Effectiveness of Functional Resistance Training in Hospital to Prevent Deconditioning and Improve Discharge Pathways: A Service Evaluation

Introduction

Deconditioning is a complex process of physiological change following a period of inactivity. This can be observed in a clinical setting when hospital patients have prolonged periods of bed rest. Prolonged bed rest negatively affects health-related outcomes such as cardiovascular, respiratory and musculoskeletal function, and is linked to increased mortality. To combat deconditioning in patients, a functional resistance exercise intervention may be suitable to employ. Exercise interventions can successfully prevent and reverse muscle loss and functional decline, the main component of deconditioning.

Methods

This service evaluation investigates functional resistance training (FRT) as a preventive measure against inpatient deconditioning, conducted from September 2023 to January 2024 with 146 inpatients admitted to medical or orthopaedic wards. Inclusion criteria were age 65 years or older, ability to follow instructions, no baseline hoisting, and sufficient medical fitness. FRT was delivered by sport and exercise professionals. Outcome measures were strength and function-based and were completed pre- and post-intervention. Statistical analysis was conducted using IBM SPSS Statistics 29 (Windows). Normality was assessed via the Shapiro–Wilk test, with statistical significance set at p ≤ 0.05. Paired t-tests compared admission and discharge outcomes to evaluate the intervention's effectiveness. Spearman's ρ was used to assess correlations between engagement rate and each outcome measure. As this is an evaluation of a current service, with no additional interventions carried out, or additional data collected, ethics approval was not required.

Results

Preliminary findings reveal high engagement (average 80%) and significant improvements (p ≤ 0.001) in muscle strength, grip strength, 30-s sit-to-stand test (30STS), and DeMorton's Mobility Index (DEMMI) post-FRT. Handheld dynamometry indicates a notable 30%–50% increase in muscle strength, while grip strength improved by 11%. However, a 20% reduction occurred in patients with < 50% engagement, suggesting deconditioning without FRT. The 30STS observed a 100% increase in repetitions, indicating improved lower limb strength. DEMMI scores showed a statistically significant enhancement in overall mobility post-intervention. Notably, 26 pathways were downgraded with over 80% engagement, suggesting FRT-engaged patients are more likely to downgrade.

Conclusion

The positive effects on muscle and grip strength, lower limb function, and overall mobility underscore FRT's potential as a valuable clinical intervention. Downgrades in discharge pathways suggest positive financial implications of FRT. Further research with larger samples and controlled designs is crucial for validating these findings and determining optimal FRT protocols in healthcare settings.