Activity in GEriatric acute CARe (AGECAR): rationale, design and methods

Steven J Fleck,María-Teresa Vidán,Alejandro Lucia,José A Serra-Rexach,Natalia Bustamante-Ara,Javier Ortiz

doi:10.1186/1471-2318-12-28

Abstract

BackgroundThe Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older.Methods/DesignPatients aged 75 years or older admitted for a short hospital stay (≤14 days) will be randomly assigned to either a usual care (control) group or an intervention (training) group. Participants allocated in the usual care group will receive normal hospital care and participants allocated in the intervention group will perform multiple sessions per day of lower limb strength training (standing from a seated position) and walking (10 min bouts) while hospitalized. The primary outcome to be assessed pre and post of the hospital stay will be functional capacity, using the Short Physical Performance Battery (SPPB), and time to walk 10 meters. Besides length of hospitalization, the secondary outcomes that will also be assessed at hospital admission and discharge will be pulmonary ventilation (forced expiratory volume in one second, FEV1) and peripheral oxygen saturation. The secondary outcomes that will be assessed by telephone interview three months after discharge will be mortality, number of falls since discharge, and ability to cope with activities of daily living (ADLs, using the Katz ADL score and Barthel ADL index).DiscussionResults will help to better understand the potential of regular physical activity during a short hospital stay for improving functional capacity in old patients. The increase in life expectancy has resulted in a large segment of the population being over 75 years of age and an increase in hospitalization of this same age group. This calls attention to health care systems and public health policymakers to focus on promoting methods to improve the functional capacity of this population.Trial registrationClinicalTrials.gov ID: NCT01374893.

Highlights

The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older
The increase in life expectancy has resulted in a large segment of the population being over 75 years of age and an increase in hospitalization of this same age group
This calls attention to health care systems and public health policymakers to focus on promoting methods to improve the functional capacity of this population

Summary

Introduction

The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older. Especially in Spain, it is of public health and clinical relevance to better understand the effects of regular physical activity in old people. Loss of strength with bed rest can be as great as 5% per day [9] With such significant losses of strength it is not surprising that even short hospital stays result in a decrease in functional capacity, including the ability to cope with activities of daily living (ADLs). 30–50% of seniors admitted for a short hospital stay show a decrease in functional capacity at discharge [10,11,12,13,14] These decreases in functional capacity are associated with an increased risk of mortality. Individuals showing the least decrease in functional capacity with a hospital stay have a mortality rate of 10.7% three months after discharge compared to 36.7% in individuals showing the greatest decrease in functional capacity [15]

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