Walking 25 mins a day ‘enough to counter physical impact of bedrest’

Slow walking for little as 25 minutes a day seems to be sufficient to counter the detrimental physical effects of bedrest on older hospital patients, according to Spanish researchers.

For optimal improvements in physical function, around 50 minutes a day of slow walking or around 40 minutes of combined physical activities are the most effective, they said.

They highlighted examples of a mix of activities such as 20 minutes of resistance bands with around 20 minutes of aerobic activity.

“This meta-analysis has yielded critical information to support the use of physical activity as a core part of the daily routine of acutely hospitalised older adults”

However, there may be a threshold effect, with no clear benefit of more than 90 minutes a day of light intensity, or 60 minutes per day of moderate intensity, physical activity.

These findings, published in the British Journal of Sports Medicine, are based on analysis by researchers from the University of Cádiz and Biomedical Research and Innovation Institute of Cádiz.

They noted that older people admitted to hospital, even those able to walk unaided, usually spent most of their stay in bed.

They warned that this level of inactivity could cause “post hospital syndrome”, defined as a period of vulnerability after discharge associated with general physical deconditioning.

If not actively managed, this deconditioning could have various consequences, including readmission, disability, the need for nursing home care, illness, or death, said the researchers.

They said recent studies indicated that getting patients out of bed and moving about could help ward off decline, but it was not previously clear what type of activity, or how much, was most effective.

As a result, the researchers looked for published trials that involved people over 50 who had been admitted for a serious bout of illness and prescribed any form of physical activity while an inpatient.

Their analysis looked at 19 clinical trials, involving 3783 participants and published between 2000 and 2022.

Over half of participants, 2,087 (55%), were women, ranging in age from 55 to 87. Their average length of stay was seven days and the average monitoring period after discharge was 68 days.

Pooling the trial results showed that the minimal amount required to counter the effects of bedrest and improve older inpatients’ functional capacity was estimated to be around 40 minutes per day of light intensity physical activity or around 25 minutes a day of moderate intensity physical activity.

The optimal amount was estimated to be 70 minutes a day of light intensity, or around 40 minutes per day of moderate intensity physical activity.

There was no clear benefit for more than 90 minutes a day of light intensity, or 60 minutes a day of moderate intensity physical activity, suggesting a threshold effect, said the researchers.

In terms of the best type of physical activity to ward off physical decline, they found a mix of physical activity in any one daily session and slow-paced walking were deemed the most effective.

However, only walking was more than 80% effective, with the optimal dose reached at around 50 minutes per day, and the minimal effective dose reached at 25 minutes a day.

The analysis showed that the effectiveness of physical activity interventions increased from admission to discharge, peaking at around 19 days after discharge.

The fall rate was similar among the intervention and comparison groups, but those prescribed physical activity experienced fewer adverse consequences, overall, than those given usual care.

The study authors said: “This review has shown the optimal type and dose of physical activity necessary to prevent functional decline and reduce adverse events in older adults admitted to hospital.”

“If the most potent intervention is provided [walking], the beneficial effects of in-hospital supervised physical activity programmes can be maximised with as little as around 25 minutes a day of slow-paced walking, an achievable target for most hospitalised older adults.

“Together, this meta-analysis has yielded critical information to support the use of physical activity as a core part of the daily routine of acutely hospitalised older adults,” they added.