During hospitalization, older adults rapidly lose muscle mass, leading to functional decline unrelated
to their admission condition. It is well documented that immobility significantly weakens muscles,
particularly in those over 60, with effects within the first week. This loss prolongs hospital stays,
reduces functional abilities, lowers quality of life, and increases mortality rates. High load dynamic strength exercises (i.e. moving limb against high resistance) are optimal for combating muscle
strength loss. However, bedridden or support-restricted patients cannot engage in such dynamic
exercises (PROBLEM1). Isometric strength exercises (i.e. contracting muscles without limb
movement) are the preferred choice for early-stay hospital rehabilitation. The addition of blood flow
restriction (BFR) to such exercises has proven comparable effects as dynamic exercises but BFR is
not yet considered as usual care (PROBLEM2). Another barrier is the lack of the patient’s motivation
to exercise, particularly without supervision, leading to very low adherence (50% in older adults)
(PROBLEM3). Serious games can address this, but despite numerous motivational and behavior
change features, most current technological applications lack end-user input and evidence-based
clinical recommendations, resulting in wide variability in effectiveness (PROBLEM4). Our group cocreated a serious game with end users to facilitate muscle training in non-therapy time, as an add-on
to supervised rehabilitation. The app processes the user’s electromyographical (EMG) data to play an
attractive and engaging game that complies with the latest clinical recommendations to treat muscle
strength loss. In summary, our aim is to assess (multicenter trial, RCT) in hospitalized older
adults(P), the combined BFR and EMG Driven Serious Game intervention(I) compared to standard
care(C), focusing on its impact on functional ability(O). Positive outcomes hold promise for reducing
healthcare and social expenditures.