1. Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH
The PHYSICAL Study
PHYsical activity Study of older people In hospital: a Cross-sectional analysis using AcceLerometers
Varun Anand, Terence Ong, Alison Bicker, Wei Tan, Gemma Walker, Philippa Logan, Opinder Sahota
Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH
Introduction
Older people in hospital spend the majority of their time in a physically inactive state
This leads to:
Functional decline
Longer length of stay
Higher rates of institutionalisation and re­admission
Studies have used direct observation and structured interviews to measure physical activity (PA)
These methods are either time consuming or subjective and potentially biased
Accelerometers are electromechanical devices that can be used to objectively measure PA
Physical activity measured using triaxial accelerometer device, activPAL (Fig 1)
Small and lightweight
Identifies postural changes: sitting/lying, standing and stepping
Participant wears device for 7 days or until discharge, whichever comes first
Figure 5: Snapshot of activity profile
Table 2: Physical activity vs outcomes
Fig 2: activPAL device inserted into nitrile sleeve
Attached onto anterior thigh above the knee so as not to impede movement
Adhered to skin using waterproof Hydrofilm dressing (10 x 15cm)
Fig 3: activPAL device adhered to skin using Hydrofilm dressing
Fig 1: activPAL accelerometer device (53 x 35 x 7mm)
Weight: 15 grams
Aim
Primary aim:
To determine the level of physical activity among older people in hospital
Secondary aims
To identify what factors predict low PA in hospital
To identify any relationship between low PA and healthcare outcomes, adjusting for possible confounders
Results
Table 1: Baseline characteristics (N = 40)
Total monitored time = 5111 hours (213 days)
Time active = time standing + stepping
Median time active per 24 hours = 33 minutes
IQR 12.4 – 50.5
2.3% of total time active
23.5 / 24 hours (97.7%) sitting or lying (inactive)
Median number of steps per 24 hours = 85
IQR 12 – 346
Figure 4: Activity profile during admission
Outcome
Odds ratio
95% CI
P value
Length of stay
-0.07,0.02
0.226
Discharge destination
0.996
0.98, 1.01
0.688
Fall
1.032
0.99,1.08
0.142
Change in elderly mobility scale
0,0.044
0.050
Change in Barthel index
-0.005,0.134
0.150
Male 21
Female 19
Age (mean, SD)
86.5 (6.0)
BMI (mean, SD)
23.9 (5.6)
Residential Status:
Lives alone
Lives with others
Warden-aided
Care home 24 9 6 1
Package of care:
Nil
Carers OD/BD
Carers TDS/QDS 24 9 7
Presenting complaint:
Fall
Other 20
MMSE (mean, SD)
23.4 (5.1)
Charlson comorbidity index (mean, SD)
(1.6)
Method
Prospective observational study
Convenience sample of older adults
Inclusion criteria:
Age ≥ 65 years
Admitted from acute medical assessment unit to elderly care ward
Recruited within 48 hours of ward admission
Written informed consent (patient / proxy)
Exclusion criteria:
Poor baseline mobility
Need for palliative or higher level of care
Isolation precautions
Fracture needing bed rest
Predicted length of stay ≤ 48 hours
Discussion
Older inpatients are overwhelmingly sedentary
Likely multifactorial
No patient factors predict PA in hospital, no relationship between PA and outcomes
Small sample size; ongoing recruitment
Other confounders not accounted for
Intervention(s) needed to increase physical activity
Day
Median time active (mins)
Acknowledgements
We would like to thank Tahir Masud, Mun Hoe Poon, Shabina Sadiq, David Seddon, Dawn Skelton and the staff on wards C52 and B49 at Queen’s Medical Centre for their support.