Published December 2022
When older people have unplanned hospital admissions, they often experience muscle strength loss. This can have long-lasting effects when they return home, meaning they’re not able to do everyday tasks that they were previously able to do. Peter Hartley investigated loss of muscle strength in older people during hospital admissions, and whether doing exercise during their hospital stay could prevent it.
As a hospital physiotherapist, I want to know why older adults are losing their independence despite getting better and what can we do to prevent thisPeter Hartley – PhD student and Physiotherapist
30-60% of older adults who stay at hospital experience associated functional decline – meaning they are less able to do everyday tasks and activities even though they recover and go home. For frail older adults, even the smallest deterioration in muscle strength could be the difference between living independently or requiring new or more support.
Evidence around why this happens isn’t always clear or consistent. While some loss of muscle strength is expected, owing to a lack of activity and bedrest, we don’t know whether it’s the sole reason for functional decline or if there are other factors at play.
From bedside to benchside
My DMT Research Training Fellowship funded my PhD to explore functional decline and muscle loss in older people who are hospitalised, and test whether an exercise intervention could help.
As a hospital physiotherapist, I want to know why older adults are losing their independence despite getting better and what can we do to prevent this. As my first opportunity to conduct primary research, it was great to focus on a question key to my clinical practice, while developing skills that will lead to a clinical academic career.
The DMT provides a really supportive network that makes a big difference for early career researchers like myself.Peter Hartley
Investigating mechanisms and risk factors for muscle loss
I started by carrying out a systematic review looking at the current evidence for changing muscle strength during hospital admission. The review found that, regardless of age, larger muscles in the legs tended to lose around 10% of their strength during an admission. But past research rarely focused on older adults or NHS settings, and there was no clear evidence that the amount of muscle strength loss is related to a lack of activity during an admission. The systematic review also threw up inconsistent results on the effectiveness of exercise interventions in hospitals.
After developing a method to measure someone’s activity levels while in hospital – using two accelerometers attached to the legs – we conducted a study with 70 people to see whether people would be happy to wear the accelerometers and if we could associate a lack of activity with a loss of muscle strength. We did find an association – overall, the less physically active a participant was, and the frailer they were, the greater their strength loss was.
Next, we went on to test the feasibility of an exercise intervention. Unfortunately, we only had 15 participants for this part of the research because COVID-19 interrupted our recruitment. However, we used interviews to collect additional data about their recovery.
We’re starting to understand the causes of functional decline and the importance of factors such as loss of muscle strength and confidence.Peter Hartley
Muscle strength, exercise and confidence
This research has built a more holistic view of the physical, psychological and social elements contributing to loss of muscle strength and functional decline.
I was surprised that adherence to the exercise intervention was much lower than expected. Through the interviews, we heard participants often felt too unwell to do the exercises or wanted to focus on rest. Feedback from staff also showed us that there can be limited opportunities to help patients be more active.
It was also surprising that even 4-6 weeks after being back home again, on average participants had not regained their lost muscle strength. For example, one participant who was previously quite active and would happily get the bus on their own was still anxious to leave their home.
What we thought was a straightforward intervention turned out to be more complex. Through this research, we have greater appreciation that for an exercise intervention to be successful in hospital, we require strategies that target behaviour changes in patients and clinicians. We’re starting to understand the causes of functional decline and the importance of factors such as loss of muscle strength and confidence.
Building a clinical academic career
The DMT provides a really supportive network that makes a big difference for early career researchers like myself. Their events allow fellows and early career researchers to network and learn from each other. They also supported me when I went back into clinical practice full-time during the pandemic – helping me to not worry about pausing my research and PhD.
While my PhD presented some challenges – such as recruiting and doing hospital-based research during COVID – I found it hugely rewarding and enjoyable. It’s reinforced that I want to work towards a clinical academic post in future.
With COVID, the challenges around functional decline have become even greater. We’re seeing people coming into hospitals who are already deconditioned and more sick than the average patient before the pandemic. Patients are also losing strength and independence at a faster rate. This reiterates the urgency of looking into these questions and raises more challenges as to how they are overcome.