Objectives Examine the effectiveness of a short term leg strengthening exercise program compared to attentional control on improving strength, walking abilities, and function one year after hip fracture. Design Randomized controlled pilot study. Setting Interventions occurred in patients’ homes. Participants Community-dwelling older adults (n=26) six months post hip fracture at baseline. Intervention Exercise and control participants received interventions by physical therapists twice weekly for 10 weeks. The exercise group received high intensity leg strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery. Measurements Isometric force production of lower extremity muscles; usual and fast gait speed, six minute walk (6-MW) distance, modified physical performance test (mPPT), and SF-36 physical function. Results The primary endpoint was at one year post fracture. Isometric force production (p<.01), usual and fast gait speed (p=.02 & .03, respectively), 6-MW (p<.01), and mPPT (p<.01) improved at one year post fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for mPPT scores, 0.56 for gait speed, 0.49 for 6-MW, and 0.30 for SF-36 scores. More patients in the exercise group made meaningful changes in gait speed and 6-MW distance than control patients (χ2: p=.004). Conclusion A 10-week home-based progressive resistance exercise program was sufficient to achieve moderate to large effects on physical performance and quality of life and may offer an alternative intervention mode for hip fracture patients who are unable to leave home at 6 months after the fracture. The effects were maintained at 3 months after completion of the training program.

Background and Purpose. The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate-or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. Subjects. Thirty-three elderly people (24 women, 9 men; Xϭ78.6 years of age, SDϭ6.8, rangeϭ64 -89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. Methods. Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes. Results. Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed. Discussion and Conclusion. High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained.[Mangione KK, Craik RL, Tomlinson SS, Palombaro KM. Can elderly patients who have had a hip fracture perform moderate-to high-intensity exercise at home ? Phys Ther. 2005;85:727-739.] Key Words: Exercise, aerobic performance; Exercise, force production; Hip fractures; Home care services. H ip fracture is a common medical problem that can drastically change the quality of life for the elderly person. More than 300,000 older people are expected to fracture a hip each year 1 at an estimated cost of $5 billion. 2 It has been well established that the majority of patients with hip fracture do not return to prefracture functional status at 1 year after surgery. [3][4][5][6][7] In a study of 120 people, Marottoli et al 5 showed that, 6 months after hip fracture, only 8% climbed a flight of stairs, 15% walked across a room...

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