How to regain strength after a hospital stay

How long does it take to regain strength after a hospital stay?

Longer than the stay, and longer than most people are led to expect. Two studies answer the two halves of the question, and neither of them is comfortable reading.

The best measurement of how fast it goes is a small study. Eleven healthy volunteers with an average age of 67 spent ten days in continuous bed rest, eating a normal diet with enough protein, and came out having lost 13.2 percent of their knee extension strength and 14 percent of their stair climbing power, with aerobic capacity 12 percent lower than when they went in (Kortebein and colleagues, 2008). Nothing was wrong with those people. An illness, an operation, broken sleep and a poor appetite all sit on top of pure inactivity in a real admission, which is why that figure is better read as a floor than as a ceiling.

There is a detail in it that matters more than the percentages. Over the same ten days, the standard performance tests the researchers used did not change. Strength can fall a long way before a test, or a reader, can see it, which is part of why the weakness comes as a shock in the first week at home.

Getting it back runs to a year rather than a month, and it is not guaranteed. One study followed people aged 70 and over who had been admitted as emergencies to general medical wards at two American hospitals between 1993 and 1998, and compared them with how they had been two weeks before admission. Among those who went home needing help with washing, dressing or getting about that they had not needed before, 30 percent were back at their old level twelve months later. Among those who left hospital still able to do everything they could before, 67 percent were at their old level at a year (Boyd and colleagues, 2008).

The gap between those two numbers is the thing to take from this page. How much you had lost by the morning you came home counts for more than how many nights you were in.

So plan in months. The first changes usually show up within a week or two, and they show up in small practical things rather than in how much you can lift.

Standing up without pushing off the arms of the chair. Carrying a cup through to the next room. Doing the stairs once a day instead of staying upstairs. Those are the markers worth watching, because they move before anything you could measure on a scale.

Why am I so weak after a hospital stay?

Because muscle keeps only what it is asked for, and almost nothing in a hospital day asks anything of your legs. Even a short admission with a few days of bed rest takes strength out faster than most people believe is possible. The medical word for what has happened is deconditioning, and it means what it sounds like: the fitness and strength you had has lapsed rather than been damaged.

Illness is doing its own damage alongside the inactivity. The European working group on sarcopenia names three separate causes of muscle loss: disease, particularly an inflammatory one, physical inactivity whether from a sedentary life or from disease-related immobility, and inadequate intake of energy or protein, including from poor appetite, trouble absorbing food or difficulty eating (Cruz-Jentoft and colleagues, 2019). An admission usually arrives with all three at once, and that is why two weeks in hospital with a chest infection costs more than two weeks of sitting at home would.

The chair is where you feel it first. Standing up from a seat is one of the hardest things most people do in a day, and it is the movement that gives way soonest. Once it starts to go, everything shrinks around it: you sit longer, you go out less, you lose more. That is why the program below puts chair work at every stage instead of treating it as a beginner's exercise.

Some of what you have lost is practice rather than muscle, which is the encouraging half. The nervous system forgets the pattern of a movement quickly and relearns it quickly, so the first week or two of improvement is often faster than anything that follows. Enjoy it, but do not read it as the rate for the next six months.

If nobody has measured you and you simply want to get stronger as you age, strength training for older adults is the page for that. If a doctor or physio has timed your chair stands or measured your grip and told you the result was low, or has used the word sarcopenia about you, the sarcopenia program follows that diagnostic pathway. This page is for the specific event of a stay in hospital: what the first week looks like, how long the whole thing takes, and the weakness that needs a doctor rather than a program.

When weakness is not loss of condition, and needs help today

Being weak after you come home is not the same as getting weaker after you come home. Loss of condition improves slowly, and improves a little further on a day when you have eaten and slept properly. Weakness that is worse this week than last, or that arrived suddenly, or that has brought something else new along with it, is a symptom. It belongs with a doctor before it belongs with an exercise program.

