Exercise training during hospitalization in community-acquired pneumonia: effects on functional ability, body composition, and physical activity level

Abstract

Abstract Background Physical inactivity contributes to functional decline and is associated with increased risk of adverse outcomes in patients hospitalized with community-acquired pneumonia (CAP). Exercise programs applied during acute hospitalization may mitigate these effects, particularly in older adults. This study aimed to evaluate the effect of standard care versus supervised in-bed cycling or booklet-exercise, including resistance and endurance exercises, on functional ability, body composition, and physical activity level in patients hospitalized with CAP. Methods In this randomized controlled trial, 178 patients hospitalized with CAP were allocated to standard care ( n = 59), in-bed cycling ( n = 58), or booklet-exercise ( n = 61). Functional ability was assessed using grip strength, the 30-second sit-to-stand, and the Barthel index. Body composition was measured with bioelectrical impedance analysis, and physical activity was monitored using accelerometers. Outcomes were evaluated from admission to 3-month post-discharge using linear mixed-effect models. Results Baseline measures were comparable across groups. At 3 months post-discharge, participants performing in-bed cycling showed a significant improvement in the Barthel index compared to standard care (mean difference: 4.15 points, 95% ΔCI: 0.26–8.04, P = 0.037), while no difference was observed for participants in the booklet-exercise group. There was no effect of the exercise interventions on changes in grip strength, 30-sec sit-to-stand performance, fat mass index, fat-free mass index, or daily step count. Conclusion Supervised exercise training during hospitalization improved functional ability in patients with CAP 3 months post-discharge. However, the short duration of hospitalization may limit the overall impact of in-hospital exercise interventions, highlighting the need for continued post-discharge exercise strategies to support functional recovery and independence in patients with CAP.