Physical rehabilitation

​Background

The aging process is associated with physiological changes including decreased muscle mass, increased fat mass and altered muscle-nerve function resulting in decreased functional capacity.

Acute illness in combination with inactivity and bed rest during hospitalization accelerates the age-related loss of functional capacity. Thus, older hospitalised patients risk losing functional independency as a consequence of their hospitalization. Because physical activity and exercise generally increase functional capacity, physical activity and exercise interventions may help reduce the loss of functional capacity and independency in these patients.

Main focus

We focus on physical activity and exercise interventions to reduce inactivity-induced loss of functional capacity and to optimize transitions of care for older hospitalised patients. In all phases of our research, our approach is to include key stakeholders (eg. patients, clinicians, policy makers) to conduct relevant research and to facilitate successful implementation in clinical practice.   

On-going studies

The STAND-Cph trial. Supervised progressive cross-continuum strength training compared with usual care in older medical patients. After baseline assessments, patients are randomized to either supervised progressive strength training during hospitalization and after discharge (home-based) or usual care. Follow-up assessments shortly after discharge and 4 weeks after discharge (primary end point) in the patients' own homes. The intervention consists of strength training of the lower extremities daily during hospitalization and three times per week for 4 weeks after discharge. 80 patients will be enrolled. Project leaders: Mette Merete Pedersen and Lillian Mørch Jørgensen.

The WALK-Cph trial (Stå og gå i Region H): Cross-continuum physical activity in older medical patients: a pragmatic, mixed-methods and implementation study to increase 24-hour mobility in older medical patients during acute hospitalization and following discharge. WALK-Cph is a tailored intervention which has been developed and co-designed in collaboration with key stakeholders (patients, relatives, health professionals and researchers) to enable successful implementation (Phase 1). In the upcoming phases of the study, we will fidelity-test the intervention (Phase 2), impact-test the intervention in an RCT-study (Phase 3) and measure adoption of the intervention (Phase 4). Project leaders: Jeanette Wassar Kirk and Mette Merete Pedersen.

PREHAB-TKA. The QUADX-1 Trial: An exercise dose-response trial in patients eligible for total knee arthroplasty due to end-stage knee osteoarthritis. Three knee-extensor exercise dosages are investigated. Following baseline assessment, patients are randomized either 2, 4 or 6 exercise sessions a week for 12 weeks. Follow-up assessment is after 12 weeks of exercise (primary end-point), shortly following surgery (total knee arthroplasty) and three months following surgery. The primary outcome is change in knee-extensor strength. 140 patients will be enrolled. The trial includes a systematic review and meta-analysis investigating the relationship between pre-operative knee-extensor exercise dose and change in knee-extensor strength prior to and following total knee arthroplasty. In a qualitative study we will investigate perspectives on barriers and facilitators among orthopedic surgeons, physiotherapists and patient on home-based knee exercise. Project leader: Rasmus Skov Husted.

Publications

Effect of Pain and Mild Cognitive Impairment on Mobility. Schepker CALeveille SGPedersen MMWard REKurlinski LAGrande LKiely DKBean JF. J Am Geriatr Soc. 2016 Jan;64(1):138-43. doi: 10.1111/jgs.13869.

Efficacy of pre-operative quadriceps strength training on knee-extensor strength before and shortly following total knee arthroplasty: Protocol for a randomized, dose-response trial (The QUADX-1 trial). Husted, R.S., Troelsen, A., Thorborg, K., Rathleff, M., Husted, H., Bandholm, T. 2018. I: Trials;19(1).

A tailored strategy for designing the WALK-Copenhagen (WALK-Cph) intervention to increase mobility in hospitalized older medical patients: A protocol for the qualitative part of the WALK-Cph project. Kirk J., Bodilsen A.C., Tjørnhøj-Thomsen T., Pedersen M.M., Bandholm T., Husted R., Poulsen L., Petersen J., Andersen O., Nilsen P.. BMJ Open 2018;8:e020272.doi: :10.1136/bmjopen-2017-020272.

Prediction of Mobility Limitations after Hospitalization in Older Medical Patients by Simple Measures of Physical Performance Obtained at Admission to the Emergency Department.  Bodilsen AC,  Klausen HH , Petersen J, Beyer N , Andersen O , Jørgensen LM , Juul-Larsen HG , Bandholm T. PLoS One 2016 May 19;11(5):e0154350. doi: 10.1371/journal.pone.0154350. eCollection 2016.