Here is what gets mistaken for loss of condition. Read it now rather than when something happens, because several of these are much easier to explain away than to notice.

A blood clot in a leg, which is more likely after any spell of being much less mobile than usual. The NHS lists throbbing pain in one leg, usually the calf or thigh, swelling in one leg, skin that looks red, blue or darker than usual, and swollen veins that are sore to touch, and any one of those on its own is enough to get urgent advice. A clot that has traveled to the lungs shows up as sudden breathlessness or chest pain, and that is a call to emergency services.

An infection, which does not always announce itself. A wound, a chest, a urine infection or the site where a drip went in can all produce a few days of feeling weaker and more tired with no obvious temperature. The NHS notes that confusion is common in older people who have pneumonia, and that urine infections are a common cause of sudden confusion, so the first sign of an infection is sometimes muddled thinking rather than a cough or a fever.

Anemia from blood loss. The symptoms the NHS lists for iron deficiency anemia are tiredness and a lack of energy, shortness of breath, noticeable heartbeats, skin paler than usual and headaches, and it says the condition is often caused by blood loss. What makes it worth checking rather than pushing through is the direction of travel: tiredness and breathlessness that build week by week, doing something you managed easily a fortnight ago. It is treatable, and it does not get treated while it is being put down to being out of condition.

A new or changed medicine. Most people come home from hospital on a different list from the one they went in with. The NHS names some medicines among the causes of low blood pressure, among the causes of falls, and among the causes of sudden confusion. Never stop or change a prescribed medicine on your own. Ask your doctor or pharmacist to go through the whole list instead, and say that you have become weak, dizzy or muddled since you came home.

A drop in blood pressure when you stand up. Dizziness, blurred vision, weakness, feeling sick or fainting in the moments after getting out of a chair is postural hypotension. The NHS lists it among the causes of falls, and your doctor can check it.

Confusion, which has the medical name delirium. Suddenly becoming muddled, much drowsier than usual, unable to follow what is being said, unsure where you are, or seeing or hearing things that are not there is an emergency at home, whatever has caused it. There is a quiet form as well, and that is the one taken for loss of condition: withdrawing, answering slowly, moving about less, losing interest in food, over hours or days rather than weeks. NICE names those as the signs most often missed. Both are on the warning list below, each with its own route.

Fluid the heart is not keeping up with. Breathlessness that comes on when you lie flat, waking at night needing to sit up to breathe, ankles or legs more swollen than when you came home, or weight that climbs by the day are the pattern, and the NHS puts breathlessness on lying down, sudden weight gain and coughing up frothy pink phlegm among the reasons to get urgent advice. Going back into hospital in the first weeks at home is common for exactly this, and it is treatable.

A new neurological event. One-sided weakness, a face that droops, speech that slurs, a sudden loss of balance, or a foot that has started to drag or catch is not something to train through. Those signs mean calling emergency services even if they have already gone away.

Each of these is written out in full, with what to do and how quickly, in the warning signs at the foot of this page. There is a link straight to that list at the top of this page as well. Read it before you start the program rather than afterwards.

Does being sent home mean you are cleared to exercise?

No. Discharge is a judgement that you no longer need to be in a hospital bed. It is not a statement that you are safe to start a strength program, and it is not a set of limits on what you can do.

So the first job is finding out who sets your limits. After an operation, your surgical team decides how much weight goes through the limb, which movements are off and when each restriction lifts, and that plan beats everything on this page for as long as it runs. With a heart or lung condition, or blood pressure that is not under control, your doctor is the one to ask before you begin. If you were handed a rehabilitation plan or a physio referral when you left, use that rather than this page, and take this page to the appointment if it is useful.

Before you decide that nobody is reachable, work down the list, because one unanswered call is not the same thing as having nobody to ask.

