Progressive strength training in older patients after hip fracture: a randomised controlled trial

Sylliaas, Hilde; Brovold, Therese; Wyller, Torgeir Bruun; Bergland, Astrid

doi:10.1093/ageing/afq167

Cited by 103 publications

(105 citation statements)

References 30 publications

(34 reference statements)

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“…Different opinions exist regarding what should be considered a meaningful improvement in gait speed after hip fracture, ranging from 0.1 [44] to 0.26 m/s for a substantial meaningful improvement [45] . We have reported improved gait speed performances, although obtained at the same [3] or at a longer interval post-surgery compared with other studies [11,15] , and we have demonstrated an average improvement of 0.25 m/s. More than 80% of the patients improved by more than 0.1 m/s.…”

Section: Objective Outcome Measuressupporting

confidence: 46%

“…These increases emphasise the importance of adjusting weight loads on a set-to-set basis, as reported in previous studies of patients after knee arthroplasty [37] , for the strength training to be progressive, compared to re-evaluation every 2-wk [3] or over a longer interval [15,16] , using a one-RM estimation for the training.…”

Section: Weight Loadmentioning

confidence: 69%

“…Natural recovery and/or less hip pain during followup testing probably should be credited to some of the large improvements observed in our study, particularly with regard to knee-extension strength and the 6MWT. Moreover, our patient group walked a mean of 323 m, compared with a mean of 297 m in a Norwegian study that examined patients after ceasing standard rehabilitation and after an additional 3 mo of rehabilitation, including strength training twice weekly plus home training once weekly [15] . In addition, 84% of our patients improved by more than 50 m, which has been considered a meaningful change for the 6MWT in older adults [42] and in patients with hip fractures (> 54 m) [43] .…”

Section: Objective Outcome Measuresmentioning

confidence: 99%

“…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] .…”

Section: Introductionmentioning

confidence: 99%

“…However, no similar studies have been conducted in community-dwelling geriatric patients with hip fractures or have succeeded in promoting the regaining of symmetrical lower limb muscle strength. In addition, most strength intervention studies have based their training intensity on the one repetition maximum (RM) level [3,[10][11][12][15][16][17] , which requires further calculations before use in clinical practice, as well as new one-RM measurements for the subsequent adjustment of training intensity. Such one-RM-based programmes challenge progressive exercise in comparison with, e.g., programmes that start with 12 repetitions and a 12-RM intensity, which in principal, allows physiotherapists to adjust weight loads after each set.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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AIM:To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients. METHODS:This prospective, single-blinded cohort study evaluated 31 community-dwelling patients from four outpatient geriatric health centres aged 60 years or older, who started a 6-wk programme at a mean of 17.5 ± 5.7 d after hip fracture surgery. The intervention consisted primarily of progressive fractured kneeextension and bilateral leg press strength training (twice weekly), with relative loads commencing at 15 and increasing to 10 repetitions maximum (RM), with three sets in each session. The main measurements included progression in weight loads, hip fracture-related pain during training, maximal isometric knee-extension strength, new mobility score, the timed up and go test, the 6-min walk test and the 10-meter fast speed walk test, assessed before and after the programme. RESULTS:Weight loads in kilograms in the fractured limb knee-extension strength training increased from 3.3 ± 1.5 to 5.7 ± 1.7 and from 6.8 ± 2.4 to 7.7 ± 2.6, respectively, in the first and last 2 wk (P < 0.001). Correspondingly, the weight loads increased from 50.3 ± 1.9 to 90.8 ± 40 kg and from 108.9 ± 47.7 to 121.9 ± 54 kg in the bilateral leg press exercise (P < 0.001). Hip fracture-related pain was reduced, and large improvements were observed in the functional outcome measurements, e.g. , the 6-min walk test improved from 200.6 ± 79.5 to 322.8 ± 68.5 m (P < 0.001). The fractured limb knee-extension strength deficit was reduced from 40% to 17%, compared with the non-fractured limb. Ten patients reported knee pain as a minor restricting factor during the last 10 RM knee-extension strength-training sessions, but with no significant influences on performance. CONCLUSION:Progressive strength training, initiated shortly after hip fracture surgery, seems feasible and does not increase hip fracture-related pain. Progressive strength training resulted in improvement, although a strength deficit of 17% persisted in the fractured limb compared with the non-fractured limb. Core tip: The recovery of strength and function in patients with hip fractures is an on-going challenge. We aimed to evaluate the feasibility of a 6-wk progressive lower limb strength-training programme. To our knowledge, this was the first study to implement such a program successfully in an outpatient geriatric setting within 2-3 wk after hip fracture surgery. Training loads, muscle strength and functional performances improved without an increase in hip fracture-related pain, which

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Section: Objective Outcome Measuressupporting

confidence: 46%

Section: Weight Loadmentioning

confidence: 69%

Section: Objective Outcome Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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Interventions for improving mobility after hip fracture surgery in adults

Fairhall

Dyer

Mak

et al. 2022

Cochrane Database of Systematic Reviews

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Effectiveness of Task Specific Gait and Balance Exercise 4 Months After Hip Fracture: Protocol of a Randomized Controlled Trial — The Eva‐Hip Study

Thingstad

Taraldsen

Hagen

et al. 2014

Physiotherapy Res Intl

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This paper describes a task specific exercise programme aimed to improve gait and balance after a hip fracture. