Hospitalized older adults’ attitude toward physical activity during hospitalisation

physical activity geriatrics

B.C. van Munster
T. Hortobagyi
L. Brouwer

Nature of the research:
Qualitative / semi-structured interviews

Fields of study:
movement sciences rehabilitation geriatrics

Background / introduction
In older patients, acute medical illness that requires hospitalization is a ‘turning point’ that often precipitates new disabilities. Hospitalization and its sequelae therefore often lead to an inability to live independently and execute basic activities of daily living (ADLs). Such a so-called hospitalization-associated deconditioning (HAD) may be triggered even when the illness that necessitated the acute hospital admission is successfully treated. Up to 60% of hospitalized Dutch old adults experience HAD in the form of mobility difficulty (Buurman et al., 2012). In a review of Covinsky et al. (2011) it is stated that amongst others, age, poor mobility and cognitive function pre-illness are determinants of the physical reserve of patients and therefore the chance on HAD. Bed rest has a multitude of unfavorable effects on physical and cognitive function and on returning to live independently at home. However, sedentariness in the form of bed rest is a sickness behavior. Promoting physical activity (PA) within the hospital is one of the major recommendations of Covinsky et al. (2011) to reduce the incidence of HAD.

The Health Belief Model tries to explain why people do or do not engage in health protective behaviour. Preventive health action, like PA, is determined by the belief in a personal health threat (i.e. bedrest) and the belief in the effectiveness of a health protective behaviour (i.e. PA). The way participants see bedrest as a personal health threat is dependent on the perceived susceptibility to develop hospital associated decline and the perceived severity/impact of this decline (individual perceptions). Fundamentally, the participant needs to be aware of the threat, otherwise cues to action will not have any effect and interventions need to focus on rising awareness of the problem. Belief in the effectiveness of a health behaviour is based on perceived benefits the participant experiences from PA and the perceived barriers they experience if they need to be physically active within the hospital setting (health behaviour).

In order to design and conduct an intervention study aimed at preventing the unfavorable consequences of bedrest in form of HAD, it is import to combine quantitative and qualitative research methods in order to achieve a clinically meaningful and theory-based intervention (Ludvigsen et al., 2013). Therefore, a pilot study is set-up that focusses on the development and feasibility of an intervention that is both feasible and effective for recently hospitalized older medical patients (Craig et al. 2008a; Craig et al. 2008b).
Research question / problem definition
What are the attitudes and beliefs of hospitalized older adults (≥70 years) towards physical activity while in the hospital and after discharge.
1. Conducting semi structured interviews with older adults (age over 70) together with staff about patients attitude towards physical activity and bedrest.
2. Transcription of interviews into text
3. Qualitative analyses the interview text by software called Atlas Ti and summarizing across interviews the qualitative data
4. Other duties needing attention in conjunction with the entire project.
Buurman BM, Hoogerduijn JG, van Gemert EA, de Haan RJ, Schuurmans MJ, de Rooij SE (2012). Clinical characteristics and outcomes of hospitalized older patients with distinct risk profiles for functional decline: a prospective cohort study. PLoS One. 7(1), e29621

Covinsky KE, Pierluissi E, Johnston CB (2011). Hospitalization-Associated Disability: “She Was Probably Able to Ambulate, but I’m Not Sure”. JAMA, 306(16), 1782–1793. doi:10.1001/jama.2011.1556

Craig, P.; Dieppe, P.; Macintyre, S.; Michie, S.; Nazareth, I.; Petticrew, M. (2008a). Developing and evaluating complex interventions: new guidance. Internet Resource: www. [24.09.2018].
Craig, P.; Dieppe, P.; Macintyre, S.; Michie, S.; Nazareth, I.; Petticrew, M.; Medical Research Council Guidance (2008b). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ, 337, a1655.

Janz, N. & Becker, M.H. (1984). The health belief model: a decade later. Health Education Quarterly, 11, 1-47

Ludvigsen MS, Meyer G, Hall E, Fegran L, Aagaard H, Uhrenfeldt L (2013). Development of clinically meaningful complex interventions - the contribution of qualitative research. Pflege, 26, 207–14.
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