There is usually a number on your discharge letter. The ward or the team you went home from will take a call about their own patient, and that is the right place for anything to do with an operation, a wound or a drain. Your own doctor's practice can be asked for a telephone appointment, and saying that you came out of hospital last week changes how that request is handled. A pharmacist will go through your medicine list with you without an appointment. In the United Kingdom, NHS 111 answers day and night and will tell you what to do next.

If nobody gave you anything and you still cannot get hold of anybody, that is not a reason to sit still. Stage 1 of the program below is done sitting or lying, which is where nearly everybody starts in any case, and the warning signs tell you when to stop and who to contact. The one exception inside stage 1 is standing up out of the chair using the armrests, which does put your weight through your legs. Leave that one out, and ask first, if you were told to put only part of your weight through a leg, or none of it, or to keep using a frame or crutches for now. If instead you were told to limit what you lift, push or pull with an arm, or to keep an arm in a sling or a splint, the same applies to the band row and the grip squeeze in stage 1, and to the wall push-ups in stage 2.

Standing work away from the chair is the part that waits until you have asked. If you have tried and genuinely cannot reach anybody, the question is not whether you feel strong enough, which is not something you can judge from the inside. It is whether any of these six things is true of you. Take them one at a time and answer each one about yourself, because a single yes keeps you in stage 1.

• An operation during this stay or in the past three months, or an operation at any time since which you were given a restriction and nobody has told you it has lifted.
• You were told to limit the weight going through a leg, or to keep using a frame or crutches.
• A broken bone, or a wound that has not healed.
• You were told that your heart, lungs or blood pressure need settling.
• You get breathless, or feel your heart race, doing something small such as getting to the toilet or getting dressed, when that was not happening on the day you came home. This one does not wait for a call back: it is on the same-day list in the warning signs below, so get medical advice the same day.
• Anything new on one side of your body, such as weakness, numbness or a foot that drags, or dizziness and feeling faint when you stand up. These do not wait for a call back either, and they do not all get the same answer. New weakness or numbness on one side of your body or face means calling emergency services now, even if it has already passed, and the stroke line in the warning signs below gives the rest of the signs that go with it. A foot that drags or catches, and dizziness or feeling faint when you stand up, need medical advice the same day.

If one of those is true, that is the thing to ask about, and stage 1 is where you stay until you have an answer.

If all six are no, you can start the stage 2 work with a hand on a counter for the whole of every exercise, and keep trying to get a physio to see you. There is one further condition, in the falls section below, and it is about company rather than about medicine: if you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, the standing work waits until somebody can be at home while you do it.

Falls: the riskiest few weeks

A strength program means standing up, and standing up is how people fall. Set this part up properly before you do anything else, because it is the difference between a program and an accident.

Use a firm, heavy chair that will not slide or tip, with its back against a wall. A wheeled office chair is not safe for this. Keep one hand on a kitchen counter or a solid worktop for everything you do standing at it, and keep the other hand free rather than holding anything.

A walking aid is different: if you came home with a stick, crutches or a frame, it stays in your hand for every walk, including the walking practice in the program. Wear flat shoes that fit well and grip the floor, not socks, tights or bare feet. Move the rug, the trailing cable and anything else on the floor out of the space before you start rather than halfway through a set.

Keep your phone in a pocket every time you exercise, not on a table across the room. If you have a personal alarm, wear it for the session, and if you live alone without one, ask whoever arranged your discharge about getting one.

Then there is the question of being on your own. If you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, keep a hand on the counter throughout, practice only when someone else is at home, and ask your doctor or physio about a falls check. If that is you and nobody can be there, stay with stage 1 until somebody can, or until a physio or doctor has seen you, which is not the same as doing nothing, because the seated work in stage 1 needs nobody there. The one exception inside stage 1 is standing up from the chair with the armrests, whose own page asks a reader who has fallen before to have somebody nearby for it. If none of that applies and you simply live alone, do the standing exercises at a time of day when somebody normally rings or calls in, so that if you do end up on the floor you are not there for long.

