How can physical activity reduce the readmission rate in acute hospitals?

Lack of physical activity among hospitalised patients is a profound problem (Loyd et al., 2020). Lack of physical activity during hospitalisation has been found to correlate with reduced functional capacity, prolonged stays and higher readmission rates in the elderly population (Brown et al., 2004).

In addition, the authors found that on average 88.4% of patients remained inactive throughout the day, either lying down or sitting (Brown et al., 2004). The Federal Statistical Office conducted a study in Swiss hospitals in 2021. They found that 37.6% of all hospitalised patients were hospitalised at least twice within two years. Among patients with a high number of hospitalisation days (at least 21 days), half (50.8%) were hospitalised at least four times, with an average length of stay of 5.3 days (Federal Statistical Office, 2021). If a readmission occurs within 30 days of discharge, hospitals do not receive any additional remuneration for these patients, as it is considered the same case. This increases the pressure to optimise the quality of care in order to avoid readmissions and at the same time ensure financial stability (Leppin et al., 2014). Due to demographic trends, the number of hospital admissions of elderly and chronically ill patients is expected to continue to rise in the future, both in Switzerland as a whole and at the University Hospital Basel (USB) (Federal Statistical Office, 2021). This increases the potential for long-term patients and multiple admissions and highlights the increased need for efficient and effective treatment methods for the corresponding population. The operating costs of Swiss hospitals exceeded CHF 33 billion in 2022, which corresponds to daily costs per patient of around CHF 2,500 in acute hospitals (Federal Statistical Office, 2021). The clinical relevance of physical activity for acute inpatients on the length of stay has already been proven several times. For example, it has been shown that physical activity can improve quality of life, HAD (hospital associated disability) and functional performance (Rezaei-Shahsavarloo et al., 2020; Scheerman et al., 2021)
(See: B.2 Knowledge contribution no. 1: How can hospital associated disabilities be reduced?)

McCullagh and colleagues found that a 50% increase in the total number of steps taken by hospitalised patients can result in a 6% reduction in length of stay (McCullagh et al., 2016). As a result, several million CHF can be saved annually in the healthcare system. An increase in physical activity, with the associated health benefits, not only leads to a reduction in the length of stay, but also reduces the financial burden on the healthcare system, see Figure 1 (Taheri et al., 2000; van Grootel et al., 2023).