Can Elderly Patients Who Have Had a Hip Fracture Perform Moderate- to High-Intensity Exercise at Home?

Abstract

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...

Home‐Based Leg‐Strengthening Exercise Improves Function 1 Year After Hip Fracture: A Randomized Controlled Study

“…Most exercise trials have used usual care, 33 education, 17 or recommendations for continued unsupervised exercise as the control condition 34 or nothing at all. 7 The authors of the current study believe that this is the first to use an attentional control for patients after hip fracture.…”

“…Treatment sessions occurred twice a week for 10 weeks for 20 total sessions, a frequency of visits found to be sufficient for change that was established in previous work. 17 Each session lasted approximately 30 to 40 minutes. Licensed physical therapists conducted treatment sessions for both groups.…”

“…[18][19][20] Protocols for these exercises have been reported elsewhere. 17 Briefly, subjects were positioned supine for the combination exercise of hip and knee extension (leg press) and the hip abduction exercise. Patients performed an additional hip extension exercise in a standing position and heel raises to train the ankle plantar flexors.…”

The effects of manipulation of Frequency, Intensity, Time, and Type (FITT) on exercise adherence: A meta‐analysis

“…The trials were conducted in Australia (n = 2), Canada (n = 3), England (n = 1), Norway (n = 1), and the United States (n = 13) . The intervention settings included community settings (n = 9), hospital or clinic (n = 2), laboratory (n = 12), and home (n = 2) . The number of participants included in each trial ranged from 17 to 379, with the number of women in each trial ranging from 0 to 239.…”

Design and Implementation of a Home‐Based Exercise Program Post‐Hip Fracture: The Baltimore Hip Studies Experience

“…On the basis of knowledge gained from the authors' previous 15 years of experience in studying the hip fracture patient, the research team designed a home-based program consisting of a combination of supervised and unsupervised exercise. Only a small number of studies have been conducted that examine the effect of both facility-and homebased exercise after hip fracture [17,29,[40][41][42][43][44][45]. A wide range of rates of adherence to and drop out from these programs has been reported.…”