The NHS advice if you cannot get up is to call for help with a phone or an alarm, or by shouting or banging on a wall or the floor, and while you wait to keep warm, covering yourself with anything you can reach such as a coat or a blanket, keep moving your arms and legs, and change position about every half an hour, which helps prevent pressure sores.

Build in one habit from the first session: pause for a few seconds after you stand up, before you walk off. A quick rise leaves some people light-headed, and that moment is where falls happen. If you do feel dizzy, sit back down and wait for it to pass rather than carrying on, and the warning signs below say when that needs checking.

Getting up from the floor is worth being able to do, and it is deliberately not in the program below. Learn it with a physio first. The balance and falls prevention program is the other half of this work, and it pairs with the strength side rather than replacing it.

How to use this program

Pick the stage that matches you today. If you are not sure, start at stage 1. Move up when the current stage feels easy and you have recovered by the next day, and drop back a stage for a few days after a bad night or a setback rather than stopping altogether.

This page is for adults. A child or teenager who has come home from hospital should follow the plan from their own doctor or physio, and ask them before trying any exercise on this page. If you are pregnant, check with your midwife or physio before you start. If your stay was for a cesarean or any other operation, the first of the six questions in "Does being sent home mean you are cleared to exercise?" covers you, and your surgical team sets your limits.

Each exercise page gives a typical starting dose. In the first week at home, the right number is usually fewer repetitions than the page suggests, done more often through the day. Little and often beats one long session when you tire quickly, and it has a safety advantage too: a short set does not leave you so tired that standing up afterwards is risky.

More often means splitting the page's number across the day, not doing the whole of it three times over, because it is the total by bedtime that your legs feel. Two or three short goes at a stage is plenty in the first week. Your physio will adjust the exercises and the numbers to suit you.

There is a measured answer on how often, for this exact situation, although it is expert agreement rather than trial evidence. Fifteen clinicians and researchers from eight countries reached consensus on a program of daily sessions in the first week after discharge, then two to three times a week out to about twelve weeks, combining strength, aerobic and functional work, individually tailored and supervised (Aarden and colleagues, 2023). The supervision is part of what they were describing, and a web page cannot be that, which is a fair argument for getting a physio involved even briefly at the start. The same panel agreed an intensity, and this page does not pass it on, because it was a share of maximum heart rate and the panel attached it to there being no reasons against exercising at all. A heart rate ceiling is close to meaningless for someone on a medicine that slows the heart, and misleadingly gentle for someone whose heart is already racing because she is short of blood.

The evidence on whether any of this works splits in a way worth knowing. Trials of exercise given during the admission itself have not shown a clear gain in day-to-day independence by the time people go home: a Cochrane review of 24 trials in 7,511 patients aged 65 and over, admitted for medical reasons, found a difference of 1.8 points on a 100 point independence scale in the 16 of those trials that measured it, where 11 points is the smallest difference a patient would notice, and rated the certainty low (Hartley and colleagues, 2022). The same review found, with moderate certainty, that exercise did not increase falls in hospital.

After discharge the picture improves, though not by much and not cleanly: a meta-analysis of randomized trials in people who had just gone home found greater improvement in physical function overall with exercise than with usual care, which in those trials included advice to be active, while none of the individual measures it looked at separately, grip strength, the chair and balance and walking battery, the six-minute walk and gait speed, reached significance on its own, and the authors put that down to how few trials existed (Carneiro and colleagues, 2022). And in older adults generally, strength work that gets harder as you get stronger has a large effect on strength and a moderate to large effect on getting out of a chair (Liu and Latham, 2009). Those 121 trials were mostly in older people who were not acutely unwell, and the reviewers add a caution of their own about carrying the exercises straight across to clinical groups, because the trials recorded harms poorly. In most of them the training ran two to three times a week.

The practical reading of all that: the work that changes things is the work you do at home after the ward, and the chair is the thing to train.

