Evidence from Research and Practice
When functional capacity is maintained, the need for intensive care services often decreases — and this is where measurable cost savings can emerge. This article explores how structured physical exercise and a rehabilitative approach can influence the demand for long-term care, hospital stays, and fall-related injuries.
While several examples and cost figures presented here are based on Finnish research and healthcare data, the underlying principles and observed outcomes are widely relevant across ageing societies and healthcare systems globally.
Functional Capacity and Service Demand Are Directly Linked
In home care, assisted living, and rehabilitation services, everyday reality shows a clear pattern: as mobility and basic daily functions decline, the need for services grows rapidly and becomes more demanding. Conversely, when functional capacity is supported systematically and measurably, it is possible to influence the same factors that later appear as increased care hours, hospital days, and fall-related injuries.
Beyond resources, this is also a leadership and system-design question: how to build operating models that support rehabilitative work in 24-hour care environments and how to monitor and evaluate their impact.
Significant Savings Can Result from Reduced Need for Intensive Care
In practical terms, this means examining how many individuals are able to live safely at home — or in lighter service environments — and for how long, and what this requires from a functional-capacity perspective.
The largest economic impact is typically linked to long-term institutional care and its duration. For example, Finnish regional data has indicated that if only approximately 5% of people aged 75+ require 24-hour care, national-level savings could reach close to one billion euros annually.
In Finland, the average annual cost of one 24-hour care bed has been estimated at approximately €55,000. While cost structures vary significantly between countries, the relative impact of delayed institutionalization is comparable internationally.
Strength Training Benefits Older Adults — Even in the Short Term
Research and expert discussions in international rehabilitation and gerontology contexts consistently show that measurable changes in muscle strength can occur quickly. Regular strength training twice per week over a short intervention period has been associated with approximately 10% improvements in maximal strength, which is directly linked to improved physical function.
In practical implementation, safety and individual progression are essential. Demonstrating impact also requires consistent monitoring of training adherence and before-and-after assessments.
Longer interventions show even more pronounced results. In a year-long strength training intervention conducted in residential care environments with very old participants (average age close to 90 years), improvements of up to 90% in both upper and lower limb strength were observed. Functional improvements were reflected in daily activities such as dressing and eating independently, measured through standardized functional assessment tools.
Exercise-Based Cardiac Rehabilitation: Health Benefits and Cost Reduction
In a Finnish study evaluating one-year exercise-based cardiac rehabilitation, the average annual healthcare cost per patient — including primary care, specialized care, occupational health, and rehabilitation — was €1,652 in the exercise group compared to €2,629 in the usual care group. This represented a 37% reduction in healthcare costs.
Beyond direct cost savings, quality-adjusted life years (QALY) were also significantly more favorable in the exercise group. Although national healthcare financing structures differ, the relative cost-effectiveness of structured exercise-based rehabilitation is supported by international literature.
Falls: A Major Cost Driver That Can Be Addressed
Falls represent a substantial burden on both safety and healthcare economics worldwide. In Finland alone, hospitalizations related to falls have been estimated to cost approximately €400 million annually, with around 7,000 hip fractures occurring each year as a result of falls. Similar patterns are seen in many ageing populations globally.
The Australian SUNBEAM randomized controlled trial combined progressive strength and balance training for older adults in residential care. Over a 12-month follow-up, the intervention group experienced significantly fewer falls and fall-related injuries compared to standard care. Even when accounting for the initial setup costs of training environments, the intervention was found to be cost-effective and dominant in economic modeling scenarios.
Targeting Interventions: The Role of Data and Predictive Models
When discussing cost impact, an important practical question arises: who benefits most from which intervention? Identifying individuals at higher risk of increased service usage allows resources to be allocated more effectively while still supporting overall well-being.
Recent machine-learning-based research has examined how common cardiovascular risk factors relate to healthcare costs during exercise-based cardiac rehabilitation. Diabetes, for example, was strongly associated with higher healthcare costs, explaining approximately 16% of total cost variation. When body mass index and systolic blood pressure were added to the model, predictive accuracy increased further.
In practice, this suggests that even a small number of easily identifiable risk indicators can improve forecasting of where healthcare costs are most likely to accumulate.
Functional Capacity as a Leadership and System-Level Investment
When the full chain of impact — from training and assessment to service utilization — is made visible, investment in functional capacity shifts from a budget discussion to a leadership and strategy tool.
The combined message from expert panels and international research is clear: investing in functional capacity can translate into financial savings when outcomes are measurable and verifiable. Reliable monitoring, standardized assessments, and data-driven decision-making are essential — while never losing sight of the individual patient or client and their overall well-being.
Professor Arto Hautala is a Professor of Physiotherapy and Rehabilitation and a long-term researcher in cardiovascular function and exercise-based rehabilitation. His work spans over two decades of research in exercise physiology, cardiac rehabilitation, and health economics.
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