Physiological improvements and health benefits during an exercise-based comprehensive rehabilitation program in medically complex patients

OBJECTIVES: To determine the effects of an exercise-based comprehensive rehabilitation program on the physiological, health, and cost benefit in medically complex patients. DESIGN: Case series SETTING: Comprehensive rehabilitation centers. PARTICIPANTS: Elderly chronically ill men (n = 39, age = 75.3 +/- 1.4) and women (n = 74, age = 76.5 +/- 0.9 years). INTERVENTION: Patients participated in individualized physical therapy with therapeutic exercises (stretching, strengthening, endurance, balance, sitting and standing dynamic exercises) three times/week for three months under the supervision of a physician. MEASUREMENTS: Upper (back) and lower (leg flexors) extremity strength, aerobic power as measured by metabolic equivalents (METS) at 80% of age predicted maximal heart rate (APMHR), physical functioning and mental health as assessed by the Short Form-36 (SF-36) questionnaire, and medical events (falls, physician visits, and hospitalizations) questionnaire was collected at baseline and after three months of the program. RESULTS: Strength measures improved by approximately 30% (P < 0.05) as well as aerobic power improved by approximately 25% (P < 0.05) over the three-month period. There were significant improvements in two of the SF-36 Physical Component Scales: Physical Functioning (P < 0.05) and Role Physical (P < 0.05); plus, there were significant improvements in all four of the Mental Component Scales: Vitality (P < 0.05), Social Functioning (P < 0.05), Role Emotional (P < 0.05), and Mental Health (P < 0.05). There were significant reductions in fall rate (P < 0.05), physician visits (P < 0.05), and hospitalizations (P < 0.05). CONCLUSION: Patients improve physical capacity, which result in improvements in health status with concurrent reductions in healthcare utilization during a comprehensive rehabilitation program.