Why physical activity during a hospital stay is important

Many people still associate a hospital stay with lying in bed and believe that rest promotes recovery. However, research shows that unnecessary inactivity actually has negative effects on health. To address this problem, a group of physiotherapists in the Netherlands founded the Beweegziekenhuizen expert group. They developed the concept of the movement hospital, a hospital where movement is a natural part of life for patients, visitors, and staff. The goal is to reduce inactivity during admission and promote recovery.

This is achieved through various interventions, such as encouraging patients to get out of bed for meals, perform daily activities (ADLs) independently whenever possible, and use walking routes to maintain strength, fitness, and independence.

The main goals of this concept are:

Preventing physical decline in patients caused by inactivity
Encouraging behavioral change in both patients and healthcare staff
Creating a multidisciplinary approach, movement care is supported by all professionals involved in patient care

Benefits for patients may include:

Maintaining muscle strength and physical fitness
Fewer complications
More autonomy and less dependence on care
Possibly a shorter hospital stay
Improved quality of life

The professional association for physiotherapists (KNGF) has also issued a position statement on this concept (read more: KNGF Position Paper - Movement Hospitals).

The Netherlands Journal of Medicine recently published a clear overview of studies examining strategies that promote movement during hospital stays (Movement interventions during hospital admissions. Ned Tijdschr Geneeskd. 2023;167:D7904).

One of the described movement interventions was the STRIDE intervention, a supervised walking program implemented in eight hospitals in the United States. The main outcome of that study was that fewer patients were discharged to nursing homes (STRIDE intervention).

However, achieving the movement goals proved challenging, and sustainable implementation was also difficult. Unfortunately, the long-term sustainability of the intervention was not studied further. Moreover, there was no control group without the walking intervention, making it difficult to draw firm conclusions about the observed effects.

The role of healthcare staff in active mobilization

Het aanmoedigen van patiënten en actief mobiliseren door zorgpersoneel bleek een belangrijke Encouragement and active mobilization by healthcare staff turned out to be a decisive factor in whether patients were active or not. This proved to be a complex process, influenced by factors such as high workload and time pressure, knowledge and assumptions about movement among patients and staff, and whether the hospital infrastructure supports physical activity.

The article also discusses the “Beter uit Bed” (“Better out of Bed”) project at RadboudUMC. This movement intervention includes informing patients about the importance of movement, activating and mobilizing them, performing ADLs, and exercising independently or with assistance in designated spaces (RadboudUMC, Beter uit Bed).
After implementation, patients were found to be more physically active and discharged home sooner compared to before the intervention. The program was also cost-effective, saving approximately €75,000 per department per year, with an annual investment of €7,000.

The Maastricht UMC+ also uses an application to measure and visualize patient activity for both patients and staff (Hospital fit). At Amsterdam UMC, organizational barriers were identified as the main factors limiting physical activity among hospitalized patients.

The general conclusion of this overview was that to promote physical activity during hospitalization, barriers to movement must be removed, and facilitators should be supported. Movement interventions are cost-effective and encourage patients to adopt an active lifestyle even after discharge.

How can you create a movement-stimulating environment in the hospital?

Talk with patients about what motivates or prevents them from being active during their stay.
If their condition allows, actively encourage them to move.
Turn every patient interaction into a movement opportunity.
Offer different options for movement. For those who find walking the corridor boring, consider introducing Bike Labyrinth to your ward. Cycling is a low-impact, accessible form of exercise for knees and hips. With more than 800 routes around the world, no one will get bored.
Do it together: involve colleagues and other healthcare workers in motivating patients to move.

The main goals of this concept are:

Benefits for patients may include:

The role of healthcare staff in active mobilization

How can you create a movement-stimulating environment in the hospital?

Further reading

Bike Labyrinth for