Physical activity in the hospital: changing mentalities is necessary

The majority of people admitted to hospitals are elderly. We know that there is a significant risk for this category of the population concerning the loss of functional capacities when hospitalization extends into the duration. This is not without consequences: a higher risk of readmission (in particular because of more frequent falls), placement in a hospital for dependent elderly people (Ehpad) up to death.

In fact, it goes without saying that the level of activity physical in hospital structures is very low and that it represents a risk factor for the loss of functional capacities and the ensuing consequences. However, if we look at the glass half full, it means that it is possible to act to increase this level of physical activity and reduce the associated risks. How to do ? This is the question posed by Dutch researchers who publish a systematic review in International Journal of Behavioral Nutrition and Physical Activity.

The difficult reality on the ground: promoting physical activity in the hospital

The authors highlight the existence of many brakes and driving forces at the intra-individual level (what patients and caregivers feel and believe), inter-individual (the interactions between patients and caregivers) and institutional (the rules that govern the care, the environment where the care takes place, etc.).

First of all, it is necessary to point out the major obstacles represented by certain beliefs such as the fact of systematically associating the hospital with rest: “ The most common perception among patients when they are admitted to hospital is that they need to rest and that this rest is necessary to recover as well as possible. This goes against the data published in the literature which clearly shows that a physically active patient recovers on average faster than a bedridden patient”, points out Boris Cheval, researcher in the psychology of physical activity at the Swiss Center for Affective Sciences, also working at the University Hospital of Geneva.

Similarly, the fear and apprehension of patients is a factor limiting their mobility, especially when the reason for admission to hospital is a fall: “ IYou often have to go see the patients to reassure them and remind them that they shouldn’t hesitate to call us to help them get around. Most are embarrassed by the idea of ​​being a burden on caregivers. In addition, people who have fallen must regain their confidence. The fall is often experienced as a real traumatic shock. Consultation with a mental health professional should be systematic,” develops Vincent Girod, physiotherapist at the Alpes Isère Hospital Center.

However, it is not just patients who have inaccurate beliefs, unfounded fears and stereotypical representations. Caregivers are also victims of this and this impacts their interactions with patients and can result in weak support in terms of pushing them to recover a certain autonomy : “ These ideas are also rooted in caregivers who generally prefer to suggest to a patient who has muscle or joint pain that this is normal because he has just had surgery and that he needs rest. recalls Boris Cheval.

Vincent Girod also evokes the extent to which the collective representation that we have of the elderly impacts the recommendations in matter of physical activity: It is difficult to imagine a dynamic elderly person who continues to be physically active. I am regularly confronted with this in my practice where certain colleagues will suggest to a patient who is nevertheless very physically active that certain movementscertain activities or certain loads to be lifted must be prohibited or considerably limited without taking into account the initial activity of the person”.

Finally, the environment of the hospital is generally not designed so that travel or activities are easily carried out there. In the literature, we speak of bed centrism, to describe the fact that everything in the hospital revolves around the bed. This has direct consequences on the functional abilities of patients: “ If everything takes place in the same place, the patients have no motivation to leave their room. The hospital has for too long focused on care instead of focusing on people,” deplores Vincent Girod.

In addition, this environment influences even the most committed doctors who are aware of the importance of physical activity, however small it may be: When discussing with doctors, even the most motivated to move their patients let themselves be fooled by the disconcerting ease offered by bed-centrism for lack of time, by carrying out their clinical examination simply by putting the patient on the side, whereas, with a view to recovering functional capacities, the patient should be suggested, encouraged and encouraged to get up”, says Boris Cheval.

Taking the lead: promoting physical activity in the general population

But the first factor that determines the physical activity of a patient in the hospital is his level of physical activity in daily life. Therefore, if interventions are possible downstream of admission to work on beliefs, reduce apprehension or modify the environment, we can also act upstream with public health policies to increase the level of physical activity. of the general population. However, despite the constant communication of public health authorities on the health benefits of physical activity and the universal acceptance of this state of affairs in the population, physical inactivity continues to increase.

Again, it would seem that people do not make decisions as perfect rational beings as some economic theories postulate, but as human beings who are also governed by their emotions. Emotions that are more useful than we think for making decisions. In any case, this is the hypothesis defended by Boris Cheval in his work where he seeks to demonstrate that, in order to observe the maintenance of physical activity, the affective experience of this activity must be positive: “ We are able to show, even if the results are not very consistent at the moment and the effect sizes are relatively small, that the affective response during exercise predicts the maintenance of physical activity in the long term rather well”.

Towards a global paradigm shift?

If specialists such as researchers in the psychology of physical activity, teachers of adapted physical activity or even physiotherapists are generally all aware of the issues, many locks remain, particularly at the level of resources: “ There are not enough staff to simply visit patients and encourage them to go for walks in the corridors and outside the hospital. There’s nothing more gloomy than a hospital corridor, so it takes people to make patients want to move. Unfortunately, that time is not valued because it is not really considered care,” regrets Vincent Girod.

Also, as we mentioned earlier, perhaps we should review the issues of physical education and sports at school. Indeed, if affective experience plays a preponderant role in commitment to physical effort, shouldn’t physical and sports education teachers (EPS) focus above all on this parameter?

Of course, EPS has multiple objectives such as the development of motor skills. But delivering minimum skills is useless if we don’t want to use them later. In effect, there is a correlation enter here valence memories we have of our physical education classes and our propensity to engage in physical activity. The PE class could then also become a place of exploration to discover what we like, of developing physical virtues (like moral virtues and epistemic virtues) such as the taste for effort and learning sports and metacognitive skills to preferentially engage in activities that are ends in themselves.