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Table 4 Round 4 final draft recommendation/targets

From: Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study

Final draft recommendations for physical activity and sedentary behaviour of older adults while hospitalised with an acute medical illness

Source of recommendation

Existing recommendations

The following recommended levels of physical activity for adults aged 65 and above remain applicable while hospitalised with an acute medical illness:

 

• When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

WHO guidelines [30]

• Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.

WHO guidelines [30]

• Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.

WHO guidelines [30]

Alternative wording for the first recommendation above may be applicable for the context of older adults while hospitalised with an acute medical illness:

 

• When older adults cannot do the recommended physical activity due to illness or health conditions, they should be as physically active as their abilities and health status allows. b

Item 1c b (Table S2)

Consistent with country specific guidance for older adults, the following recommendations have a component specific to sedentary behaviour that remains applicable while hospitalised with an acute medial illness:

 

• adults should move more and sit less throughout the day, some physical activity is better than none,b and adults who sit less and do any amount of MVPA gain some health benefits.

US guidelines [59]

Item 1bb (Table S2)

• all older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.

UK guidelines [60] a

• if you can, also try to reduce the time you spend sitting for long periods.

AUS guidelines [39]

Newly developed recommendations

There are some overarching principles that are relevant to all of the newly developed recommendations (or targets), relating to people and organisational factors as follows:

 

• A person-centred approach should be taken to engage and enable older adults to be physically active and minimise sedentary behaviour during hospitalisation.b

Item 9ab (Table S2)

• Enabling physical activity and minimising sedentary behaviour in hospital should be a shared responsibility; all health care professionals, people at different organisational levels, caregivers and relatives, volunteers, and older adults have abilities to contribute.

Item 7b (Table S2)

• When encouraging physical activity and minimising sedentary behaviour, people should:

o act with sensitivity and respect by partnering with, supporting and being ready to hear the perspective of older adults.b

o be culturally responsive and mindful of older adults’ physical and mental capabilities.b

Items 10ab and 10bb (Table S2)

• Opportunities for physical activity and minimising sedentary behaviour should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living.b

Item 15ab (Table S2)

Physical activity (defined as, any bodily movement produced by skeletal muscles that requires energy expenditure) [2]

 

• Older adults should aim to be as active as possible during hospitalisation for an acute medical illness, adding movement into everyday activities and incrementally if required.

Item 1a (Table S2)

• Physical activity should be accumulated regularly, in bouts throughout the day.

Item 2 (Table S2)

• Walking is one example of physical activity for older adults while hospitalised.

Item 3a (Table S2)

• For older adults who are able, walking should be accumulated regularly throughout the day and for progressively longer periods.

Items 3d and 3e (Table S2)

• Older adults who can walk independently should be encouraged to do so, considering their current and usual ability.b

Item 3bb (Table S2)

• Older adults who require help to walk should be assisted, considering their current and usual ability.

Item 3c (Table S2)

• Other types of activity should be considered for people who are unable to walk.

Item 3a (Table S2)

Sedentary behaviour (defined as, the waking time spent sitting or lying down, or, according to an energy expenditure threshold of ≤1.5 METs) [10]

 

• Older adults should aim to minimise long periods of uninterrupted sedentary behaviour during waking hours while hospitalised.

Item 4 (Table S2)

• When possible, sitting out of bed and movement from bed to chair are preferable to time spent lying in bed.

Item 5a (Table S2)

• Older adults should break up sedentary time by standing up and or/walking as often as possible, with assistance as needed; a modifiable target may be to stand up and/or walk each waking hour.

Item 5b (Table S2)

• If standing up is not possible, a modifiable target may be completing light intensity movements in a seated or lying position.

Item 5c (Table S2)

The following recommendations related to people factors that may support physical activity and minimising sedentary behaviour:

 

• To address physical activity and sedentary behaviour during hospitalisation, the culture, philosophy of care, and value of physical activity in hospitals should be examined.

Item 6 (Table S2)

• Clear professional roles and responsibilities are needed to enable older adults to be physically active and minimise sedentary behaviour; this may include directives for mobility and having appropriately trained people who are available to assist older adults.

Item 8 (Table S2)

• When enabling older adults to be physically active and minimise sedentary behaviour, consideration should be given to what permissions for activity, instructions (including self-directed, independent or minimally supervised activities), inclusion of caregivers and knowledge of the environment and daily care plans is required.

Item 9b (Table S2)

• Principles of behaviour change including mobility goal setting, self-monitoring and feedback may support physical activity and sedentary behaviour in the acute hospital setting.b

Item 10cb (Table S2)

The following recommendations relate to organisational factors that may support physical activity and minimising sedentary behavior:

 

• Consideration should be given to moments for physical activity and minimising sedentary behaviour as part of common care activities like mealtime, hygiene and dressing.b

Item 15bb (Table S2)

• Consideration should be given to the value of education and training as it relates to the shared responsibility of enabling physical activity and minimising sedentary behaviour in hospital (e.g. older adults, caregivers and relatives, developing and practicing health care professionals, people at different organisational levels).b

Item 14b (Table S2)

• To address physical inactivity and sedentary behaviour during acute hospitalisation, it is important to understand the complexity of local issues and consider hospital-system based solutions that address the physical and social environment, along with other factors.

o consideration should be given to the potential value of policies and procedures; it may be relevant to address,

▪ roles and responsibilities

▪ work organisation (such as transport and bed allocations)

▪ adverse event reporting

▪ care plans and ward rounds

▪ methods for prompting behaviours of older adults and health care professionals

▪ the use of digital technologies or devices for monitoring or assistance

Items, 11, 12, and 13 (Table S2)

• Consideration should be given to the influence of the physical environment on the ability for older adults to be active, including in- and out-door environments, portable adaptations and equipment.b

Item 16a and 16bb (Table S2)

  1. AUS Australian, MET metabolic equivalent of task, MVPA moderate-to-vigorous physical activity, UK United Kingdom, US United States, WHO World Health Organization
  2. aSince conduct of this Delphi study, UK guidance has been replaced with a newer version of recommendations [41] that were not tested for consensus agreement on applicability to hospitalised older adults
  3. bdenotes recommendations/targets that were revised from original draft statements in Round 4 that received responses of endorsement from ≥70% of respondents