The impact of changes in physical activity on functional recovery for older inpatients in community-based integrated care units

The impact of changes in physical activity on functional recovery for older inpatients in community-based integrated care units | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The impact of changes in physical activity on functional recovery for older inpatients in community-based integrated care units Hiroki Saegusa, Iwao Kojima, Yusuke Terao, Shingo Koyama, Mizue Suzuki, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4470314/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose The effect of increased physical activity duration on functional recovery in older inpatients in subacute settings is not well established. This study aimed to investigate the relationship between physical activity and functional recovery in older patients receiving post-acute and subacute care. Methods We analyzed cohort data of hospitalized older patients (age ≥ 65 years) in the community-based integrated care units. The main outcome was functional independence measure (FIM) gain. Physical activity was measured using a triaxial accelerometer. Changes in sedentary behavior and total physical activity time from admission to discharge were measured as changes in each physical activity time. Logistic regression analysis was performed to examine the relationship between changes in physical activity and FIM gain. Results A total of 210 patients were eligible for analysis. The mean age of the study patients was 83.6 ± 7.2 years, and 63.8% (n = 134) were female. According to the multivariate regression analysis, changes in sedentary behavior time were significantly associated with better recovery of FIM gain (odds ratio [OR] 0.996, 95% confidence interval [CI]: 0.992–0.999; p = 0.018), and changes in total physical activity time also showed a similar association (OR 1.006, 95% CI: 1.001–1.011; p = 0.023). Conclusion Decreased sedentary behavior time and increased total physical activity time were significantly associated with better functional recovery in community-based integrated care units. These results suggest that interventions for physical activity duration may be effective in older post-acute and subacute patients. Post-acute Subacute Community-based integrated care units Older patients Physical activity Functional recovery Figures Figure 1 Key summary points Aim: We investigated the relationship between physical activity and functional recovery in a community-based integrated care units. Findings: Decreased sedentary behavior time and increased total physical activity time were associated with better functional recovery. Message: Interventions for physical activity duration may be effective in post-acute and subacute older patients. 1 Introduction Functional decline during hospitalization, which is called “hospital associated disability” is a huge problem especially for older patients. In the acute ward, one-third to one-half of older patients experience functional decline [ 1 – 5 ], and many patients remain restricted in activities of daily living (ADL) a year after discharge [ 3 ]. Furthermore, functional decline during hospitalization is associated with institutionalization [ 6 ] and mortality [ 3 ]. Therefore, post-acute care for functional recovery has become important owing to the increasing aging population [ 7 ]. Community-based integrated care units were established in Japan in 2014 to support the functional recovery of older patients. The objective of this unit is to provide rehabilitation for post-acute and subacute patients with the goal of returning home [ 8 ]. However, achieving this goal is difficult because many patients experience negative factors for functional improvement such as less physical activity and malnutrition [ 9 ] in community-based integrated care units. Therefore, it is necessary to improve or support these negative factors during early hospitalization. Reducing sedentary time and promoting physical activity are important for improving functional recovery in older patients. It is well known that hospitalized older patients become inactive from the time of admission [ 10 – 12 ], and this lifestyle leads to adverse health outcomes, such as muscle wasting [ 13 , 14 ] and declining cardiovascular health [ 15 ], and even has a negative impact on functional recovery [ 16 ]. Among them, the effect of promoting increased activity time/decreased inactivity time on functional recovery for some diseases, such as stroke [ 17 , 18 ] and postoperative lower extremity [ 19 , 20 ], is well established, but not for older inpatients in subacute settings. Therefore, this study aimed to investigate the relationship between changes in physical activity and functional improvement in older patients in community-based integrated care units. We believe that the current study provides novel information that will help in the functional improvement of older patients in the post-acute and subacute phases. 2 Methods 2.1. Study design and Participants This prospective cohort study included older patients admitted to the community-based integrated care units of Shonan Keiiku Hospital, Fujisawa, Japan, from October 2020 to January 2022. The inclusion criteria were patients aged 65 years and older. The exclusion criteria were patients who did not intend to improve ADL, independent ADL at admission, ADL limitations due to rest management, difficulty in communication, hospitalization for less than one week, readmission during the study period, hospital transfer, missing data, and death during hospitalization. This study was conducted in accordance with the Declaration of Helsinki, and the study protocol was reviewed and approved by the Ethics Committee of Shonan Keiiku Hospital. Written informed consent was obtained from all the participants or their families. 2.2. Rehabilitation program All patients underwent rehabilitation for 40–60 min daily during hospitalization under the medical insurance system. Rehabilitation programs were individually designed according to health conditions and goals for each patient and included gait training, balance exercises, strength exercise, self-care skills training, and swallowing training by physical, occupational, and speech therapy. 2.3. Measurements 2.3.1. Outcome The outcome of the current study was functional independence measure (FIM) gain. The FIM is an indicator of ADL and consists of a motor domain of 13 sub-items and a cognitive domain of five sub-items [ 21 ]. The scores were evaluated on a 7-point scale ranging from 1 (total assistance) to 7 (complete independence). The total FIM scores range from 18 to 126, with lower scores indicating greater dependency. The FIM gain was obtained by subtracting the admission scores from the discharge scores [ 22 ]. We operationally defined the third quartile or higher for FIM gain as a better recovery for ADL. In this study, well-trained physical therapists assessed the FIM. 2.3.2. Physical activity We investigated the amount of 3 days’ physical activity at two time points: immediately after admission and immediately before discharge. Physical activity was measured using a triaxial accelerometer (Active Style Pro HJA-750C; Omron Healthcare Co. Ltd. Kyoto, Japan; 52 × 40 × 12 mm, weighing approximately 23 g, and including a battery), which can estimate metabolic equivalents (METs) from a wide range of body movements during ADL [ 23 , 24 ]. The accelerometer was worn on the waist for 24 h, excluding the dressing and bathing times. We analyzed the acceleration data between 5:00 AM and 0:00 AM each day and estimated the METs every 60 s. From the estimated METs data, we calculated time (min/day) spent in sedentary behavior (≤ 1.5 METs) [ 25 ] and in total physical activity (≥ 1.6 METs). We defined total physical activity as an accumulation of light-intensity physical activity (1.6–2.9 METs) [ 25 ] and moderate-to-vigorous physical activity (≥ 3.0 METs) [ 26 ]. We defined the changes in sedentary behavior and total physical activity time from admission to discharge as the change in each physical activity time. 2.3.3. Other variables Demographic and clinical characteristics, including age, sex, body mass index (BMI), reason for admission to the acute ward, comorbidities, length of hospital stay, requirement for long-term care, cognitive function, depression, and nutritional intake were investigated. Comorbidity was assessed using the Charlson comorbidity index (CCI) [ 27 ], and we defined scores 3 or more as disease severity [ 28 ]. We defined requiring long-term care as all care need levels (one to five) according to the standards for long-term care requirement certification in Japan [ 29 ]. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) [ 30 ], which ranges from 0 to 30; we defined scores of 23 or less as cognitive dysfunction [ 31 ]. Depression was assessed using the 15-item Geriatric Depression Scale (GDS-15) [ 32 ]. Nutritional intake was estimated as the average calorie intake per actual body weight per day based on the intake rate of the main and side dishes recorded by the nurse during the three days (9 meals) immediately after admission [ 9 ]. 2.3.4. Statistical analysis We compared all variables between the better recovery of FIM gain group and the non-better recovery group using the chi-square test, t-test, or Mann–Whitney U test for categorical or continuous variables. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of the relationships between changes in physical activity (sedentary behavior and total physical activity) and FIM gain. Demographic details and level of physical activity were used as covariates to adjust for confounding factors in the multivariate logistic regression models (model 1: adjusted for age, sex, CCI, and MMSE; model 2: model 1 + changes in sedentary behavior or changes in total physical activity). All statistical analyses were performed using the IBM SPSS for Mac (version 27.0; IBM Japan, Tokyo, Japan). Statistical significance was set at p < 0.05. 3 Results Of the 620 patients enrolled in the study, 410 were excluded based on the aforementioned exclusion criteria, resulting in 210 eligible patients for analysis (Fig. 1). The clinical and demographic characteristics of patients in the better recovery (FIM gain) and non-better recovery groups are shown in Table 1. The mean age of the study patients was 83.6 ± 7.2 years, and 63.8% (n = 134) of them were female. The comparison between the two groups showed significant differences in sex ( p = 0.041), requirement for long-term care ( p = 0.002), MMSE ( p = 0.027), and FIM scores at discharge ( p < 0.001). FIM gain, changes in sedentary behavior, and total physical activity time are shown in Table 2. The median FIM gains (interquartile range [IQR]) in the better and non-better recovery groups were 26 [ 23 – 32 ] and 9 [ 3 – 14 ], respectively ( p < 0.001). The better recovery group showed a significant decrease in sedentary behavior time ( p < 0.001) and a significant increase in total physical activity time ( p < 0.001) compared with the non-better recovery group. According to the multivariate logistic regression analysis, changes in sedentary behavior time were significantly associated with better recovery of FIM gain (OR 0.996, 95% CI: 0.992–0.999; p = 0.018), and changes in total physical activity time also showed a similar association (OR 1.006, 95% CI: 1.001–1.011; p = 0.023). 4 Discussion This prospective cohort study investigated the relationship between changes in physical activity and functional recovery in subacute and post-acute older patients. We found that greater changes in sedentary behavior time and amount of physical activity were significantly associated with better functional recovery after adjusting for covariates. This result suggests that reducing sedentary behavior time and increasing amount of physical activity may be valuable factors for functional recovery in older patients in community-based integrated care units. The amount of physical activity for these study participants was only 1.5 h/day, which is similar to that of patients in acute care wards [ 33 , 34 ]. It is well known that this inactivity leads to functional decline in acute patients but is not well established in post-acute patients. In the better functional recovery group, part of the sedentary time was replaced with physical activity time during the post-acute hospitalization period. These results suggest the need to promote physical activity for functional recovery in post-acute patients. The current findings suggest that replacing sedentary time with physical activity may help prevent or improve functional decline caused by disuse. Reducing sedentary behavior in acute care units is important to prevent disuse syndrome [ 35 , 36 ], and increasing the amount of physical activity leads to the recovery of lower extremity muscle strength and the cardiovascular system after the acute phase [ 37 , 38 ]. Thus, sedentary and physical activity durations may be more likely to promote ADL recovery. In particular, post-acute patients are more likely to have limited physical activity owing to several impairments and disease management; therefore, replacing sedentary behavior with mild physical activity may have been successful. This cohort study had two major strengths. First, we used an objective measure of physical activity levels in older post-acute patients. Because many previous studies on physical activity in post-acute older patients used a number of steps and questionnaires [ 39 , 40 ], it was difficult to apply them clinically based on several findings. Among these, we measured physical activity in detail, as it suggests that encouraging a change from sedentary to active behavior contributes to ADL recovery. Second, this study included patients with ambulatory difficulties and mild to moderate cognitive impairment, which are common in post-acute care units. Previous studies examining physical activity and functional changes have excluded cases of cognitive impairments [ 4 , 16 ]. The findings of this study can be widely applied to post-acute and subacute older patients. This cohort study had two limitations. First, patients had a wide range of acute illnesses. The degree of functional recovery varied with the disease type and needed to be included as an adjustment variable. Second, physical activity and FIM were measured simultaneously, and this study was cross-sectional; therefore, it was not possible to refer to a causal relationship. In other words, it is possible that the amount of physical activity may have improved as a result of functional recovery. However, several previous studies have shown that physical activity affects functional recovery [ 16 , 17 – 20 , 39 ], and the present study suggests a similar causal relationship. A larger sample size that considers diseases and interventions is required to clarify these limitations. 