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Aging, mobility and physical activity

​We want to understand if and how we can enhance in-hospital mobility and prevent hospital-associated functional decline to avoid loss of ability to maintain independent living.

​Theme lead

​​​​​​Senior Researcher ​Mette Merete Pedersen, PhD, MHSc., PT​

Background

In older adults, hospitalization has been linked with loss of functional capacity, also known as hospital-associated disability, and loss of independence. The prevalence of hospital-associated disability is a high a 30% in acutely hospitalized older adults. Multiple risk factors for hospital-associated disability have been identified and include low mobility, inadequate nutritional status, polypharmacy, and cognitive impairment. Internationally, studies have shown low in-hospital mobility to be highly common in older hospitalized adults. Also, on admission 40 % or more present with risk of malnutrition, polypharmacy and/or cognitive impairment. ​

​Focus 

We want to understand if and how we can enhance in-hospital mobility and prevent hospital-associated functional decline to avoid loss of ability to maintain independent living. This also encompasses a focus on e.g. adequate nutrition and medication. We develop and investigate interventions to optimize treatment both during and after hospitalization and consider structural and organizational factors that contribute with or hinder e.g. in-hospital mobility and adequate nutrition to be able to identify potential for change.       

​Examples of ongoing work

Online patient education material: Out of be​d during hospitalization ​​​


Using daily clinical interaction to promote physical activity: "making every contact count" in Danish health care (The TALK-ACTIV projekt)


Program leaders: Mette Merete Pedersen, Thomas Quaade Bandholm, Jeanette Wassar Kirk

Program group: Mette Merete Pedersen, Thomas Quaade Bandholm, Jeanette Wassar Kirk, Ove Andersen, Trine Schifter Larsen, Maria Swennergren Hansen, Cynthia J Brown, Jo Hart, Stig Mølsted, Morten Tange Kristensen, Søren T Skou

Problem: Physical inactivity during hospitalization is highly prevalent across diagnoses, and hospital-associated disability is a common problem. WHO has launched an action plan to reduce physical inactivity by 15% by 2030. In alignment with this plan, prevention of physical inactivity during hospitalization is important because of its known association with hospital-associated disability. We believe that the hospital is an obvious setting to help solve the societal problem of inactivity.  
Solution: We envision a hospital that plays an active role in reducing physical inactivity; a hospital that is not only a place where you receive treatment for the condition that you are acutely admitted for. According to WHO’s Global Action Plan, patient guidance on physical activity is a cost-effective approach. It therefore makes perfect sense to promote physical activity in daily care through already available resources. Therefore, we wish to investigate how we can use the hospital setting to promote and increase physical activity. 

The TALK-Activ (Let’s TALK about ACTIVity) program consists of 4 planned phases that all inform each other and will qualify a possible large-scale randomized effectiveness trial (Phase 5). We will 1) perform a thorough investigation to understand the current practice regarding physical activity (Understanding the context), 2) adapt a British approach on communication about activity to the Danish context by the help of a range of stakeholders, and develop a program theory, 3) investigate stakeholder acceptability of the adapted approach and investigate feasibility, 4) develop and test an implementation plan, 5) evaluate effectiveness of the adapted approach in a randomized effectiveness trial.

Understanding and optimizing clinical practice regarding basic mobility and physical activity in patients following a hip fracture. The HIP-ME-UP research program

Program leader: Maria Swennergren Hansen, PT, PhD, Postdoc
Program group: Maria Swennergren Hansen, Mette Mer​ete Pedersen​, Jeanette Wassar Kirk​, Kira Mari​e Milandt Skibdal​, Sofie Tscherning Lindholm​, Sabina Mette Staal, Thomas Band​holm

Problem: Despite strong evidence, many patients admitted with hip fracture fail to regain pre-fracture basic mobility during hospitalization. This loss of independence is associated with infections, readmissions, and higher mortality risk. Initial studies at our hospital suggested that clinical practice in mobilization and physical activity is not optimal.

Progress so far: Since 2022, Phase 1 of HIP-ME-UP has systematically explored and explained clinical practice. Using sensor-based monitoring, ethnographic fieldwork, and interviews, we documented that patients were inactive more than 98% of the time on day 4 after surgery (PubMed link: https://pubmed.ncbi.nlm.nih.gov/39835691/) and that getting in and out of bed posed challenges (PubMed link: https://pubmed.ncbi.nlm.nih.gov/40257221/). We also identified cultural, organizational, and professional barriers that shape mobility practices, as well as the perspectives of patients, relatives, and staff. Together, these findings demonstrate a significant evidence–practice gap.

