Each day in the hospital leads to functional decline and loss of muscle mass, which older adults can find difficult or impossible to restore in the post-acute period. The overall objective of this proposed project is to explore the feasibility and preliminary efficacy of a virtual reality physical activity intervention at helping older adults engage in physical activity and maintain physical function and mental health during their hospital stay. As virtual reality technology becomes more affordable and ubiquitously available across the world, this study will demonstrate how this technology could be leveraged to maintain the function of older adults in the hospital.

Older adults (≥60 years) experience multi-level barriers to physical activity when hospitalized. Patient level barriers to physical activity when hospitalized include tethers (e.g., foley catheters, intravenous infusions), symptoms of their acute illness (e.g., pain, fatigue), low self-efficacy to perform physical activity, and a perception that they should remain on bedrest when hospitalized. Interpersonal barriers to physical activity, highlighted during this post pandemic environment, include staffing shortages and increased patient acuity, which can force nurses to prioritize other critical tasks over the physical activity of their patients. Environmental barriers to physical activity include bed alarms and a hospital climate that is hyper focused on the incorrect assumption that physical activity increases fall risk among hospitalized older adults.

This lack of physical activity in the hospital generates major personal and societal costs. Each day a patient spends in the hospital increases their risk of functional decline and loss of muscle mass, which older adults can find difficult or impossible to restore in the post-acute period. Hospital associated deconditioning increases the length of hospital stays, and increases the susceptibility of patients to delirium, falls, and re-admission. Such complications ultimately increase health care costs. Therefore, there is a significant unmet need to identify strategies to increase older patients' physical activity while minimizing staff burden.

The overall objective of this proposed project is to explore the feasibility and preliminary efficacy of a virtual reality physical activity intervention to engage older adults in physical activity and maintain physical function and mental health during their hospital stay. This quasi-experimental study has two aims.

Primary) Aim 1: Using the NIH Behavior Change consortium guidelines, the Acceptability/Appropriateness of Intervention Measure, the Simulator Sickness Questionnaire, and semi-structured individual interviews, determine the feasibility of a virtual reality intervention among hospitalized older adults.

Aim 2: Test the preliminary efficacy of the PAVE intervention on 1) time spent in physical activity during the hospital stay, 2) maintenance of physical function, and 3) maintenance of mental health, compared to the education only control group.

Hypothesis 2.1. Patients exposed to the PAVE intervention will demonstrate more time spent in physical activity (MotionWatch, Modified Physical Activity Vital Sign) during their hospital stay, when compared to those exposed to the education control, controlling for appropriate covariates.

Hypothesis 2.2. Patients exposed to the PAVE intervention will better maintain their physical function throughout their hospital stay (Barthel Index, UMove), when compared to those exposed to the education control, controlling for appropriate covariates.

Hypothesis 2.3. Patients exposed to the PAVE intervention will better maintain their mental health throughout their hospital stay (Hospital Anxiety and Depression Scale, Brief Reslience Scale), when compared to those exposed to the education control, controlling for appropriate covariates.

Inclusion Criteria:

1. in the last 72 hours, they were admitted to the medical floor that is the setting of the study,
2. are 55 years or older,
3. their bedside nurse approves their physical activity participation in this study

Exclusion Criteria:

1. they are unable to pass the Evaluation to Sign Consent Measure,
2. they score 20 or lower on the Montreal Cognitive Assessment Basic,
3. they have an admitting diagnosis that could be worsened through virtual reality exercise,
4. they have an attached medical device that decreases the safety of physical activity such as a nasogastric tube or continuous fluids running through a PICC line that cannot be paused,
5. they are unable to follow commands or move their extremities against gravity during the UMove Mobility Assessment,
6. they are unable to wear the virtual reality headset,
7. they received the education control intervention or PAVE intervention during a prior admission,
8. there is an active plan to discharge this patient during day of recruitment or the following day,
9. they are on airborne or droplet precautions

During informed consent, study participants will be asked to consent to de-identified quantitative data sharing upon recommendations of the local IRB. We will share all collected quantitative data in a de-identified format (age, comorbidities, feasibility, physical activity, physical function, and mental health), removing all personal identifying information. All direct participant identifiers (e.g., name, date of birth) will be removed from data prior to sharing. Users of the generalist repository that will store this study's data, Zenodo, must agree to the Terms and Conditions of Zenodo, and agree not to share or redistribute the data. We will not share the transcripts from the qualitative individual interviews.

We will actively disseminate the findings of the proposed project via standard peer review mechanisms including the submission of abstracts for poster and podium presentations at scientific meetings and the publication of peer reviewed articles.

Data will be stored and maintained on University of Maryland's HIPAA-compliant servers. We will make all de-identified quantitative data publicly available upon publication of the work related to this proposed project, or the end of the project period, whichever comes first. This de-identified data will remain available indefinitely on Zenodo, a generalist repository supported by the NIH.

Users of the generalist repository that will store this study's data, Zenodo, can access the individual quantitative data collected from this study, including information related to age, comorbidities, feasibility, physical activity, physical function, and mental health. All direct participant identifiers (e.g., name, date of birth) will be removed from data prior to sharing. We will not share the transcripts from the qualitative individual interviews.

Participants will not be blinded to the behavioral intervention they are receiving. However, we have designed this study with sequential (blocked) recruitment to minimize bias due to awareness of another group, such as a control group participant being roommates with a PAVE participant as they perform virtual reality physical activity.