Your systematic review tackled a topic that has been addressed before: the Journal recently published a randomised trial demonstrating an intervention that is effective to improve physical activity levels in older inpatients. But the problem of loss of functional mobility during hospitalisations is not completely solved, is it?

The problem of loss of functional mobility during hospitalisation has not been fully solved yet.

Many recent studies show very low activity levels of patients during hospital stay, despite their possibility to be physically active.

This problem is not limited to elderly people: hospitalised patients of all ages seem to be physically inactive during their hospital stay.

Our study is new in the sense that we summarise and interpret findings from earlier qualitative studies.

With the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research), we rate our confidence in findings.

Our study addresses many issues that can be tackled with multifaceted interventions to improve the physical activity of patients of all ages during their hospital stay.

We emphasise that simple interventions, such as providing an exercise program, might not be the way to tackle the physical inactivity epidemic.

Your systematic review synthesised the results of multiple qualitative studies of this issue and was able to generate some new insights into the problem.

One of those insights was that hospital inpatients report that they would be more receptive to personalised exercise prescription than generic educational materials, partly because of concerns about safety.

Can you explain a bit more about that?

The statement posed is correct. Personalised exercises or advice about physical activity were requested by patients in several studies.

The personalised part considers purposeful activities, and timing and tailoring of exercises.

Many exercises in physiotherapy focus on ‘lifting your leg’ or ‘extending your knee’.

Patients want to be motivated by purposeful activities such as getting a coffee, showering, or walking an inspiring or safe route.

The timing and tailoring should suit the patients instead of the healthcare professionals.

The patients in the qualitative studies stated that the timing of physiotherapy mainly suited the working program of physiotherapists. For example, patients found it uncomfortable to start with physiotherapy when they hadn’t had breakfast.

In addition, patients said they would like some tailoring of advice or exercises, rather than, for example, an information folder with standardised three series times 10 exercises.

Does what inpatients perceive about the benefits of physical activity influence their activity while in hospital?

We did not research this part quantitatively, but this is highly likely. In the behavioural model, intention to be physically active is key to actual physically active behaviour.

Thoughts about benefits and risks are important for a positive attitude/ intention towards being physically active.

Do you think patients may wait for encouragement to be physically active by hospital staff? How do hospital staff perceive that?

We found evidence that patients wait for encouragement to be physically active.

We think that this is hard to recognise, as every person might express this waiting behaviour differently.

Healthcare professionals should consider standard motivational interviewing about this subject, for example at the start of a working day, to get an impression about someone’s motivation.

In addition, personalised physical activity plans might help patients who are able to be physically active.

Do you think family members could be involved more?

We think that family members could be involved more, not in a sense of professional assistance but as additional support, or at least not as a barrier.

Family members or close relatives are crucial in supporting physical activity during hospital stay and especially at home.

We think family members should be involved, especially to guarantee this long-term physically active behaviour after discharge home. 

Niek Koenders is employed at the Radboudumc in Nijmegen, the Netherlands. He studied physiotherapy (professional bachelor’s degree) and clinical health sciences (Master of Science). Niek started as a hospital-based physical therapist on the cardiothoracic surgery and cardiology wards to help patients with heart and lung diseases, which is still his focus. In 2021, he will defend his PhD thesis titled Ban Bedcentricity.