5 Conclusion In conclusion, decreased sedentary behavior time and increased total physical activity time were significantly associated with better functional recovery in community-based integrated care units. These results suggest that interventions for physical activity duration may be effective in post-acute and subacute older patients with negative factors for functional recovery. Declarations Acknowledgments We thank the nursing staff and rehabilitation therapists of our hospitals for their contributions to data collection. We are grateful to our laboratory members for their helpful advice in drafting this manuscript. We would like to thank Tomoya Ishigaki for providing the activity analysis program. Author contribution Conceptualization: [Hiroki Saegusa], [Iwao Kojima], [Minoru Yamada]; Methodology: [Hiroki Saegusa], [Iwao Kojima], [Yusuke Terao], [Shingo Koyama], [Mizue Suzuki], [Yosuke Kimura], [Yuhei Otobe], [Minoru Yamada]; Formal analysis and investigation: [Hiroki Saegusa], [Iwao Kojima], [Yusuke Terao], [Shingo Koyama], [Mizue Suzuki], [Yosuke Kimura], [Yuhei Otobe], [Minoru Yamada]; Writing – original draft preparation: [Hiroki Saegusa]; Writing – review & editing: [Hiroki Saegusa], [Iwao Kojima], [Minoru Yamada]; Methodology: [Hiroki Saegusa], [Iwao Kojima], [Yusuke Terao], [Shingo Koyama], [Mizue Suzuki], [Shu Tanaka], [Yosuke Kimura], [Yuhei Otobe], [Takuya Aoki], [Sho Nishida], [Yasuhiro Kitagawa], [Minoru Yamada]; Resources: [Minoru Yamada]; Supervision: [Minoru Yamada]. Funding This study did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials The data generated and analyzed during this study are not publicly available but are available from the corresponding author on reasonable request. Conflict of interest The authors declare that there are no conflicts of interest. Ethical approval This study was approved by the Committee of Ethics of Shonan Keiiku Hospital (No. 20-012). Informed consent Taken from all patients or their caregivers/relatives. References Zisberg A, Shadmi E, Gur-Yaish N, Tonkikh O, Sinoff G (2015) Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. J Am Geriatr Soc 63(1):55–62. https://doi.org/10.1111/jgs.13193 Palleschi L, Fimognari FL, Pierantozzi A, Salani B, Marsilii A, Zuccaro SM, Di Cioccio L, De Alfieri W (2014) Acute functional decline before hospitalization in older patients. 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Comparison between the better recovery and non-better recovery groups Overall Better recovery group Non-better recovery group P -value (n = 210) (n = 53) (n = 157) Age, mean ± SD 83.6 ± 7.2 83.5 ± 7.2 83.6 ± 7.2 0.934 Female, n (%) 134 (63.8) 40 (75.5) 94 (59.9) 0.041 BMI, kg/m², median [IQR] 20.3 [17.9–23.1] 20.4 [17.9–23.2] 20.1 [17.6–23.0] 0.420 Reason for admission to acute ward Musculoskeletal system diseases, n (%) 80 (38.1) 25 (47.2) 55 (35.0) 0.116 Nervous system diseases, n (%) 52 (24.8) 9 (17.0) 43 (27.4) 0.129 Nutritional and metabolic diseases, n (%) 18 (8.6) 5 (9.4) 13 (8.3) 0.795 Genitourinary system diseases, n (%) 16 (7.6) 5 (9.4) 13 (8.3) 0.565 Circulatory system diseases, n (%) 13 (6.2) 3 (5.7) 10 (6.4) 0.853 Digestive system diseases，n (%) 12 (5.7) 2 (3.8) 10 (6.4) 0.481 Respiratory system diseases, n (%) 10 (4.8) 3 (5.7) 10 (6.4) 0.722 Others, n (%) 9 (4.3) 1 (1.9) 8 (5.1) 0.319 CCI, score, median [IQR] 2 [1–3] 2 [1–3] 2 [1–3] 0.856 Length of stay Acute ward, days, median [IQR] 9 [1.3–22.8] 8 [1–24] 11 [3–21] 0.433 Community-based integrated care units, days, median [IQR] 51 [40–57] 52 [41–57] 51 [40–57] 0.490 Requiring long-term care, yes (%) 98 (46.7) 15 (28.3) 83 (52.9) 0.002 MMSE, score, median [IQR] 22 [16–25] 23 [19–26] 21 [16–25] 0.027 GDS-15, score, median [IQR] 5 [3–8] 5 [3–8] 5 [3–8] 0.656 Nutritional intake, kcal/kg/day, mean ± SD 24.4 ± 8.6 25.3 ± 9.1 24.1 ± 8.5 0.371 Physical activity Sedentary behavior (≤1.5 METs), min/day, median [IQR] 1016.0 [942.0–1068.1] 1016.0 [949.3–1068.3] 1016.0 [938.7–1067.3] 0.874 Total physical activity (≥1.6 METs), min/day, median [IQR] 82.0 [42.4–143.3] 116.3 [49.0–167.7] 75.0 [38.7–134.3] 0.073 FIM At admission, score, median [IQR] 78 [60–94] 80 [69–96] 74 [57–94] 0.129 At discharge, score, median [IQR] 93 [71–110] 109 [101–118] 84 [63–104] < 0.001 SD, standard deviation; IQR, interquartile range; BMI, body mass index; CCI, Charlson comorbidity index; MMSE, Mini-Mental State Examination; GDS-15, Geriatric Depression Scale-15; METs, metabolic equivalents; FIM, functional independence measure Table 2. Changes in physical activity time and FIM during hospitalization Overall Better recovery group Non-better recovery group P -value (n = 210) (n = 53) (n = 157) FIM gain, score, median [IQR] 12 [4–19.8] 26 [23–32] 9 [3–14] < 0.001 Changes in physical activity time Sedentary behavior (≤1.5 METs), min/day, mean ± SD −54.6 ± 129.4 −121.7 ± 115.5 −32.0 ± 126.2 < 0.001 Total physical activity (≥1.6 METs), min/day, mean ± SD 34.5 ± 79.7 79.1 ± 91.2 19.4 ± 69.6 < 0.001 SD, standard deviation; IQR, interquartile range; FIM, functional independence measure; METs, metabolic equivalents Table 3. Results of logistic regression analysis for FIM gain Crude Model 1 Model 2 OR 95% CI P OR 95% CI P OR 95% CI P Changes in sedentary behavior time (per 1 min/day) 0.994 0.991–0.997 < 0.001 0.994 0.991–0.997 < 0.001 0.996 0.992–0.999 0.018 Changes in total physical activity time (per 1 min/day) 1.010 1.005–1.014 < 0.001 1.009 1.005–1.014 < 0.001 1.006 1.001–1.011 0.023 FIM, functional independence measure; OR, odds ratio; CI, confidence interval; METs, metabolic equivalents Note: Sedentary behavior, ≤1.5 METs; Total physical activity, ≥1.6 METs Crude: Changes in sedentary behavior time / Changes in total physical activity time Model 1: Crude + Age + Sex + Charlson comorbidity index + Mini-Mental State Examination Model 2: Model 1 + Changes in sedentary behavior time or changes in total physical activity time (Those not crude) Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 May, 2024 Reviewers invited by journal 29 May, 2024 Editor assigned by journal 25 May, 2024 First submitted to journal 23 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4470314","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308108144,"identity":"ce887626-a5a7-45b2-91ba-1e8cdbef032d","order_by":0,"name":"Hiroki Saegusa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACAyD+wMAgxyDBzHwAyJaQIUYL4wwGBmOgFrYEkBYeErQw8IBsZCCsxZz/AGMzT4VB4sx2ns+vbtRY8DCwHz66AZ8WyxkJQC1nDBJnM/Nus845BnQYT1raDbwOu8HA/pi37U/iPKAW4xw2oBYJHjP8Ws4DHcb7zwCoheeZcc4/YrQcADqMtwHkMB7mx7ltxGi5kdjYOOeYgfHMZjYz5tw+CR42gn45f/hgw5saA9kZ5w8//pzzrU6On/3wMbxagNHSAGOxSYBJ/MpRAfMHUlSPglEwCkbByAEAR9tEIxnIBRcAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0006-3855-596X","institution":"Keio University: Keio Gijuku Daigaku","correspondingAuthor":true,"prefix":"","firstName":"Hiroki","middleName":"","lastName":"Saegusa","suffix":""},{"id":308108145,"identity":"596813a1-f0d7-4081-8076-be41b92a15dd","order_by":1,"name":"Iwao Kojima","email":"","orcid":"","institution":"University of Tsukuba Graduate School of Comprehensive Human Sciences: Tsukuba Daigaku Daigakuin Ningen Sogo Kagaku Kenkyuka","correspondingAuthor":false,"prefix":"","firstName":"Iwao","middleName":"","lastName":"Kojima","suffix":""},{"id":308108146,"identity":"ccfcbc14-2ac8-465a-a9c1-87093fd40a3a","order_by":2,"name":"Yusuke Terao","email":"","orcid":"","institution":"University of Tsukuba Graduate School of Comprehensive Human Sciences: Tsukuba Daigaku Daigakuin Ningen Sogo Kagaku Kenkyuka","correspondingAuthor":false,"prefix":"","firstName":"Yusuke","middleName":"","lastName":"Terao","suffix":""},{"id":308108147,"identity":"11dd98ea-3640-4151-a478-ac9afee8b2fc","order_by":3,"name":"Shingo Koyama","email":"","orcid":"","institution":"Tsukuba Gijutsu Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Shingo","middleName":"","lastName":"Koyama","suffix":""},{"id":308108148,"identity":"85297d6e-b2bc-44e0-97c9-28ed639acd87","order_by":4,"name":"Mizue Suzuki","email":"","orcid":"","institution":"Yamato University Faculty of Allied Health Sciences: Yamato Daigaku Hoken Iryo Gakubu","correspondingAuthor":false,"prefix":"","firstName":"Mizue","middleName":"","lastName":"Suzuki","suffix":""},{"id":308108149,"identity":"3b29360f-b626-4af2-aa1e-c0b4c999a450","order_by":5,"name":"Shu