Development and validation of two physical exercise programmes to prevent hospital-associated disability in older adults during hospitalisation: Protocol for two Delphi studies.

<ns7:p>Introduction Older adults admitted to hospital are particularly vulnerable to rapid functional decline, primarily due to prolonged inactivity, a phenomenon known as hospital-associated disability (HAD). Structured exercise interventions preserve functional independence and physical performance in this population substantially better than usual care. Many research articles fail to provide sufficiently detailed descriptions of the exercises and their specific modalities, limiting the feasibility of translating these interventions into clinical practice. Aim We aim to use evidence from an ongoing living systematic review with network meta-analysis to establish consensus on two exercise programmes identified as the most effective for hospitalised older adults. One programme will consist exclusively of resistance training exercises, while the other will adopt a multicomponent approach integrating balance, resistance, and gait training exercises. Each programme will be refined through a separate Delphi study. Methods and analysis We will use a modified Delphi study design to reach consensus among 30 participants, including clinicians, prescribing physical exercises to older adults and researchers in the relevant fields. Each study will consist of three Delphi rounds conducted via electronic surveys. Quantitative responses will be analysed by dichotomising the results of Likert items with a six-point ordinal scale into “in favor” and “not agreeing”, with consensus defined as ≥80% agreement. Qualitative responses will be examined using a modified version of the argument-based qualitative analysis strategy (AQUA). Ethics and dissemination: This study does not collect health-related data. These two studies are part of a broader project designed to enhance the accessibility of up-to-date scientific evidence on preventing hospital-associated disability (HAD) in older adults for both clinicians and patients. The findings will serve as a foundation for developing structured clinical training programmes tailored for geriatric hospitals in Switzerland.</ns7:p>