Supervised progressive cross-continuum strength training compared with usual care in older medical patients: study protocol for a randomized controlled trial (the STAND-Cph trial). Pedersen, M. M., Petersen, J., Beyer, N., Damkjær, L. & Bandholm, T. april 2016 I : Trials. 17, 176  

Feasibility of progressive sit-to-stand training among older hospitalized patients. Pedersen, M. M., Petersen, J., Bean, J. F., Damkjaer, L., Juul-Larsen, H. G., Andersen, O., Beyer, N. & Bandholm, T. dec 2015 I : PeerJ. 3, s. 2-21 

Leptin, IL-6, and suPAR reflect distinct inflammatory changes associated with adiposity, lipodystrophy and low muscle mass in HIV-infected patients and controls. Langkilde, A., Petersen, J., Henriksen, J. H., Jensen, F. K., Gerstoft, J., Eugen-Olsen, J. & Andersen, O. sep 2015 I : Immunity & Ageing. 12, s. 9  

The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients - A randomized controlled trial. Buhl , S. F., Andersen, A. L., Andersen, J. R., Andersen, O., Jensen, J-E. B., Rasmussen, A. M. L., Pedersen, M. M., Damkjær, L., Gilkes, H. & Petersen, J. feb 2016 I : Clinical nutrition (Edinburgh, Scotland). 35, 1, s. 59-66  

Reply, Letter to Editor - Combined intervention of protein supplementation and resistance training in medical patients. Buhl , S. F., Andersen, A. L., Andersen, J. R., Andersen, O., Jensen, J-E. B., Rasmussen, A. M. L., Pedersen, M. M., Damkjær, L., Gilkes, H. & Petersen, J. 4 jun 2015 I : Clinical nutrition (Edinburgh, Scotland) 

Feasibility and inter-rater reliability of physical performance measures in acutely admitted older medical patients. Bodilsen, A. C., Juul-Larsen, H. G., Petersen, J., Beyer, N., Andersen, O. & Bandholm, T. 23 feb 2015 I : P L o S One. 10, 2, s. 1-15 

Mild Cognitive Impairment Status and Mobility Performance: An Analysis From the Boston RISE Study. Pedersen, M. M., Holt, N. E., Grande, L., Kurlinski, L. A., Beauchamp, M. K., Kiely, D. K., Petersen, J., Leveille, S. & Bean, J. F. 5 maj 2014 I : The journals of gerontology. Series A, Biological sciences and medical sciences. 69, 12, s. 1511-1518  

Psychometric properties of the Late-Life Function and Disability Instrument: a systematic review. Beauchamp, M. K., Schmidt, C. T., Pedersen, M. M., Bean, J. F. & Jette, A. M. 2014 I : B M C Geriatrics. 14, s. 12

Life-long endurance exercise in humans: Circulating levels of inflammatory markers and leg muscle size. Mikkelsen, U. R., Couppé, C., Karlsen, A., Grosset, J. F., Schjerling, P., Mackey, A. L., Klausen, H. H., Magnusson, S. P. & Kjær, M. 2013 I : Mechanisms of Ageing and Development. 134, 11-12, s. 531-40 

Acute Hospitalization of the Older Patient: Changes in Muscle Strength and Functional Performance During Hospitalization and 30 Days After Discharge. Bodilsen, C., Pedersen, M. M., Petersen, J., Beyer, N., Andersen, O., Lawson-Smith, L., Kehlet, H. & Bandholm, T. 2013 I : American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 92, 9, s. 789–796  

Twenty-Four-Hour Mobility During Acute Hospitalization in Older Medical Patients. Pedersen, M. M., Bodilsen, C., Petersen, J., Beyer, N., Andersen, O., Lawson-Smith, L., Kehlet, H. & Bandholm, T. 2013 I : Journals of Gerontology. Series A: Biological Sciences & Medical Sciences. 68, 3, s. 331-337  

Inflammation in HIV-Infected Patients: Impact of HIV, Lifestyle, Body Composition, and Demography - A Cross Sectional Cohort Study. Langkilde, A., Petersen, J., Klausen, H. H., Henriksen, J. H., Eugen-Olsen, J. & Andersen, O. 2012 I : P L o S One. 7, 12, s. e51698
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