Tanaka","email":"","orcid":"","institution":"Tokyo University of Technology: Tokyo Koka Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Shu","middleName":"","lastName":"Tanaka","suffix":""},{"id":308108150,"identity":"32f2e8c3-c0d7-451a-9f1f-e7ee86983ac8","order_by":6,"name":"Yosuke Kimura","email":"","orcid":"","institution":"Kanto Gakuin University: Kanto Gakuin Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Yosuke","middleName":"","lastName":"Kimura","suffix":""},{"id":308108151,"identity":"88e7e5bc-5107-4485-a2b3-f54ed1fac633","order_by":7,"name":"Yuhei Otobe","email":"","orcid":"","institution":"Osaka Metropolitan University: Osaka Koritsu Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Yuhei","middleName":"","lastName":"Otobe","suffix":""},{"id":308108152,"identity":"2eaa7d0e-7ae7-41f1-aae9-2f581c94c556","order_by":8,"name":"Takuya Aoki","email":"","orcid":"","institution":"University of Tsukuba Graduate School of Comprehensive Human Sciences: Tsukuba Daigaku Daigakuin Ningen Sogo Kagaku Kenkyuka","correspondingAuthor":false,"prefix":"","firstName":"Takuya","middleName":"","lastName":"Aoki","suffix":""},{"id":308108153,"identity":"ab558cb7-3f15-42aa-bd02-bb2f52b84828","order_by":9,"name":"Sho Nishida","email":"","orcid":"","institution":"University of Tsukuba Graduate School of Comprehensive Human Sciences: Tsukuba Daigaku Daigakuin Ningen Sogo Kagaku Kenkyuka","correspondingAuthor":false,"prefix":"","firstName":"Sho","middleName":"","lastName":"Nishida","suffix":""},{"id":308108154,"identity":"d1ca3d00-59cf-489c-ba3c-4c000bf0e0bd","order_by":10,"name":"Yasuhiro Kitagawa","email":"","orcid":"","institution":"Shonan Keiiku Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yasuhiro","middleName":"","lastName":"Kitagawa","suffix":""},{"id":308108155,"identity":"006d16ca-8569-4c0d-80a0-7a722986461e","order_by":11,"name":"Minoru Yamada","email":"","orcid":"","institution":"University of Tsukuba School of Human Sciences: Tsukuba Daigaku Ningen Gakugun","correspondingAuthor":false,"prefix":"","firstName":"Minoru","middleName":"","lastName":"Yamada","suffix":""}],"badges":[],"createdAt":"2024-05-24 06:10:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4470314/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4470314/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58244316,"identity":"226900b6-423e-44ec-aea2-93384e008f57","added_by":"auto","created_at":"2024-06-13 02:08:55","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50384,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDiagram \u0026nbsp;\u0026nbsp;of the selection process for participants\u003c/p\u003e\n\u003cp\u003eADL, \u0026nbsp;\u0026nbsp;activities of daily living\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4470314/v1/52dbd9848d5a38d7c1228edc.jpg"},{"id":58244317,"identity":"e891c16a-c6c8-4f4f-a393-67f0b1a88be1","added_by":"auto","created_at":"2024-06-13 02:09:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":574857,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4470314/v1/c2879f4d-7920-4975-bad8-244a713e8023.pdf"}],"financialInterests":"","formattedTitle":"The impact of changes in physical activity on functional recovery for older inpatients in community-based integrated care units","fulltext":[{"header":"Key summary points","content":"\u003cul start=\"12\"\u003e\n \u003cli\u003eAim: We investigated the relationship between physical activity and functional recovery in a community-based integrated care units.\u003c/li\u003e\n \u003cli\u003eFindings: Decreased sedentary behavior time and increased total physical activity time were associated with better functional recovery.\u003c/li\u003e\n \u003cli\u003eMessage: Interventions for physical activity duration may be effective in post-acute and subacute older patients.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1 Introduction","content":"\u003cp\u003eFunctional decline during hospitalization, which is called \u0026ldquo;hospital associated disability\u0026rdquo; is a huge problem especially for older patients. In the acute ward, one-third to one-half of older patients experience functional decline [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and many patients remain restricted in activities of daily living (ADL) a year after discharge [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, functional decline during hospitalization is associated with institutionalization [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and mortality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, post-acute care for functional recovery has become important owing to the increasing aging population [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunity-based integrated care units were established in Japan in 2014 to support the functional recovery of older patients. The objective of this unit is to provide rehabilitation for post-acute and subacute patients with the goal of returning home [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, achieving this goal is difficult because many patients experience negative factors for functional improvement such as less physical activity and malnutrition [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] in community-based integrated care units. Therefore, it is necessary to improve or support these negative factors during early hospitalization.\u003c/p\u003e \u003cp\u003eReducing sedentary time and promoting physical activity are important for improving functional recovery in older patients. It is well known that hospitalized older patients become inactive from the time of admission [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and this lifestyle leads to adverse health outcomes, such as muscle wasting [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and declining cardiovascular health [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and even has a negative impact on functional recovery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Among them, the effect of promoting increased activity time/decreased inactivity time on functional recovery for some diseases, such as stroke [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and postoperative lower extremity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], is well established, but not for older inpatients in subacute settings.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to investigate the relationship between changes in physical activity and functional improvement in older patients in community-based integrated care units. We believe that the current study provides novel information that will help in the functional improvement of older patients in the post-acute and subacute phases.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and Participants\u003c/h2\u003e \u003cp\u003eThis prospective cohort study included older patients admitted to the community-based integrated care units of Shonan Keiiku Hospital, Fujisawa, Japan, from October 2020 to January 2022. The inclusion criteria were patients aged 65 years and older. The exclusion criteria were patients who did not intend to improve ADL, independent ADL at admission, ADL limitations due to rest management, difficulty in communication, hospitalization for less than one week, readmission during the study period, hospital transfer, missing data, and death during hospitalization. This study was conducted in accordance with the Declaration of Helsinki, and the study protocol was reviewed and approved by the Ethics Committee of Shonan Keiiku Hospital. Written informed consent was obtained from all the participants or their families.