Next steps: Building directly on this knowledge, we are now initiating Phase 2, where we will co-design an optimized treatment pathway in collaboration with patients, relatives, healthcare professionals, and managers. The revised protocol will integrate practical solutions for mobilization and basic mobility, making them realistic to implement in acute hospital settings. Phase 3 will then test feasibility and fidelity in preparation for a large-scale effectiveness trial.

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​Optimisation of Nutrition and Medication for Acutely Admitted Older Medical Patients (OptiNAM) (ClinicalTrials.gov; identifier: NCT03741283).​​

Recent outputs

  1. Hansen MS, Kristensen MT, Zilmer CK, Berger AL, Kirk JW, Marie Skibdal K, Kallemose T, Bandholm T, Pedersen MM. Very low levels of physical activity among patients hospitalized following hip fracture surgery: a prospective cohort study. Disability and Rehabilitation, 47(17), 4486–4495. doi.org/10.1080/09638288.2025.2451769

  2. Pedersen MM, Juul-Larsen HG, Brødsgaard RH, Jawad B, Bean JF, Petersen J, Bandholm T. Increased knee-extension strength and steps per day after a novel post-hospitalization rehabilitative program in older adults (65+): Secondary analyses of a randomized controlled single-blinded trial using an expanded sample size. Experimental Gerontology 196 (2024) 112582​

  3. Piper K, Oxfeldt M, Pedersen MM, Christensen J. Hospital-Induced Immobility – A Backstage Story of Lack of Chairs, Time, and Assistance. BMC Geriatrics 2024;24(1).

  4. Jezek AH, Pedersen SGH, Thorsted A, Pedersen MM, Thygesen LC. Validation of the de Morton Mobility Index (DEMMI) among subacute stroke patients aged ≥65 years: a register study. Disbility and Rehabilitation 2024;03:1-8​

  5. Andersen AL, Houlind MB, Nielsen RL, Jørgensen LM, Bengaard AK, Bornæs O, Juul-Larsen HG, Hansen NM, Brøchner LD, Hansen RG, Skovlund CAR, Pedersen AML, Beck AM, Pedersen MM, Petersen J, Andersen O. Effectiveness of a multidisciplinary and transitional nutritional intervention compared with standard care on health-related quality of life among acutely admitted medical patients aged ≥65 with malnutrition or risk of malnutrition: A randomized controlled trial. Clinical Nutrition ESPEN 2024;61:52-62.

  6. Netværk for det fysisk aktive hospital (NEFAH)​​

  7. Thorsted AB, Thygesen LC, Jezek AH, Pedersen MM, Jorgensen MG, Vinding K, Kannegaard P, Pedersen SGH. The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study. Archives of Gerontology and Geriatrics 2024. In press.

  8. Nielsen RL, Bornaes O, Storgaard IK, Kallemose T, Jørgensen LM, Jawad B, Altintas I, Juul-Larsen HG, Tavenier J, Durhuus JA, Bengaard AKP, Holst JJ, Kolko M, Sonne DP, Breindahl T, Damgaard M, Porrini E, Hornum M, Andersen O, Pedersen MM, Rasmussen HH, Munk T, Lund TM, Jensen PS, Andersen AL, Houlind MB. Appetite stimulation with cannabis-based medicine and methods for assessment of glomerular filtration in older patients with medical illness: a study protocol. Basic Clin Pharmacol Toxicol 2023;1-17​

  9. Pedersen BS, Kodal LS, Kaalund AB, Holm-Yildiz, Pedersen MM, Dysgaard T. Effect of strength training on functional outcomes and strength in patients with polyneuropathy: A scoping review. Frontiers in Physiology 2023;14:1158039​

  10. Zisberg A, Shadmi E, Andersen O, Shulyaev K, Petersen J, Agmon M, Gil E, Gur-Yaish N, Pedersen MM. Shared and distinct factors underlying in-hospital mobility of older adults in Israel and Denmark. Accepted for publication in BMC Geriatrics, Nov 2022

  11. Quach L, Pedersen MM, Ogawa E, Ward R. Gagnon DR, Spiro A, Burr J, Driver JA, Dhand A, Bean JF. Mild Neurocognitive Disorder, Social Engagement, and Falls Among Older Primary Care Patients. Accepted for publication in Arch Phys Med Rehabil, Oct 2022.