Progress comes in two forms, and the order matters. Take help away first, which means fewer hands on the chair, a lower seat, a lighter touch on the counter. Then add load. Change one thing at a time, and add repetitions before you add weight. A firm cushion on the chair is the easiest dial on the whole program: take it out when standing up gets easy, put it back on a bad day.

Breathe steadily through every repetition rather than holding your breath, which matters most if you have high blood pressure. The WHO guidelines ask adults of every age for muscle strengthening on at least two days a week and are plain that some activity is better than none (Bull and colleagues, 2020). That last point is the right frame for a week when you can manage almost nothing.

Soreness for a day or two after a new exercise is normal. Sharp pain during an exercise means stop that exercise for today, and a joint that is more painful or swollen the next day means the load was too much for now, so do less next time rather than stopping altogether. Being far more tired the next day than the session should explain means you did too much, so do less next time rather than giving up. If it keeps happening week after week even as you do less, stop putting it down to the exercise: that pattern is on the warning list below. A calf or thigh that is swollen, warm or red is not ordinary soreness, and it is on the warning list below.

The exercise program

The exercises below carry their own stop signs and precautions. Open the line under an exercise and read them before you try it.

Fatigue and pacing, which is not the same as strength

Plenty of people looking for this page are not really asking about muscle. They are asking why they are so tired. The two travel together and they do not answer to the same treatment: weakness gets better with loading, while fatigue gets worse if the loading is badly spread.

Pacing is the answer, and it is dull on purpose. Work out roughly what you can do on an average day without paying for it tomorrow, then do slightly less than that, consistently, instead of doing everything on a good day and nothing for the two days after. Break the big jobs into pieces with a sit down between them, so a shower and getting dressed are not one single effort. Put the exercises at the time of day you have most in the tank, which for most people is the morning.

Fatigue after a serious illness can run for a long time. Among survivors of intensive care in a Dutch study, 36 percent of those admitted for a medical reason reported fatigue a year afterward (Geense and colleagues, 2021). That is a more unwell group than most readers of this page, and the point of the figure is not the number. It is that months of tiredness is a known pattern rather than a sign you are doing something wrong.

Two kinds of tiredness are not fatigue and need checking instead of pacing. Tiredness that builds week by week alongside breathlessness doing everyday things, a racing heart or paler skin than usual is on the warning list below. So is tiredness with a cough, a temperature or feeling hot and shivery.

Eating and drinking enough to rebuild

You cannot rebuild muscle out of nothing, and appetite is often the last thing to come back after an illness. Inadequate intake of energy or protein is named as a cause of muscle loss in its own right, alongside inactivity and disease, with poor appetite, trouble absorbing food, difficulty eating and limited access to healthy food among the reasons for it (Cruz-Jentoft and colleagues, 2019).

This page gives no protein figure, and that is deliberate. How much you need depends on your body size, your kidney function, your other conditions and what you are already eating, so the number belongs to your doctor or a dietitian rather than to a web page. The practical half needs nobody's permission: something with protein at each meal rather than all of it at dinner, smaller meals more often if a full plate puts you off, and a drink kept within reach of the chair you spend the day in rather than in the kitchen.

If you are losing weight without trying, eating much less than usual, or finding eating difficult, that is not something to sort out once you are stronger. It is on the warning list below, and it is the kind of thing a doctor can act on.

If your stay was for an operation

Your surgical team's plan replaces this one for as long as it runs. They set how much weight can go through the limb, which movements are off, and when each restriction lifts. None of that can be worked out from how the limb feels, because a repair is often comfortable long before it can take load.

We have pages built around the common operations, and they follow the surgical timetable rather than this general one: after a hip replacement, after a knee replacement and after a broken hip, after a rotator cuff repair, after a shoulder replacement, after a broken ankle and after a broken wrist. Use one of those if it fits your operation.