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Rehabilitation program\u003c/h2\u003e \u003cp\u003eAll patients underwent rehabilitation for 40\u0026ndash;60 min daily during hospitalization under the medical insurance system. Rehabilitation programs were individually designed according to health conditions and goals for each patient and included gait training, balance exercises, strength exercise, self-care skills training, and swallowing training by physical, occupational, and speech therapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Measurements\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1. Outcome\u003c/h2\u003e \u003cp\u003eThe outcome of the current study was functional independence measure (FIM) gain. The FIM is an indicator of ADL and consists of a motor domain of 13 sub-items and a cognitive domain of five sub-items [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The scores were evaluated on a 7-point scale ranging from 1 (total assistance) to 7 (complete independence). The total FIM scores range from 18 to 126, with lower scores indicating greater dependency. The FIM gain was obtained by subtracting the admission scores from the discharge scores [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. We operationally defined the third quartile or higher for FIM gain as a better recovery for ADL. In this study, well-trained physical therapists assessed the FIM.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2. Physical activity\u003c/h2\u003e \u003cp\u003eWe investigated the amount of 3 days\u0026rsquo; physical activity at two time points: immediately after admission and immediately before discharge. Physical activity was measured using a triaxial accelerometer (Active Style Pro HJA-750C; Omron Healthcare Co. Ltd. Kyoto, Japan; 52 \u0026times; 40 \u0026times; 12 mm, weighing approximately 23 g, and including a battery), which can estimate metabolic equivalents (METs) from a wide range of body movements during ADL [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The accelerometer was worn on the waist for 24 h, excluding the dressing and bathing times. We analyzed the acceleration data between 5:00 AM and 0:00 AM each day and estimated the METs every 60 s. From the estimated METs data, we calculated time (min/day) spent in sedentary behavior (\u0026le;\u0026thinsp;1.5 METs) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and in total physical activity (\u0026ge;\u0026thinsp;1.6 METs). We defined total physical activity as an accumulation of light-intensity physical activity (1.6\u0026ndash;2.9 METs) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and moderate-to-vigorous physical activity (\u0026ge;\u0026thinsp;3.0 METs) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. We defined the changes in sedentary behavior and total physical activity time from admission to discharge as the change in each physical activity time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3. Other variables\u003c/h2\u003e \u003cp\u003eDemographic and clinical characteristics, including age, sex, body mass index (BMI), reason for admission to the acute ward, comorbidities, length of hospital stay, requirement for long-term care, cognitive function, depression, and nutritional intake were investigated. Comorbidity was assessed using the Charlson comorbidity index (CCI) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and we defined scores 3 or more as disease severity [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. We defined requiring long-term care as all care need levels (one to five) according to the standards for long-term care requirement certification in Japan [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], which ranges from 0 to 30; we defined scores of 23 or less as cognitive dysfunction [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Depression was assessed using the 15-item Geriatric Depression Scale (GDS-15) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Nutritional intake was estimated as the average calorie intake per actual body weight per day based on the intake rate of the main and side dishes recorded by the nurse during the three days (9 meals) immediately after admission [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4. Statistical analysis\u003c/h2\u003e \u003cp\u003eWe compared all variables between the better recovery of FIM gain group and the non-better recovery group using the chi-square test, t-test, or Mann\u0026ndash;Whitney U test for categorical or continuous variables. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of the relationships between changes in physical activity (sedentary behavior and total physical activity) and FIM gain. Demographic details and level of physical activity were used as covariates to adjust for confounding factors in the multivariate logistic regression models (model 1: adjusted for age, sex, CCI, and MMSE; model 2: model 1\u0026thinsp;+\u0026thinsp;changes in sedentary behavior or changes in total physical activity). All statistical analyses were performed using the IBM SPSS for Mac (version 27.0; IBM Japan, Tokyo, Japan). Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eOf the 620 patients enrolled in the study, 410 were excluded based on the aforementioned exclusion criteria, resulting in 210 eligible patients for analysis (Fig.\u0026nbsp;1). The clinical and demographic characteristics of patients in the better recovery (FIM gain) and non-better recovery groups are shown in Table\u0026nbsp;1. The mean age of the study patients was 83.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years, and 63.8% (n\u0026thinsp;=\u0026thinsp;134) of them were female. The comparison between the two groups showed significant differences in sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041), requirement for long-term care (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), MMSE (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027), and FIM scores at discharge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFIM gain, changes in sedentary behavior, and total physical activity time are shown in Table\u0026nbsp;2. The median FIM gains (interquartile range [IQR]) in the better and non-better recovery groups were 26 [\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and 9 [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The better recovery group showed a significant decrease in sedentary behavior time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a significant increase in total physical activity time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with the non-better recovery group. According to the multivariate logistic regression analysis, changes in sedentary behavior time were significantly associated with better recovery of FIM gain (OR 0.996, 95% CI: 0.992\u0026ndash;0.999; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018), and changes in total physical activity time also showed a similar association (OR 1.006, 95% CI: 1.001\u0026ndash;1.011; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023).\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis prospective cohort study investigated the relationship between changes in physical activity and functional recovery in subacute and post-acute older patients. We found that greater changes in sedentary behavior time and amount of physical activity were significantly associated with better functional recovery after adjusting for covariates. This result suggests that reducing sedentary behavior time and increasing amount of physical activity may be valuable factors for functional recovery in older patients in community-based integrated care units.