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Could a Tailored Exercise Intervention for Hospitalised Older Adults Have a Role
in the Resolution of Delirium? Secondary Analysis of a Randomised Clinical Trial

Article · January 2022

DOI: 10.14283/jfa.2022.60

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Nicolás Martínez Velilla Lucía Lozano-Vicario

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Mikel L. Sáez de Asteasu Fabricio Zambom Ferraresi

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J Frailty Aging 2022;in press
Published online October 16, 2022, http://dx.doi.org/10.14283/jfa.2022.60
Could a Tailored Exercise Intervention for Hospitalised Older Adults Have
a Role in the Resolution of Delirium? Secondary Analysis of a Randomised
Clinical Trial
N. Martinez Velilla1,2, L. Lozano-Vicario1, M.L. Sáez de Asteasu1,2, F. Zambom-Ferraresi1,2, A. Galbete1,
M. Sanchez-Latorre1, M. Izquierdo1,2
1. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; 2. CIBER of Frailty and Healthy Aging (CIBERFES),
Instituto de Salud Carlos III, Madrid, Spain.
Corresponding Author: Nicolas Martinez Velilla, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain,
nicolas.martinez.velilla@navarra.es
Abstract
Delirium is a transient neurocognitive disorder. Nonpharmacological
measures can be efficient in reducing the incidence and intensity of
delirium, but there is a paucity of evidence when using a physical exercise
program exclusively. This was a secondary analysis of a randomised
clinical trial that provided evidence on the functional and cognitive
benefits of an individualised exercise intervention in hospitalised older
adults. Of the 370 patients who participated in the trial, 17.1% in the
intervention group had delirium and 12.1% in the control group. After
the exercise intervention, 84.6% of the patients in the intervention group
showed improvement in delirium compared to 68.4% of patients in
the control group. Despite the fluctuating nature of delirium,we show
that it is feasible to establish individualised exercise interventions in
hospitalised geriatric patients in the periods when patients are able to
cooperate. Baseline functional status, measured by the Barthel Index, is
a clinical marker that could help to identify those who will benefit most.
Key words: Delirium, exercise, geriatric, hospital.
Introduction
D
elirium is a transient neurocognitive disorder
characterised by an acute onset and fluctuating
course, inattention, cognitive dysfunction, and
behavioural abnormalities (1), with a prevalence ranging from
15–75%, depending on the clinical setting, although discharge
data underreport the occurrence of delirium (2). The short- and
long-term consequences have a high impact in older adults and
are associated with poorer clinical outcomes and utilisation
of health-related resources. This population, especially those
who are frail, is particularly vulnerable to the development of
delirium and its consequences (3).
Numerous pharmacological and nonpharmacological
alternatives have been explored, and despite the failure to
demonstrate the efficacy of drugs in the management of
delirium, nonpharmacological measures such as those
implemented by the multicomponent Hospital Elder Life
Program (HELP) appear to be more efficient and reduce the
incidence of delirium by 43% compared to usual care (4, 5).
One element of these multicomponent strategies is to encourage
physical activity in both medical and surgical patients.
Received June 14, 2022
Accepted for publication October 3, 2022
1
Brief Report
However, there is a paucity of evidence when using a physical
exercise program exclusively.
This type of intervention is a real challenge, despite the
theoretical benefits. Implementing exercise in patients with
hyperactive delirium is very difficult in the acute phase of
delirium, but as it is a fluctuating phenomenon, it is feasible
that in periods when the patient can actively or passively
collaborate, individualised interventions could add synergistic
benefits even more intensively than just promoting physical
activity.
Previously, our team developed a randomised clinical trial
in which we showed the important functional and cognitive
benefits of this type of strategy in hospitalised patients, but
we failed to demonstrate any benefit in the course of delirium,
probably due to a selection bias, since the patients had to
collaborate and understand the instructions (5). However, our
subjective perception was that exercise could be beneficial. We
therefore specifically explored what effects exercise alone had
on patients in the intervention group to explore the theoretical
possibilities.
Methods
This was a secondary analysis of a randomised clinical trial
(NCT02300896) that provided evidence on the functional and
cognitive benefits of an individualised exercise intervention in
hospitalised older adults (5). We initially analysed the patients
in the intervention group who improved delirium with those
who did not, and posteriorly explored the associated baseline
characteristics and clinical courses of those patients whose
delirium improved in both groups.
Results
Of the 370 patients who participated in the trial, 17.1% in the
intervention group had delirium and 12.1% in the control group.
After the exercise intervention, 84.6% of the patients in the
intervention group showed improvement compared to 68.4%
of patients in the control group, with no statistically significant
differences in the baseline characteristics of these patients.
When we compared the patients with delirium who improved
 COULD A TAILORED EXERCISE INTERVENTION FOR HOSPITALISED OLDER ADULTS HAVE A ROLE?

in both groups, we found no obvious phenotypic differences, To the best of our knowledge, there is no previous medical
except that those patients for whom exercise had a beneficial literature applying this type of intervention. There are pre-
effect on delirium had a better Barthel index (82.6 vs. 70.8). habilitation programs for surgical patients or intensive care
Additionally, those patients who showed an improvement in patients, and the results are in line with ours (6). This sub-
delirium also showed improvements in the Short Performance analysis has numerous limitations, such as the small number
Physical Battery, Yesavage Depression Scale and Quality of of included patients and the secondary nature of the analysis.
Life scale (Table 1). However, we believe that it is important to consider such
individualised strategies given the potential benefits, despite
Table 1. Changes in outcomes within patients that improve the very difficult challenges that such interventions may
Delirium pose for geriatric medical or surgical hospitalised patients
Variable (score reference) Control Intervention p1
with any type of delirium. Given the great impact of non-
(n=13) (n=22) pharmacological measures in the management of delirium, it
SPPB (0-12) 0.6 (2.4) 1.8 (1.5) 0.010 is necessary to explore the possibility of customising specific
Barthel Index (0-100) -0.42 (17.5) 1.42 (6.9) 0.274
programs through individualised exercise in the same way as
Minimental State Evaluation (0-30) 1.0 (3.1) 2.7 (1.9) 0.100
other aspects of personalised medicine are being developed..
Yesavage Depression Scale (0-15) 0.8 (1.5) -2.0 (1.7) <0.001 Conflicts of Interest: All authors declare no Conflicts of Interest related to this
manuscript.
Handgrip 0.2 (2.0) 1.8 (2.6) 0.058
QoL -3.9 (11.7) 11.8 (21.1) 0.045 Ethical standard: The study followed the principles of the Declaration of Helsinki
and was approved by the Complejo Hospitalario de Navarra Clinical Research Ethics
1. Mann-Whitney U test; QoL: Quality of Life; SPPB: Short Physical Performance Committee. All patients or their legal representatives provided written informed consent.
Battery There was no financial compensation.

Funding: NM-V received funding from “la Caixa” Foundation (ID 100010434), under
Discussion agreement LCF/PR/PR15/51100006.

Despite the fluctuating nature of delirium, it is feasible to References

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cooperate. Baseline functional status, measured by the Barthel
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©
Serdi 2022
How to cite this article: N. Martinez Velilla, L. Lozano-Vicario, M.L. Sáez de Asteasu, et
al. Could a Tailored Exercise Intervention for Hospitalised Older Adults Have a Role
in the Resolution of Delirium? Secondary Analysis of a Randomised Clinical Trial. J
Frailty Aging 2022; http://dx.doi.org/10.14283/jfa.2022.60

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