amount of physical activity were attached to the ankle and possible factors influencing physical activity were measured by the researcher, such as descriptive data, physical performance measures, functional restraints and self-efficacy.
Results: Patients (70.7% male, mean(sd) age 56.91 (16.76), median(IQR) length of stay of 10(7-18) days, 54.8% independent mobility) were lying in bed during 71.5% of the day and spend most of the time (94.2%) in their hospital room. Activities out of bed were predominantly sitting in a chair (21.4%). Patients were active (>1.4 MET) during the 12-hour daytime period for median(IQR) 20(11-46.5) minutes. Moderate to heavy activity >3.0 MET was only observed for 3(2-11.5) minutes.
Physical activity intensity was associated with age (r=-.0.381, p=0.001), the presence of a urinary catheter (p=0.008), comorbidity (Charlson Comorbidity Index) (r=-.243, p=0.047), the degree of independent mobility (Activity Measure for Post-Acute Care Basic Mobility short form) (r=0.725, p 0.000), self-efficacy (r=0.415, p=0.001) and muscle strength (handheld dynamometer) (p=0.002). There was no significant association with the amount of intravenous-lines, length of stay and pre-admission functional independence (Katz-ADL).
Multiple regression analysis show that the degree of independent mobility, age and muscle strength explain 28.8% of the total variation in physical activity.
Conclusion(s): Severely decreased physical activity was observed in all hospitalized patients on gastrointestinal surgery and internal medicine wards, which may imply that all hospitalized patients on these wards exhibit an excessive amount of physical inactivity. In addition, it appears that older patients with poorer physical performance measures are particularly vulnerable for decreased physical activity.
Implications: Our findings contribute to current knowledge that describes the physical inactivity issues of patients during hospital stay. Health care providers worldwide should be more aware of this physical inactivity epidemic. Our findings also implicate that the physical (in)activity of patients during hospital stay is impaired by factors which can be influenced. For example, the need for a urinary catheter can be critically reviewed. Therefore, tailored interventions that encourage out-of-bed physical activity are necessary to address this underrecognized problem.
Keywords: Hospital, Physical activity, Sedentary behaviour
Funding acknowledgements: Internal funding Amsterdam University Medical Centers, location Academic Medical Center
Purpose: To describe the physical activity patterns in hospitalized patients on the gastrointestinal surgery and internal medicine wards and investigate which factors influence the amount of physical activity.
Methods: Forty-seven randomly selected patients on the gastrointestinal surgery and 27 patients on the internal medicine ward were observed throughout a random, 12-hour daytime period. The location, position and activity was registered for 10-minute intervals. In addition, wireless accelerometers (Atris-PAM) measuring the amount of physical activity were attached to the ankle and possible factors influencing physical activity were measured by the researcher, such as descriptive data, physical performance measures, functional restraints and self-efficacy.
Results: Patients (70.7% male, mean(sd) age 56.91 (16.76), median(IQR) length of stay of 10(7-18) days, 54.8% independent mobility) were lying in bed during 71.5% of the day and spend most of the time (94.2%) in their hospital room. Activities out of bed were predominantly sitting in a chair (21.4%). Patients were active (>1.4 MET) during the 12-hour daytime period for median(IQR) 20(11-46.5) minutes. Moderate to heavy activity >3.0 MET was only observed for 3(2-11.5) minutes.
Physical activity intensity was associated with age (r=-.0.381, p=0.001), the presence of a urinary catheter (p=0.008), comorbidity (Charlson Comorbidity Index) (r=-.243, p=0.047), the degree of independent mobility (Activity Measure for Post-Acute Care Basic Mobility short form) (r=0.725, p 0.000), self-efficacy (r=0.415, p=0.001) and muscle strength (handheld dynamometer) (p=0.002). There was no significant association with the amount of intravenous-lines, length of stay and pre-admission functional independence (Katz-ADL).
Multiple regression analysis show that the degree of independent mobility, age and muscle strength explain 28.8% of the total variation in physical activity.
Conclusion(s): Severely decreased physical activity was observed in all hospitalized patients on gastrointestinal surgery and internal medicine wards, which may imply that all hospitalized patients on these wards exhibit an excessive amount of physical inactivity. In addition, it appears that older patients with poorer physical performance measures are particularly vulnerable for decreased physical activity.
Implications: Our findings contribute to current knowledge that describes the physical inactivity issues of patients during hospital stay. Health care providers worldwide should be more aware of this physical inactivity epidemic. Our findings also implicate that the physical (in)activity of patients during hospital stay is impaired by factors which can be influenced. For example, the need for a urinary catheter can be critically reviewed. Therefore, tailored interventions that encourage out-of-bed physical activity are necessary to address this underrecognized problem.
Keywords: Hospital, Physical activity, Sedentary behaviour
Funding acknowledgements: Internal funding Amsterdam University Medical Centers, location Academic Medical Center
Topic: Disability & rehabilitation; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Academic Medical Center
Ethics committee: Academic Medical Center Medical Ethical Research Committee
Ethics number: Reference number W17_479 # 18.003
All authors, affiliations and abstracts have been published as submitted.