\u003c/p\u003e \u003cp\u003eThe amount of physical activity for these study participants was only 1.5 h/day, which is similar to that of patients in acute care wards [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It is well known that this inactivity leads to functional decline in acute patients but is not well established in post-acute patients. In the better functional recovery group, part of the sedentary time was replaced with physical activity time during the post-acute hospitalization period. These results suggest the need to promote physical activity for functional recovery in post-acute patients.\u003c/p\u003e \u003cp\u003eThe current findings suggest that replacing sedentary time with physical activity may help prevent or improve functional decline caused by disuse. Reducing sedentary behavior in acute care units is important to prevent disuse syndrome [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and increasing the amount of physical activity leads to the recovery of lower extremity muscle strength and the cardiovascular system after the acute phase [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Thus, sedentary and physical activity durations may be more likely to promote ADL recovery. In particular, post-acute patients are more likely to have limited physical activity owing to several impairments and disease management; therefore, replacing sedentary behavior with mild physical activity may have been successful.\u003c/p\u003e \u003cp\u003eThis cohort study had two major strengths. First, we used an objective measure of physical activity levels in older post-acute patients. Because many previous studies on physical activity in post-acute older patients used a number of steps and questionnaires [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], it was difficult to apply them clinically based on several findings. Among these, we measured physical activity in detail, as it suggests that encouraging a change from sedentary to active behavior contributes to ADL recovery. Second, this study included patients with ambulatory difficulties and mild to moderate cognitive impairment, which are common in post-acute care units. Previous studies examining physical activity and functional changes have excluded cases of cognitive impairments [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The findings of this study can be widely applied to post-acute and subacute older patients.\u003c/p\u003e \u003cp\u003eThis cohort study had two limitations. First, patients had a wide range of acute illnesses. The degree of functional recovery varied with the disease type and needed to be included as an adjustment variable. Second, physical activity and FIM were measured simultaneously, and this study was cross-sectional; therefore, it was not possible to refer to a causal relationship. In other words, it is possible that the amount of physical activity may have improved as a result of functional recovery. However, several previous studies have shown that physical activity affects functional recovery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], and the present study suggests a similar causal relationship. A larger sample size that considers diseases and interventions is required to clarify these limitations.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn conclusion, decreased sedentary behavior time and increased total physical activity time were significantly associated with better functional recovery in community-based integrated care units. These results suggest that interventions for physical activity duration may be effective in post-acute and subacute older patients with negative factors for functional recovery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the nursing staff and rehabilitation therapists of our hospitals for their contributions to data collection. We are grateful to our laboratory members for their helpful advice in drafting this manuscript. We would like to thank Tomoya Ishigaki for providing the activity analysis program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: [Hiroki Saegusa], [Iwao Kojima], [Minoru Yamada]; Methodology: [Hiroki Saegusa], [Iwao Kojima], [Yusuke Terao], [Shingo Koyama], [Mizue Suzuki], [Yosuke Kimura], [Yuhei Otobe], [Minoru Yamada]; Formal analysis and investigation: [Hiroki Saegusa], [Iwao Kojima], [Yusuke Terao], [Shingo Koyama], [Mizue Suzuki], [Yosuke Kimura], [Yuhei Otobe], [Minoru Yamada]; Writing \u0026ndash; original draft preparation: [Hiroki Saegusa]; Writing \u0026ndash; review \u0026amp; editing: [Hiroki Saegusa], [Iwao Kojima], [Minoru Yamada]; Methodology: [Hiroki Saegusa], [Iwao Kojima], [Yusuke Terao], [Shingo Koyama], [Mizue Suzuki], [Shu Tanaka], [Yosuke Kimura], [Yuhei Otobe], [Takuya Aoki], [Sho Nishida], [Yasuhiro Kitagawa], [Minoru Yamada]; Resources: [Minoru Yamada]; Supervision: [Minoru Yamada].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated and analyzed during this study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Committee of Ethics of Shonan Keiiku Hospital (No. 20-012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTaken from all patients or their caregivers/relatives.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZisberg A, Shadmi E, Gur-Yaish N, Tonkikh O, Sinoff G (2015) Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. 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Supportive care cancer: official J Multinational Association Supportive Care Cancer 28(8):3701\u0026ndash;3709. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-019-05203-3\u003c/span\u003e\u003cspan address=\"10.1007/s00520-019-05203-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable width=\"979\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"965\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Comparison between the better recovery and non-better recovery groups\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"153\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"166\"\u003e\n\u003cp\u003eBetter\u003cbr /\u003e \u0026nbsp;recovery group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"153\"\u003e\n\u003cp\u003eNon-better \u003cbr /\u003e recovery group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"67\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e(n = 210)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e(n = 53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e(n = 157)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eAge, mean \u0026plusmn; SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e83.6 \u0026plusmn; 7.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e83.5 \u0026plusmn; 7.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e83.6 \u0026plusmn; 7.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.934\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eFemale, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e134 (63.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e40 (75.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e94 (59.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.041\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eBMI, kg/m\u0026sup2;, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e20.3 [17.9\u0026ndash;23.1]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e20.4 [17.9\u0026ndash;23.2]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e20.1 [17.6\u0026ndash;23.0]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.420\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eReason for admission to acute ward\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Musculoskeletal system diseases, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e80 (38.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e25 (47.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e55 (35.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.116\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Nervous system diseases, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e52 (24.