Effectiveness of Exercise in Older Adults Discharged From the ER After Minor Injuries - The CEDeComS Stepped-Wedge Trial

Sep 29, 2026

Older adults who consult Emergency Departments (EDs) for minor injuries face substantial risk of new functional impairment within 6 months. A stepped-wedge randomized trial in six Canadian EDs compared multicomponent, risk-level adapted exercise programs with usual ED care for at-risk adults aged ≥65 years. Participants were assessed at baseline in the ED, then at 3 and 6 months, with outcomes based on OARS functional decline and Short Physical Performance Battery performance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Objective

Design and Settings

Intervention and Measures

Results

Conclusion

Introduction

Background and problem statement

Risk factors after ED discharge

Journal of the American Geriatrics Society Journal of the American Geriatrics Society Effectiveness of Exercise in Older Adults Discharged From the ERAfter Minor Injuries: The CEDeComS Stepped-Wedge Trial Marie-Josée Sirois1,2 | Joannie Blais3 | Mylène Aubertin-Leheudre4,5 | Pierre-Hugues Carmichael2 | Laurence Fruteau de Laclos1 | Audrey Desjardins2 | Raoul Daoust6,7 | Debra Eagles8,9 | Jacques Lee10 | Jeffrey J. Perry8,9 | Nancy M. Salbach11 | Marcel Émond2,12 1École des sciences de la réadaptation, Université Laval, Québec, Quebec, Canada | 2Centre d'Excellence sur le Vieillissement de Québec, Québec, Quebec, Canada | 3CHU de Québec-Université Laval, Québec, Quebec, Canada | 4Département des sciences de l'activité physique, Université du Québec à Montréal, Québec, Canada | 5Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Quebec, Canada | 6Département de médecine de famille et médecine d'urgence, Université de Montréal, Quebec, Canada | 7Centre d'étude en médecine d'urgence, Hôpital Sacré-Cœur de Montréal, CIUSSS-NIM, Quebec, Canada | 8Ottawa Hospital Research Institute, Ottawa, Ontario, Canada | 9Department of Emergency Medicine, University of Ottawa, Ontario, Canada | 10Schwartz/Reisman Emergency Medicine Institute of the Mount Sinai Hospital, Toronto, Ontario, Canada | 11Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada | 12Département de médecine de famille et médecine d'urgence, Université Laval, Québec, Quebec, Canada Correspondence: Marie-Josée Sirois ([marie-josee.sirois@rea.ulaval.ca](marie-josee.sirois@rea.ulaval.ca)) Received: 15 November 2024 | Revised: 21 August 2025 | Accepted: 26 September 2025 Funding: The Canadian Institutes of Health Research (PJT-148877) funded the trial through their Project Grant Program Competition (201603PJT-364485-PJT-CFBA-137982). Marie-Josée Sirois received support from the Canadian Institutes of Health Research Embedded Clinician Researcher Salary Award (TI3-370912, 2016–2021). Dr. Jacques Lee holds the inaugural Schwartz/Reisman Emergency Medicine Institute (SREMI) Research Chair in Geriatric Emergency Medicine. Keywords: emergency department | exercises | function-mobility | injuries | older adults ABSTRACT Background: Older adults consulting Emergency Departments (EDs) for minor injuries are at risk for new functional impairments in the 6 months following their injuries. Objective: To compare the effects of exercise programs versus usual ED practices on functional status and physical performance at 3–6 months in at-risk older adults with minor injuries. Design and Settings: Stepped-wedge randomized trial in six Canadian EDs from 2017 to 2020. Participants aged ≥65years were screened for low, moderate, or high risk of functional decline and assessed three times: baseline at ED, 3 and 6 months. Intervention and Measures: Multicomponent (flexibility, balance, strengthening, aerobic) and risk-level adapted exercise programs targeting moderate-and high-risk patients, 3×/week for 12 weeks, at home or in community groups. Control: Usual ED care. Measures: Functional decline was defined as a 2/28-point loss from baseline on the Older Americans Resources and Services (OARS) scale. Basic physical performance (leg strength, balance, walking speed) was measured using the Short Physical Performance Battery (SPPB) test. Generalized linear mixed log-binomial regressions were used to examine the effects of the intervention on outcomes compared to usual ED care, stratified by risk level. Results: The intervention and control phases included 277 and 205 moderate-risk individuals, and 249 and 128 high-risk individuals, respectively. Among moderate-risk individuals, functional loss in intervention participants at 3 months was half that of controls: 12%[95% CI: 8%–17%] vs. 25%[95% CI: 18%–34%], RR: 0.48 [0 . 26, 0 .90] . This is an open access article under the terms of the Creative Commons Attribution-NonCommerci

FAQs

What problem does the study address for older adults after minor injuries?

Older adults treated for minor injuries in emergency departments are at risk of new functional impairments within 6 months after the injury.

What was the intervention and how was it delivered?

The intervention used multicomponent exercise (flexibility, balance, strengthening, aerobic) adapted to risk level, delivered three times per week for 12 weeks at home or in community groups.

How did the exercise program affect functional decline at 3 months?

Among moderate-risk individuals, functional loss at 3 months was about half that of controls (12% vs 25%), with a reported RR of 0.48 and confidence intervals supporting reduced decline.

Sep 29, 2026

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