Abstract
Background and Aim: Delirium is a common and high-impact complication among hospitalized older adults. With increasing nursing workload, there is growing interest in simple and feasible interventions that can be integrated into routine care. This review evaluated whether structured in-hospital exercise programs for non-ICU inpatients reduce delirium incidence and improve functional outcomes.
Methods: A systematic review and meta-analysis of randomized controlled trials was conducted involving non-ICU inpatients who received structured exercise or physical activity programs compared with usual care. Searches were performed in PubMed, Embase, MEDLINE, and the Cochrane Library through August 2025. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and meta-analyses were performed with RevMan 5.4. Outcomes included delirium incidence, functional performance, mood, quality of life, length of stay, and safety.
Results: Six trials enrolling older medical and surgical inpatients were included. Overall risk of bias was rated as “some concerns,” mainly due to challenges with blinding and potential contamination, although study protocols were generally robust. Exercise interventions did not reduce delirium incidence compared with usual care (RR 1.14, 95% CI 0.82–1.58; heterogeneity 0 percent). Exercise significantly improved functional outcomes (SMD 0.48, 95% CI 0.02–0.93; heterogeneity 86 percent). No consistent effects were found for length of stay, readmissions, or mortality. Interventions were feasible, well tolerated, and safe, with no increased adverse events.
Conclusions and Implications for Nursing Practice: In-hospital exercise programs for non-ICU inpatients are safe, feasible, and effective in improving mobility, strength, and mood, but current evidence does not support a meaningful reduction in delirium. For nursing practice, these findings indicate that structured mobility activities can be incorporated into daily care as a resource-efficient way to support functional recovery and patient well-being. Nurses play a key role in encouraging mobility, monitoring cognitive status, and tailoring activity levels to individual needs. Larger trials are needed to clarify the role of exercise within broader nursing-led delirium prevention strategies.
Notes
References:
Jeffs, K. J., Berlowitz, D. J., Grant, S., Lawlor, V., Graco, M., de Morton, N. A., Savige, J. A., & Lim, W. K. (2013). An enhanced exercise and cognitive programme does not appear to reduce incident delirium in hospitalised patients: A randomised controlled trial. BMJ Open, 3(6), e002569. https://doi.org/10.1136/bmjopen-2013-002569
Liechti, F. D., Heinzmann, J., Schmutz, N. A., Rossen, M. L., Rossel, J.-B., Limacher, A., Schmidt Leuenberger, J. M., Baumgartner, C., Wertli, M. M., Aujesky, D., Verra, M., & Aubert, C. E. (2024). Effect of goal-directed mobilisation versus standard care on physical functioning among medical inpatients: The GoMob-in randomised, controlled trial. BMJ Open, 14, e086921. https://doi.org/10.1136/bmjopen-2024-086921
Lv, X., Hou, A., Han, S., Cao, J., Lou, J., Li, H., Min, S., Tan, H., Li, S., Lv, F., Zhou, Z., Chi, M., Zhang, H., Liu, Y., & Mi, W. (2024). Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial. Journal of Clinical Anesthesia, 99, 111670. https://doi.org/10.1016/j.jclinane.2024.111670
Martínez-Velilla, N., Casas-Herrero, A., Zambom-Ferraresi, F., Sáez de Asteasu, M. L., Lucia, A., Galbete, A., García-Baztán, A., Alonso-Renedo, J., González-Glaría, B., Gonzalo-Lázaro, M., Apezteguía Iráizoz, I., Gutiérrez-Valencia, M., Rodríguez-Mañas, L., & Izquierdo, M. (2019). Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: A randomized clinical trial. JAMA Internal Medicine, 179(1), 28–36. https://doi.org/10.1001/jamainternmed.2018.4869
Martínez-Velilla, N., Valenzuela, P. L., Sáez de Asteasu, M. L., Zambom-Ferraresi, F., Ramírez-Vélez, R., García-Hermoso, A., Librero-López, J., Gorricho, J., Pérez, F. E., Lucia, A., & Izquierdo, M. (2021). Effects of a tailored exercise intervention in acutely hospitalized oldest old diabetic adults: An ancillary analysis. The Journal of Clinical Endocrinology & Metabolism, 106(2), e899–e906. https://doi.org/10.1210/clinem/dgaa809
Said, C. M., Delahunt, M., Hardidge, A., Smith, P., Tran, P., McDonald, L., Kefalianos, E., & Daniel, C. (2021). Recumbent cycling to improve outcomes in people with hip fracture: A feasibility randomized trial. BMC Geriatrics, 21, 394. https://doi.org/10.1186/s12877-021-02321-8
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
Meta-Analysis/Synthesis
Research Approach
Quantitative Research
Keywords:
Delirium, Delirium--Prevention and Control, Therapeutic Exercise, Delirium Therapy, Inpatients
Recommended Citation
Li, Chen-Pi; Huang, Tsai-Mei; Chien, Hsueh-Mi; and Tsai, Ru-Yin, "In-Hospital Exercise for Delirium Prevention in Non-ICU Patients: A Meta-analysis" (2026). International Nursing Research Congress (INRC). 52.
https://www.sigmarepository.org/inrc/2026/posters_2026/52
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-30
In-Hospital Exercise for Delirium Prevention in Non-ICU Patients: A Meta-analysis
Toronto, Ontario, Canada
Background and Aim: Delirium is a common and high-impact complication among hospitalized older adults. With increasing nursing workload, there is growing interest in simple and feasible interventions that can be integrated into routine care. This review evaluated whether structured in-hospital exercise programs for non-ICU inpatients reduce delirium incidence and improve functional outcomes.
Methods: A systematic review and meta-analysis of randomized controlled trials was conducted involving non-ICU inpatients who received structured exercise or physical activity programs compared with usual care. Searches were performed in PubMed, Embase, MEDLINE, and the Cochrane Library through August 2025. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and meta-analyses were performed with RevMan 5.4. Outcomes included delirium incidence, functional performance, mood, quality of life, length of stay, and safety.
Results: Six trials enrolling older medical and surgical inpatients were included. Overall risk of bias was rated as “some concerns,” mainly due to challenges with blinding and potential contamination, although study protocols were generally robust. Exercise interventions did not reduce delirium incidence compared with usual care (RR 1.14, 95% CI 0.82–1.58; heterogeneity 0 percent). Exercise significantly improved functional outcomes (SMD 0.48, 95% CI 0.02–0.93; heterogeneity 86 percent). No consistent effects were found for length of stay, readmissions, or mortality. Interventions were feasible, well tolerated, and safe, with no increased adverse events.
Conclusions and Implications for Nursing Practice: In-hospital exercise programs for non-ICU inpatients are safe, feasible, and effective in improving mobility, strength, and mood, but current evidence does not support a meaningful reduction in delirium. For nursing practice, these findings indicate that structured mobility activities can be incorporated into daily care as a resource-efficient way to support functional recovery and patient well-being. Nurses play a key role in encouraging mobility, monitoring cognitive status, and tailoring activity levels to individual needs. Larger trials are needed to clarify the role of exercise within broader nursing-led delirium prevention strategies.
Description
Structured in-hospital exercise programs for non-ICU inpatients are safe, feasible, and improve mobility and mood, although current evidence does not show a reduction in delirium. These findings support integrating individualized mobility activities into routine nursing care to promote functional recovery. Larger trials are needed to define the role of exercise in nursing-led delirium prevention.