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e9 (17.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e43 (27.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Nutritional and metabolic diseases, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e18 (8.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e5 (9.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e13 (8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.795\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Genitourinary system diseases, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e16 (7.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e5 (9.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e13 (8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.565\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Circulatory system diseases, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e13 (6.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e3 (5.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e10 (6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.853\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Digestive system diseases，n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e12 (5.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e2 (3.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e10 (6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.481\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Respiratory system diseases, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e10 (4.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e3 (5.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e10 (6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.722\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Others, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e9 (4.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e1 (1.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e8 (5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.319\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eCCI, score, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e2 [1\u0026ndash;3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e2 [1\u0026ndash;3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e2 [1\u0026ndash;3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.856\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eLength of stay\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Acute ward, days, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e9 [1.3\u0026ndash;22.8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e8 [1\u0026ndash;24]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e11 [3\u0026ndash;21]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.433\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Community-based integrated care units, days, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e51 [40\u0026ndash;57]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e52 [41\u0026ndash;57]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e51 [40\u0026ndash;57]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.490\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eRequiring long-term care, yes (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e98 (46.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e15 (28.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e83 (52.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eMMSE, score, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e22 [16\u0026ndash;25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e23 [19\u0026ndash;26]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e21 [16\u0026ndash;25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.027\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eGDS-15, score, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e5 [3\u0026ndash;8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e5 [3\u0026ndash;8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e5 [3\u0026ndash;8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.656\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eNutritional intake, kcal/kg/day, mean \u0026plusmn; SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e24.4 \u0026plusmn; 8.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e25.3 \u0026plusmn; 9.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e24.1 \u0026plusmn; 8.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.371\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003ePhysical activity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Sedentary behavior (\u0026le;1.5 METs), min/day, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e1016.0 [942.0\u0026ndash;1068.1]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e1016.0 [949.3\u0026ndash;1068.3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e1016.0 [938.7\u0026ndash;1067.3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.874\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e Total physical activity (\u0026ge;1.6 METs), min/day, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e82.0 [42.4\u0026ndash;143.3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e116.3 [49.0\u0026ndash;167.7]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e75.0 [38.7\u0026ndash;134.3]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.073\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003eFIM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e At admission, score, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e78 [60\u0026ndash;94]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e80 [69\u0026ndash;96]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e74 [57\u0026ndash;94]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"426\"\u003e\n\u003cp\u003e At discharge, score, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e93 [71\u0026ndash;110]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003e109 [101\u0026ndash;118]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"153\"\u003e\n\u003cp\u003e84 [63\u0026ndash;104]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" rowspan=\"3\" width=\"965\"\u003e\n\u003cp\u003eSD, standard deviation; IQR, interquartile range; BMI, body mass index; CCI, Charlson comorbidity index; MMSE, Mini-Mental State Examination; GDS-15, Geriatric Depression Scale-15; METs, metabolic equivalents; FIM, functional independence measure\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable width=\"969\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"967\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Changes in physical activity time and FIM during hospitalization\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"118\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"165\"\u003e\n\u003cp\u003eBetter\u003cbr /\u003e \u0026nbsp;recovery group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"160\"\u003e\n\u003cp\u003eNon-better \u003cbr /\u003e recovery group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"62\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e(n = 210)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e(n = 53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e(n = 157)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\n\u003cp\u003eFIM gain, score, median [IQR]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e12 [4\u0026ndash;19.8]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e26 [23\u0026ndash;32]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e9 [3\u0026ndash;14]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\n\u003cp\u003eChanges in physical activity time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"160\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\n\u003cp\u003e Sedentary behavior (\u0026le;1.5 METs), min/day, mean \u0026plusmn; SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u0026minus;54.6 \u0026plusmn; 129.