Australas J Ageing. 2019;1–11. wileyonlinelibrary.com/journal/ajag | 1 © 2019 AJA Inc. 1 | INTRODUCTION Delirium is a highly prevalent clinical syndrome which can be considered to be acute brain failure. 1,2 Symptoms of delirium include a change in level of arousal, abrupt deterioration in cognitive function, disorganised speech and new perceptual disturbances such as delusions and hallucinations. 1 Long- term complications associated with delirium are common and debilitating; one episode of delirium can set off a cascade of events that may contribute to permanent cognitive deficits, functional decline and other hospital complications including falls, fractures and even death. 1,3-7 Implementing strategies to mitigate delirium risk is essential given that approximately 40% of delirium cases may be preventable. 1,8,9 Delirium man- agement is also of critical importance, given that a longer du- ration of delirium has been associated with worse outcomes, including higher rates of mortality at 6 months following hip fracture. 10 Multi-component, non-pharmacological delirium preven- tion and management strategies such as the Hospital Elder Life Program have been found to reduce the risk of delirium, prevent functional decline and reduce the risk of falls. 11,12 Such strategies typically target the modifiable risk factors for delirium, including dehydration, vision impairment, hearing Received: 1 June 2018 | Revised: 30 January 2019 | Accepted: 31 January 2019 DOI: 10.1111/ajag.12636 REVIEW ARTICLE Delirium management: Let's get physical? A systematic review and meta-analysis Melanie Nance Haley 1 | Penelope Casey 2 | Richard Youlten Kane 2 | Pēteris Dārziņš 2 | Katherine Lawler 1 PROSPERO registration: CRD 42017074355. 1 Eastern Health, Melbourne, Victoria, Australia 2 Eastern Health and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia Correspondence Melanie Haley, Physiotherapy Department, Box Hill Hospital, Melbourne, Vic., Australia. Email: melanie.haley@easternhealth.org.au Objective: To investigate whether physical training (alone or in a multi-component intervention) is effective in preventing delirium or improving outcomes for adult patients with delirium in the hospital setting. Methods: A systematic review, qualitative synthesis and meta-analysis of ran- domised controlled trials identified by searches of electronic databases, combining key concepts of delirium and physical training (the target intervention). Outcomes were incidence of delirium (for prevention trials) and delirium duration, delirium severity and hospital outcomes (for management trials). Results: Seven trials were included, five of which were multi-component. The odds of developing delirium were lower for patients who received physical training com- pared with a control intervention [odds ratio 0.46 (95% confidence interval 0.32- 0.65), P < 0.01] (moderate-quality evidence). There was insufficient evidence to draw conclusions about managing established delirium. Conclusions: Strategies incorporating physical training appear to prevent delirium in the hospital setting. More research is required regarding management of estab- lished delirium. KEYWORDS delirium, exercise, physical activity, physical mobility, physical therapy