Effectiveness of home-based exercise for improving physical activity, quality of life and function in older adults after hospitalisation: results from a systematic review

Background: Periods of hospitalisation have a detrimental effect on the physical activity levels of older adults, including after stroke. The combined effects of impairments and inactivity during hospitalisation increases the likelihood of physical and functional decline. Facilitating regular physical activity through home-based exercise may improve long-term health outcomes of older adults after hospitalisation but the efficacy of this approach is unknown.
Aims: This review sought to describe home-based exercise programs that have been utilised for older adults after hospitalisation and investigate their effectiveness for increasing physical activity and improving health outcomes when compared to no intervention, standard care or centre-based exercise.
Methods: Databases were searched from inception to March 2022. Randomised controlled trials which utilised home-based exercise for older adults recently discharged from hospital were included. Participants in those trials were admitted to hospital for various reasons including neurological conditions, such as stroke. The primary outcome was physical activity. Secondary outcomes were quality of life, performance of activities of daily living, mobility, adverse events and hospital readmissions.
Results: Ten trials were included. Three trials demonstrated that home-based exercise can improve objective and subjective measures of physical activity. Home-based exercise was more effective than no intervention at improving performance of activities of daily living (SMD 0.6, 95% CI 0.0 to 1.2); and standard care at improving quality of life (SMD 0.3, 95% CI 0.1 to 0.5) and mobility (SMD 0.2, 95% CI 0.0 to 0.5).
Conclusion: Based on individual trials, home-based exercise has the potential to improve physical activity compared to no intervention or standard care. Meta-analyses indicate that home-based exercise is more effective than no intervention and standard care at improving some health outcomes. Home-based exercise programs should be considered as a means to improve health outcomes of older adults after hospitalisation, including those after stroke.