In-hospital exercise interventions improve inpatients' frailty and demonstrate promising implementation outcomes: A systematic review and meta-analysis

BACKGROUND: Frail, hospitalized patients are at a greater risk of further health issues. Frailty levels can worsen during hospitalization, with exercise being one of the best strategies to manage frailty. However, there is a lack of synthesized evidence to indicate whether exercise interventions are effective at managing frailty in this unique setting. OBJECTIVE: This systematic review and meta-analysis determined if exercise interventions either preserve or improve frailty levels among inpatients. METHODS: Sources were searched in May 2024 (updated August 2025) and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. Studies were included if they conducted an exercise intervention in middle-to-older adult (≥45-years) inpatients and assessed frailty as an outcome using any validated frailty assessment tool. The between-group effect size of change in frailty (Intervention vs. Control) was calculated as the standardized mean difference (SMD) using a random effects model. RESULTS: Five studies including n = 810 intervention (age: 82.9 [range: 79-87.6] years; 45 ± 1 % reported females) and 900 control (age: 82.0 [range: 76.0-87.1] years; 44 ± 1 % reported females) participants were included. Improvements in patients' frailty were observed in n = 3/5 studies. The meta-analysis exhibited a favorable effect on frailty between the intervention and control groups (SMD: 0.716, 95 %CI: 0.119-1.312) with significant heterogeneity between studies (I²=92 %, p < 0.001). No differences were observed between interventions using distinct exercise types or frailty assessment tools (both, p > 0.196). CONCLUSION: Despite limited available evidence, results indicate exercise training interventions may be effective in improving frailty. This supports the inclusion of exercise interventions beyond usual hospital care to improve frailty.