Increasing physical activity among medical inpatients by digital nudging of patients and staff (the IPAMINA trial): study protocol for a stepped-wedge cluster-randomised multicentre trial

Low physical activity levels and sedentary behaviour during hospitalisation increase risk of functional decline, and adverse outcomes for medical inpatients. Increasing inpatients’ physical activity and reducing sedentary behaviour can be challenging in a busy hospital setting. Digital nudging and feedback using real-time data from wearable accelerometers may help promote in-hospital activity and improve recovery for patients. To determine whether a digital nudging intervention, targeting patients and staff, increases daily average physical activity (minutes/day) among adult medical inpatients compared with usual care. Secondly, an embedded qualitative study aims to explore the healthcare staff’s experience with the intervention and explore their perspectives on its usability in and impact on practice. This trial will be a stepped-wedge cluster randomised multicentre trial, in which medical inpatients from four hospital clusters, across the Kingdom of Denmark, sequentially will receive a digital nudging intervention. All participants’ activity levels (control and intervention group) will be measured with wearable accelerometers. The intervention involves real-time activity feedback to patients and staff regarding patients’ physical activity levels during hospitalisation. In the qualitative study, healthcare staff from all four sites will attend focus group interviews. The primary outcome is daily average minutes of physical activity. Secondary outcomes include daily minutes of sedentary behaviour, readmission, and length of stay. Target sample size is 400 patients, powered to detect a between-group difference of ≥ 38 min activity/day. Data will be collected at enrolment (< 48 h of admission to ward), during hospitalisation, at discharge, and 90 days post-discharge. By testing a digital intervention on a multicentre scale, this trial seeks to change the paradigm of inactivity during hospitalisation, making physical activity and reduction of sedentary behaviour integral to hospital care. We aim to address multiple factors that are known to impact inpatient mobilisation, by implementing a relatively simple digital intervention aimed at both patients and staff. The findings will inform best practices for patient care and culture regarding in-patient physical activity in medical wards. ClinicalTrials.gov: NCT06983977. Prospectively registered on May 14th, 2025. Date of first recruitment: May 19th, 2025. Ethics approvals have been obtained in all three countries.