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e\u0026minus;121.7 \u0026plusmn; 115.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u0026minus;32.0 \u0026plusmn; 126.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"462\"\u003e\n\u003cp\u003e Total physical activity (\u0026ge;1.6 METs), min/day, mean \u0026plusmn; SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e34.5 \u0026plusmn; 79.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e79.1 \u0026plusmn; 91.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e19.4 \u0026plusmn; 69.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" rowspan=\"4\" width=\"967\"\u003e\n\u003cp\u003eSD, standard deviation; IQR, interquartile range; FIM, functional independence measure; METs, metabolic equivalents\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"width: 962.109px;\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 603px;\" colspan=\"7\"\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Results of logistic regression analysis for FIM gain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60px;\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 50px;\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 50px;\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 228px;\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 230px;\" colspan=\"4\"\u003e\n\u003cp\u003eCrude\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 205px;\" colspan=\"3\"\u003e\n\u003cp\u003eModel 1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 192px;\" colspan=\"3\"\u003e\n\u003cp\u003eModel 2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" rowspan=\"2\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 64px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85px;\" rowspan=\"2\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 50px;\" rowspan=\"2\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" rowspan=\"2\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 50px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 228px;\" rowspan=\"2\"\u003e\n\u003cp\u003eChanges in sedentary behavior time \u003cbr /\u003e \u0026nbsp; (per 1 min/day)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.994\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.991\u0026ndash;0.997\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 64px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.994\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.991\u0026ndash;0.997\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 50px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.996\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.992\u0026ndash;0.999\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 50px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 228px;\" rowspan=\"2\"\u003e\n\u003cp\u003eChanges in total physical activity time \u003cbr /\u003e \u0026nbsp; (per 1 min/day)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e1.010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" rowspan=\"2\"\u003e\n\u003cp\u003e1.005\u0026ndash;1.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 64px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e1.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 85px;\" rowspan=\"2\"\u003e\n\u003cp\u003e1.005\u0026ndash;1.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60px;\" rowspan=\"2\"\u003e\n\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 50px;\" rowspan=\"2\"\u003e\n\u003cp\u003e1.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 92px;\" rowspan=\"2\"\u003e\n\u003cp\u003e1.001\u0026ndash;1.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 50px;\" rowspan=\"2\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 15px;\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 870px;\" colspan=\"12\" rowspan=\"4\"\u003e\n\u003cp\u003eFIM, functional independence measure; OR, odds ratio; CI, confidence interval; METs, metabolic equivalents\u003cbr /\u003e Note: Sedentary behavior, \u0026le;1.5 METs; Total physical activity, \u0026ge;1.6 METs\u003cbr /\u003e Crude: Changes in sedentary behavior time / Changes in total physical activity time\u003cbr /\u003e Model 1: Crude + Age + Sex + Charlson comorbidity index + Mini-Mental State Examination\u003cbr /\u003e Model 2: Model 1 + Changes in sedentary behavior time or changes in total physical activity time (Those not crude)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Post-acute, Subacute, Community-based integrated care units, Older patients, Physical activity, Functional recovery","lastPublishedDoi":"10.21203/rs.3.rs-4470314/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4470314/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe effect of increased physical activity duration on functional recovery in older inpatients in subacute settings is not well established. This study aimed to investigate the relationship between physical activity and functional recovery in older patients receiving post-acute and subacute care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analyzed cohort data of hospitalized older patients (age\u0026thinsp;\u0026ge;\u0026thinsp;65 years) in the community-based integrated care units. The main outcome was functional independence measure (FIM) gain. Physical activity was measured using a triaxial accelerometer. Changes in sedentary behavior and total physical activity time from admission to discharge were measured as changes in each physical activity time. Logistic regression analysis was performed to examine the relationship between changes in physical activity and FIM gain.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 210 patients were eligible for analysis. The mean age of the study patients was 83.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years, and 63.8% (n\u0026thinsp;=\u0026thinsp;134) were female. According to the multivariate regression analysis, changes in sedentary behavior time were significantly associated with better recovery of FIM gain (odds ratio [OR] 0.996, 95% confidence interval [CI]: 0.992\u0026ndash;0.999; p\u0026thinsp;=\u0026thinsp;0.018), and changes in total physical activity time also showed a similar association (OR 1.006, 95% CI: 1.001\u0026ndash;1.011; p\u0026thinsp;=\u0026thinsp;0.023).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDecreased sedentary behavior time and increased total physical activity time were significantly associated with better functional recovery in community-based integrated care units. These results suggest that interventions for physical activity duration may be effective in older post-acute and subacute patients.\u003c/p\u003e","manuscriptTitle":"The impact of changes in physical activity on functional recovery for older inpatients in community-based integrated care units","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 02:08:51","doi":"10.21203/rs.3.rs-4470314/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-05-29T09:20:59+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-29T08:49:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-25T18:14:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2024-05-24T02:09:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"96d60fd8-2c54-4258-b4cb-eb756dac5c77","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-08-28T11:21:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-13 02:08:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4470314","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4470314","identity":"rs-4470314","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}