Inpatient exercise improved outcomes in elderly type 2 diabetes patients

A single-center study randomized patients ages 75 years and older to either usual care or 20 minutes twice a day of mobility and strengthening exercises during their hospitalizations.

An inpatient exercise intervention combated cognitive and functional decline among hospitalized elderly adults with type 2 diabetes.

The study was an ancillary analysis of a trial that randomized acutely hospitalized older adults (all ≥75 years of age, mean age ~87 years) to an exercise intervention or usual care. It included 103 patients with type 2 diabetes, 54 who exercised during their stay and 49 controls. The intervention consisted of 20-minute sessions twice a day five to seven days per week. During morning sessions, patients did progressive resistance, balance, and walking exercises under supervision. In the evenings, they performed functional unsupervised exercise and walked. Results were published by the Journal of Clinical Endocrinology and Metabolism on Nov. 5.

The study's primary endpoint was change in functional status from baseline to hospital discharge as assessed with the Barthel Index and the Short Physical Performance Battery (SPPB). The intervention groups saw improvements in these measures from baseline, which were significantly different from the declines seen among controls (between-group differences: SPPB, 2.7 points [95% CI, 1.8 to 3.5 points]; Barthel Index, 8.5 points [95% CI, 3.9 to 13.1 points]; P<0.001 for both comparisons). The intervention also showed benefits on the secondary endpoints of cognitive status, depression, and handgrip strength. Length of stay was similar between groups (median, 8 days), as were mortality and readmissions in the three months after discharge.

The results “confirm that inhospital interventions can be effective even in a population at particular risk of frailty and hospitalization-related negative outcomes such as the diabetic oldest old,” the authors said. They noted that the positive effects seen in this subgroup of patients were actually greater than those observed in the overall trial. It may have been important to the success of the intervention that it included both mobility and strengthening exercises, the authors said.

Limitations of the study include its small sample size and single-center setting. However, strengths include that it may be the first study to assess the effects of exercise during hospitalization on older patients with diabetes, and exercise trials rarely include patients with so many comorbidities (patients had a mean of nine in this study). The authors called for additional research into whether an intervention like this could have any effect on longer-term outcomes.