Three months is the rough line this page uses for when to ask, and rough is all it is. Restrictions after a repaired tendon or ligament routinely run past it. In a review of 96 published rehabilitation protocols for rotator cuff repair, the commonest point for going back to working the shoulder against resistance was twelve weeks, the protocols varied widely either side of that, and the larger the tear the later it came (Coda and colleagues, 2020). Where a bone was fixed with screws, plates, nails or wires, the restriction usually ends when your surgeon says the bone has healed rather than on a date in a diary.

So the question is not how long ago the operation was. It is whether you were given a restriction that nobody has told you has lifted, and if you were, treat it as still running and ask, whatever the calendar says. Where this page still earns its place is the rest of you, because an operation on one knee costs you strength in both legs, in your arms and in your stamina, and most surgical protocols say very little about any of that.

Three sets of warning signs matter more after an operation than after a medical admission, and all three are at the foot of this page: the wound and infection signs, the blood clot signs, and the signs that the operation itself has given way. Learn them now. Infection and clots are the two complications most likely to be mistaken for a slow recovery.

The third set is the one nobody mentions on the way out of the ward. A new joint can come out of its socket. A repaired tendon can tear again. The screws, plate, nail or wires holding a bone can shift before the bone has healed, and the bone around a new joint or a plate can break after a knock small enough that you would not have given it a thought before the operation. From the inside, all of those look like the leg or the arm going backward, which is exactly what loss of condition looks like, so they get put down to a bad week.

The difference is the suddenness and the function: if the limb was taking your weight or lifting a cup last week and will not now, or if you heard a crack, a pop or a clunk and something changed after it, that is a question for the team who operated, not for your next physio appointment. Both lines are in the warning signs at the foot of this page, one of them an emergency.

If you were in intensive care

A spell in intensive care is its own recovery, and a slower one. Weakness, fatigue, poor memory and concentration, low mood and anxiety are all common afterwards, and they are grouped under the name post-intensive care syndrome, which describes a pattern rather than being a diagnosis (Hiser and colleagues, 2023). The figures behind that come from a Dutch study of 2,345 people who answered the same questions before their admission and again a year later: new physical, cognitive or mental health problems at one year were reported by 58 percent of those admitted to intensive care for a medical reason and 64 percent of those admitted after urgent surgery (Geense and colleagues, 2021). The review that collects those numbers points out that the physical problems in that study were measured with a questionnaire that had not been validated, so read them as showing how common the problem is rather than as a precise rate.

Start at stage 1 even if you were fit beforehand. Expect the timescale in months, and read a single flat week as normal rather than as failure. Several weeks with nothing moving, or ground going backward, is a different thing, and it is a reason to ask rather than to wait, which is also what the guideline below says.

Ask for a rehabilitation referral instead of assuming one will arrive, and mention the memory and mood side as well as the legs, because people tend to report only the legs. Have the chest signs on the warning list clear in your head before you start too, because a new cough or new breathlessness needs checking rather than pushing through.

What should happen after critical care has a published shape, and it is worth knowing because it tells you what to ask for. NICE sets it out for the NHS in England in its guideline on rehabilitation after critical illness in adults. Four parts of it matter to you at home. You should have been given the contact details of the person coordinating your rehabilitation, once when you left critical care and again when you left hospital, so ask for a name and a number if you have neither.

Before you went home there should have been a functional assessment covering both sides of this, the physical one, which it describes as weakness, not being able to sit, stand or walk, fatigue, pain, breathlessness, swallowing trouble, continence, changes in vision or hearing, difficulty speaking or writing, and equipment needs, and the non-physical one, which it describes as anxiety, low mood, post-traumatic symptoms, memory and attention problems, confusion and relationship difficulties. The guideline asks for a review 2 to 3 months after you left critical care, face to face, with the same assessment done again, and it says that if you are recovering more slowly than your goals expected, or something new has appeared, that review is where a referral to a rehabilitation or specialist service is made. So if nobody has contacted you by the two month mark, that is the point to ask rather than to wait. It also says a structured self-directed rehabilitation manual, lasting at least six weeks and coordinated by a clinician throughout, may be offered as part of the program, which is a thing you can ask about by name.