  12. Bornæs O, Andersen AL, Houlind MB, Kallemose T, Tavenier J, Aharaz A, Nielsen RL, Jørgensen LM, Beck AM, Andersen O, Petersen J, Pedersen MM. Mild cognitive impairment is associated with poorer nutritional status on hospital admission and after discharge in acutely hospitalized older patients. Accepted for publication in Geriatrics 2022,7,95. https:// doi.org/10.3390/geriatrics7050095

  13. Pedersen BS, Kristensen MT, Josefsen CO, Lykkegaard KL, Jønsson LR, Pedersen MM. Validation of two activity monitors in three different patient groups. Rehabilitation Research and Practice Volume 2022, Article ID 9230081, 14 pages https://doi.org/10.1155/2022/9230081

  14. Jawad BN, Petersen J, Andersen O, Pedersen MM. Variations in Physical Activity and Sedentary Behavior During and After Hospitalization in Acutely Admitted Older Medical Patients: A Longitudinal Study. Accepted BMC Geriatrics, March 2022. DOI: 10.21203/rs.3.rs-864575/v1

  15. Pedersen BS, Kirk JW, Olesen MK, Grønfeldt BM, Stefánsdóttir NT, Brødsgaard R, Tjørnhøj-Thomsen T, Nilsen P, Andersen O, Bandholm TQ, Pedersen MM. Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients - The WALK-Copenhagen project (WALK-Cph). Accepted Pilot and Feasibility Studies, March 2022

  16. Kirk JW, Nilsen P, Andersen O, Byron P, Bandholm T, Tjørnhøj-Thomsen T, Pedersen MM. Co-designing implementation strategies for the WALK-Copenhagen intervention in Denmark aimed at increasing mobility in acutely admitted older patients: a qualitative analysis of selected strategies and their justifications. BMC Health Services Research 2022;22(8) https://doi.org/10.1186/s12913-021-07395-z

  1. Kirk JW, Nilsen P, Andersen O, Stefánsdóttir NT, Grønfeldt B, Brødsgaard R, Pedersen BS, Bandholm T, Tjørnhøj-Thomsen T, Pedersen MM. Adaptations and modifications of a co-designed intervention and its clinical implementation: a qualitative study in Denmark. BMC Health Services Research 2021;21:1108. https://doi.org/10.1186/s12913-021-07142-4

  2. Andersen AL, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Tredal C, Beck AM, Pedersen MM, Andersen O, Petersen J. Risk for malnutrition upon admission and after discharge in acutely admitted older medical patients: A prospective observational study. Nutrients 2021, 13(8), 2757; https://doi.org/10.3390/nu13082757

  3. Andersen A, Baltzer Houlind M, Lundsgaard Nielsen R, Mørch Jørgensen L, Treldal C, Damgaard M, Bengaard AK, Gybel Juul-Larsen H, Bolvig Laursen L, Iversen E, Kruse M, Lynge Pedersen AM, Hornum M, Beck AM, Pedersen MM, Zoellner Ankarfeldt M, Petersen J, Andersen O. Optimization of Nutrition And Medication (OptiNAM) for acutely admitted older patients: protocol for a randomized controlled trial. Trials 2021;22:616. https://doi.org/10.1186/s13063-021-05456-6

  4. Hansen T, Nielsen RL, Houlin MB, Tavenier J, Hartmann Rasmussen LJ, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J, Andersen AL. Dysphagia prevalence, time course and association with sarcopenia and sarcopenia-related conditions in older patients admitted to an emergency department: a secondary analysis of cohort study data. Geriatrics 2021 Apr 26;6(2) doi: 10.3390/geriatrics6020046.

  5. Kirk JW, Bandholm T, Andersen O, Husted R, Tjørnhøj-Thomsen T, Nilsen P, Pedersen MM. Challenges in co-designing an intervention to increase mobility in older patients: a qualitative study- Accepted for publication in Journal of Health Organization and Management. January 2021

  6. Stefánsdóttir NT, Pedersen MM, Tjørnhøj-Thomsen T, Kirk JW. Older medical patients' experiences with mobility during hospitalization and the WALK-Copenhagen (WALK-Cph) intervention: a qualitative study in Denmark. Geriatric Nursing 42 (2021) 46-56

  7. Pedersen MM, Brødsgaard R, Nielsen P, Wassar Kirk J. Is promotion of mobility in older patients hospitalized for medical illness a physician's job? – An interview study with physicians in Denmark. Geriatrics, 2020: 5(4);74​

  8. Hansen MS, Wassar Kirk J, Kristensen MT, Kampp Zilmer C, Marie Skibdal K, Bandholm T, Pedersen MM; HIP-ME-UP Collaborative Group. Strategies used by patients when getting in and out of bed early after hip fracture surgery - The HIP-ME-UP cohort. Hosp Pract. 2025 Feb;53(1):2491305. doi: 10.​1080/2154833​1.2025.​2491305​​​. ​

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Responsible editor
Anne-Sofie Grølsted
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