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Invited Commentary
January 2019

A Novel Exercise Intervention and Functional Status in Very Elderly Patients During Acute Hospitalization

Author Affiliations
  • 1Highland Hospital Center for Health Aging, University of Rochester School of Medicine & Dentistry, Rochester, New York
JAMA Intern Med. 2019;179(1):36-37. doi:10.1001/jamainternmed.2018.6162

The adverse health effects of inactivity among older adults have been well documented.1 The resultant weakness and instability associated with inactivity can lead to a higher risk of injurious falls, hip fractures, and frailty. Recently, evidence has documented that community-based exercise programs are associated with a lower risk of injurious falls.2 However, there has been less attention in exploring the beneficial effect of exercise programs in the setting of acute care hospitalization, despite the evidence that muscle loss and bone absorption can occur within days of bed rest. The obvious barriers include relatively short hospital stays, as well as the paucity of evidence that conventional hospital-based rehabilitation programs are feasible or cost-effective. Theoretically, the goals of rapid discharge and rehabilitation are not incompatible. Over the past 2 decades, many acute care hospitals throughout the United States have begun to address the results of inactivity and bed rest on function in older adults in the setting of acute care hospitals. A growing appreciation of frailty states and the favorable effects of exercise have led to the emergence of special hospital wards, often designated as Acute Care of the Elderly (ACE) units, dedicated to early emphasis on rehabilitation of older adults admitted to acute care hospitals. However, at present, there is no consensus as to the most effective exercise interventions to attenuate functional decline3

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