Arrangements and names differ by country, so what NICE sets for England may not be what your service does. The questions are the same everywhere: who is coordinating this, when is my review, and what do I do if I am not getting better as fast as we agreed.

For the breathing side alongside the strength work, the breathing exercises for COPD and long-term chest conditions page covers techniques that help with breathlessness, and cardiac rehab covers the same ground after a heart problem.

Rehab at home: what the service is called where you live

There is usually something between the hospital and nothing at all, and its name changes with the country. In the United Kingdom you may hear reablement or intermediate care. In the United States, home health or rehabilitation in a skilled nursing facility. Canada, Australia and New Zealand each have their own arrangements and their own words for them.

We cannot tell you what you qualify for, because eligibility, duration and cost differ by country, by region and by insurer, and any figure a page gave you would be wrong somewhere. The question is the part we can give you, and who to put it to. Before you leave, ask the ward what rehabilitation has been arranged, who will come, when they will come, and who to contact if nobody does. Once you are home, ask your own doctor or physical therapist, and say plainly what you cannot manage rather than describing how you feel, because a service is arranged against tasks rather than against tiredness. The NHS has a page on care after a hospital stay which sets out how the arranging works in England, and it is a useful picture of the shape of it even if you live somewhere else.

Ask about a falls assessment in the same conversation. The NHS says a doctor may refer you to a specialist falls service, which can look for causes such as muscle weakness, weak bones or eyesight problems and can review your medicines, and that in some areas you can refer yourself after a fall.

For the person helping

If you are reading this for somebody else, the most useful thing you can do is also the hardest to make yourself do: leave them the bits they can still do. Every time you fetch the cup, a repetition disappears. Strength comes back through the standing up, the walking to the kitchen and the reaching into the cupboard, so the job is to make those safe rather than to take them away.

Four things help more than they look like they will. Set the chair up, which means firm, high, with arms, back against a wall, and a cushion on the seat for as long as standing up is hard. Be present rather than hands on, standing to the side while they do a set so that a wobble has somewhere to land. Keep a written list of what they are meant to be doing, because people come home from hospital tired and spoken instructions do not stick. And take the medicine list to the doctor and ask for the whole list to be reviewed, mentioning any new weakness, dizziness or muddled thinking since the discharge.

Then there is the watching, and you are better placed for it than anyone. Tiredness and breathlessness that build week by week. A calf or thigh that has become swollen or warm. A wound getting redder. Being more muddled, drowsy or agitated than usual, which you will spot first because you know what normal looks like for them.

Sudden confusion is an emergency at home. So is a fall where they cannot get up, or a fall they cannot remember.

The change that gets missed is the quiet one. Delirium does not always look like agitation. NICE says the kind most often missed shows up as withdrawal, slow responses, moving about less, poorer concentration and a smaller appetite, and that the changes to act on are recent ones, over hours or days, that may come and go through the day. All of that reads as tiredness, low mood or simply getting old, which is why it goes unreported.

Tell their team about a change in how they are, even a change that keeps coming and going, and even if it has passed by the time you get through. NICE's own advice to families is that delirium is common and usually temporary, and that the team wants to be told. If it does not clear, go back, because that is a reason to look again for a cause rather than to accept it as permanent.

One line for you rather than for them. A recovery measured in months is long enough to wear out the person doing the helping, and asking early what support exists for carers where you live is sensible rather than an indulgence.

When to see a physio or doctor

See a physio or your doctor if you are not getting steadily better over two weeks, if standing up from a chair, walking or the stairs are still beyond you, if you feel unsteady or have had a fall, or if you are not sure which stage of this program suits you. Ask sooner rather than later, because the first month appears to set the pattern: in the study described above, whether people had got back to their old level by one month was linked to where they ended up at a year (Boyd and colleagues, 2008). These are also the weeks when a treatable cause of weakness is most likely to be sitting undetected.

