Evaluating the effectiveness of an early individualised targeted exercise protocol “STAY FIT in HOSPITAL” in preventing Hospital Associated Deconditioning

INTERVENTION: Intervention: tailored exercise program The patients will be randomly assigned to a tailored exercise program or to usual care. The exercise program for the intervention group will be implemented by the study physiotherapist and the assistant physiotherapist. The main focus will be on strength training (progressive resistance exercises) with an intensity enough to improve/maintain the lower limb strength. The main exercise equipment will be an electric mini pedal exercise bike Monark 881E ergometer with variable resistance. This is a portable machine and can be taken to study participants and can be easily administered whilst the participant is safely sitting down in a chair. The settings can be adjusted for progressively increased resistance (watts) and rpm can be monitored. The proposed exercise program will be be carefully chosen for the patient. The exercises can be performed sitting down or lying down in bed, which is most suited to our patient cohort. The recommendations as per the American College of Sports Medicine guidelines were followed in formulating the exercise program. The guidelines recommend using a high‐intensity, low‐to‐moderate repetition maximum (RM), with completion of 10‐15 repetitions for older and /or more frail participants. Progressive resistance training exercise using leg pedal ergometer, 5 days/week (morning session), start at 40‐50% 1RM and gradually work up to 60‐80% over the period of 7 days, 1 set of 10‐12 repetition, 2 sets of light intensity with rest breaks of 10 minutes. Those participants unable to get out of bed or not tolerating the pedal exercise bike will be offered quadriceps strengthening exercises with weighted cuffs, progressively achieving 70‐80% of 1 Repetition maximum. Dumbbells will be used to maintain upper limb CONDITION: Hospital Associated Deconditioning ;Sarcopenia; ; Hospital Associated Deconditioning ; Sarcopenia Musculoskeletal ‐ Other muscular and skeletal disorders PRIMARY OUTCOME: The primary outcome measure will include mobility and functional assessments at baseline and at the completion of the intervention (seven days of receiving intervention). . ; ; 1. FIM functional independence measure The Functional Independence Measure (FIM), is a validated tool with an 18‐item, 7‐level scale developed to uniformly assess severity of patient disability and rehabilitation functional outcomes. The 18 items are divided into two major groups: motor (13 items) and cognitive (5 items). The activity that are evaluated include self‐care activities (grooming, bathing, dressing, and toileting), bowel and bladder control, transfers, mobility, communication, and social cognition. The 7‐ level scale allows to classify the individual’s ability to carry out above activity independently versus need for differing levels of assistance. ; ; [Time point ; FIM (functional independence measure); Measurements at Baseline and after receiving 7 days of intervention. ] 2. The de Morton Mobility Index (DEMMI) This is a validated instrument that captures the mobility statue of older acute medical patients, with assessment of bed mobility, sit to stand, walking, static and dynamic balance. The change in the DEMMI score from baseline to 7 days of intervention will be assessed. A change of 10 points is considered as minimally clinically important in the DEMMI score. ; [Time point ; The de Morton Mobility Index (DEMMI) will be measured at Base line and after receiving 7 days of intervention. ] ; ; ] 1. Muscle strength: Grip strength in the dominant limb will be measured by a handheld dynamometer. ; ; ; SECONDARY OUTCOME: 2. Gait velocity (GV; m/s): Habitual gait velocity will be measured with a 4 meter walk test [Gait velocity (GV; m/s) measurements will be recorded at Baseline and after receiving 7 days of intervention. ] 6. Number of falls: The number of falls will be monitored by reviewing the medical records and participants self report. ; [Number of falls at baseline (previous 12 months), after receiving 7 days of intervention and at three months from the hospital admission. ] Isometric knee extension strength of the dominant limb will be assesses using a belt‐stabilised handheld dynamometer[Muscle strength measurements will be taken at baseline and after receiving 7 days of intervention. ; [Muscle strength measurements will be taken at baseline and after receiving 7 days of intervention. ] 3, Sarcopenia: SARC‐F is a simple questionnaire to rapidly assess for Sarcopenia using a questionnaire [Sarcopenia: SARC‐F questionnaire at baseline, after receiving 7 days of intervention and at three months from the hospital admission. ] 4. Adherence to the study will be monitored by a study diary record as to the participation for each session during the intervention period of 7 days by the study physiotherapist or assistant physiotherapist [The compliance with the participation in the exercise program exercise program will be recorded for each session in a study diary while receiving the 7 days of intervention. ] 5. QOL: EQ‐5D is a health‐related quality of life measure, widely used in health economic evaluation. [ QOL: EQ‐5D evaluation after receiving 7 days of intervention and at three months from the hospital admission. ] 7. Hospital length of stay (LOS) will be assessed by data‐linkage to medical records. The Hospital LOS will include acute and subacute bed days and will be utilized to evaluate the cost effectiveness of the intervention. [ Hospital length of stay will be determined at 3 months review (from hospital admission) ] 8. Adverse effects related to the exercise program: A record of injury, exacerbation of pain, falls related to the exercise program and premature cessation of the intervention will be recorded on a daily basis in a study diary by the study physiotherapist or assistant physiotherapist during the intervention period of 7 days [Adverse effects related to exercise program will be recorded daily in a study diary while receiving the 7 days of intervention. ] INCLUSION CRITERIA: The eligible participant for this study will be patients 65 years and older ambulatory community dwellers, admitted to hospital for management of acute medical condition/s and who do not have a cognitive impairment that would stop them providing informed consent and are able to follow instructions.