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

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 strength for all participants and this will be offered as the second session of exercises (afternoon). Morning session will be about 40 minutes in duration and afternoon session about 20 minutes duration. The intervention group will also receive the usual care (once daily sit to stand practice and mobility training with the ward physiotherapist). A record of the exercises will be kept by the physiotherapists (study and usual care) as to the type of exercises, sets of repeats, intensity and duration. This will be used to monitor the acceptance and adherence to the intervention. Sample size Based on the previous studies a total of 150 patients (75 in each group) will give 90% power ) to detect a change in the FIM score at 7 days from -30 units in the usual care group to -15 units in the exercise intervention group (based on SD of 25 units which is a conservative estimate from our previous study). This allows 20% non- compliance. For this pilot study we will be aiming to recruit 50 patients using the same study protocols.