Exercise effects on intrinsic capacity in acutely hospitalised older adults: a pooled analysis of two randomised controlled trials

BACKGROUND: Hospitalisation often results in adverse effects in older adults, particularly an increased risk of functional and cognitive decline. Although in-hospital exercise interventions have shown benefits, their impact on intrinsic capacity (IC) remains unknown. OBJECTIVE: To assess the effects of multicomponent exercise training on IC in acutely hospitalised older adults. DESIGN: Pooled analysis of two randomised clinical trials. SETTING: Three Acute Care for Elders units. SUBJECTS: Hospitalised older adults (≥75 years). METHODS: The control group received standard care, whereas the exercise group participated in an in-hospital multicomponent exercise program. The primary outcome was IC assessed using a composite score (0-100) across five domains: vitality (handgrip strength), cognition (Mini-Mental State Examination), psychological health (Yesavage Geriatric Depression Scale), locomotion (Short Physical Performance Battery) and sensory function (self-reported vision and hearing). Adverse outcomes were evaluated 1 year after discharge, including emergency visits, hospital re-admission and mortality. RESULTS: A total of 570 patients (age 87.3 ± 4.8 years) were enrolled during acute hospitalisation [median duration 8 (interquartile range = 3) days] and randomised to the exercise (n = 288) or control group (n = 282). The exercise intervention significantly improved IC compared to the control group [7.74 points, 95% confidence interval (CI) 6.45-9.03, P < .001], with benefits observed in all IC domains. IC score at discharge was inversely associated with mortality risk during follow-up (OR = 0.98 per each increase in IC score at discharge, 95% CI = 0.96, 0.99, P = .010), although no association was found with emergency visits (P = .866) or re-admissions (P = .567). CONCLUSIONS: In-hospital exercise is an effective strategy to enhance IC in hospitalised older adults. Additionally, the IC score at discharge was inversely related to the mortality risk within 1 year of discharge.