Go back to whoever looked after you in hospital, rather than waiting for a routine appointment, if the problem looks like a wound, a clot, an infection or something to do with your operation. Take your discharge letter and your medicine list to any appointment. If you are worried about falling, say so plainly, because that sentence is what opens the door to a falls service.

Some signs need help faster than an appointment, from a call to emergency services down to a visit within a day or two. They are all in the warning signs below, each with its own timing. Read that list once before you start the program and once more a week later, because the things on it are not the things you would think to look for.

For physiotherapists

The prognostic point worth acting on comes from Boyd and colleagues (2008): among patients aged 70 and over discharged with new or additional self-care disability, whether they had recovered by one month was associated with their functional outcome at twelve. That makes the first month the window to be intensive in, rather than the month to let settle before starting.

Measure instead of asking. The 30-second chair stand test, the Timed Up and Go and the six-minute walk test each carry their own norms, and gait speed is the cheapest repeatable measure in the set. The comparison that matters is premorbid function two weeks before admission, which is a history to take from the patient or the family rather than a number to measure today, because current performance tells you the deficit and not the target.

On dose, there is no trial-grade figure for an unsupervised frail patient at home in week one, which is why this page gives structure and defers the numbers. Aarden and colleagues (2023) is the closest thing to a prescription for this population and it is Delphi consensus: daily sessions in the first week post-discharge, two to three a week out to twelve weeks, combined strength, aerobic and functional work, with tailoring and supervision treated as part of the intervention rather than as an optional extra. The panel also reached consensus on intensity up to 70 to 80 percent of maximum heart rate, conditional on contraindications being absent, and that figure is deliberately not on the reader-facing part of this page: it is unusable for a patient on rate-limiting medication, newly anemic or in atrial fibrillation, and the condition attached to it is one the reader cannot check alone. Hartley and colleagues (2022) and Carneiro and colleagues (2022) point in different directions, and the reading that fits both is that the dose which changes function is the one delivered after discharge and progressed, not the one delivered on the ward.

The same cohort that gives this page its recovery figures also gives the prognosis, which is worth having in mind before setting a target with a family. Of the patients discharged with new or additional self-care disability, 41.3 percent had died by twelve months, 28.6 percent were alive without having recovered their baseline and 30.1 percent were back at baseline; for those discharged at their baseline the three figures were 17.8, 15.2 and 67 percent (Boyd and colleagues, 2008). Those were patients aged 70 and over admitted nonelectively to general medical services at two American hospitals between 1993 and 1998, so they do not describe someone home after an elective joint replacement, and the authors' own conclusion was that rehabilitation of greater length, carer support and palliative care all needed evaluating. The mortality figure is kept out of the reader-facing part of this page on purpose. It is prognosis rather than education, it changes nothing the reader can do, and most readers are not in that cohort.

Screen the medical causes before progressing the program, and screen the discharge medicine list as a matter of course. An orthostatic blood pressure, asking whether a blood count has been checked when tiredness is building rather than easing, and a delirium screen in anyone whose family says they are not themselves are all faster than three wasted weeks of exercise therapy. The same applies to the premorbid baseline: a patient who was already housebound before the admission needs a different target from one who was shopping on foot two weeks ago, and the program above assumes the second.

Common questions

References

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2. Boyd CM, Landefeld CS, Counsell SR, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. Journal of the American Geriatrics Society. 2008;56(12):2171-2179. https://doi.org/10.1111/j.1532-5415.2008.02023.x
3. Hartley P, Keating JL, Jeffs KJ, Raymond MJM, Smith TO. Exercise for acutely hospitalised older medical patients. Cochrane Database of Systematic Reviews. 2022;11:CD005955. https://doi.org/10.1002/14651858.CD005955.pub3
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Written and checked by the PocketPhysio editorial team. Last updated 2026-11-02.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.