Incorporating “moving more and sitting less” into daily activities of hospitalised older medical patients: a stakeholder-directed systematic review with meta-analysis of complex interventions

Purpose: To evaluate the benefits and harms of increasing body movement throughout the day, via activities of daily living (ADLs), in older adults (≥50 years) hospitalised with an acute medical illness. Method: Prospectively registered systematic review (PROSPERO CRD42023438101). Five databases were searched until September 2024. Risk of bias was assessed using Cochrane Risk of Bias tools. Random-effects meta-analyses were conducted of randomised controlled trials (RCTs) and non-randomised studies separately, for use of the GRADE approach to establish evidence certainty. Main outcomes selected by stakeholders, including consumers, were: functional maintenance/improvement, independence in ADLs, self-efficacy, wellbeing, quality of life and clinical deterioration (delirium, other complications) at hospital discharge. Results: Nineteen studies were included, with 15 suitable for meta-analysis. Estimates of effect from RCTs (n = 2) provided low-certainty evidence, favouring the intervention for independence in ADLs (SMD 0.29, 95%CI 0.05,0.52). Very low-certainty evidence from non-randomised studies favoured the intervention for maintaining/improving function (OR 1.95, 95%CI 1.53,2.50; n = 3 studies), positive beliefs about mobility (OR 2.11, 95%CI 1.28,3.48; n = 1 study), reduced pressure injury prevalence (OR 0.53, 95%CI 0.32,0.89; n = 1 study) and LOS (MD −1.01, 95%CI −0.14,−1.87; n = 9 studies). Conclusion: Maximising movement opportunities in hospital may improve some outcomes for older adults at risk of functional decline.