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

Abstract

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.

Feasibility of progressive strength training shortly after hip fracture surgery

“…Thus, reducing strength deficits should be a high priority in rehabilitation, as the incidence of falls is higher with asymmetrical lower extremity power [7] . Some trials have suggested the benefits of exercise after hip fracture [8] , but studies have most often commenced as extended programmes after standard physical therapy has ceased, 6 to 8 wk after fracture at the earliest [9][10][11][12][13][14][15][16] . To our knowledge, only one study has evaluated the effects of early 6-wk (median of 15 d postsurgery) strength training after hip fracture as an inpatient rehabilitation programme [3] .…”

Interrater Reliability of the 6-Minute Walk Test in Women With Hip Fracture

“…10 The 6MWT, as an outcome measurement, has been proposed by Gmitter et al 22 to contribute to evidence-based examinations of individuals with hip fracture and has recently become more widely used in randomized clinical trials investigating the effects of different training regimens on individuals after hip fracture surgery. [23][24][25][26] However, to the best of our knowledge, the interrater reliability of the 6MWT in individuals with hip fracture has never been investigated. This lack of information is problematic because clinicians and researchers need to know whether different raters achieve similar results when testing the same individuals.…”

Relationship between cognition and gait performance in older adults receiving physical therapy interventions in the home

“…An intensive 10 wk (2 times per wk) program of progressive resistive exercises in the home 6 mo post hip fracture discharge produced changes in gait speed compared with a control group that were maintained at the 3 mo follow-up visit [7]. Home-based walking programs in older persons living in the community have supported changes in quality of life and a shuttle stamina walk test [8].…”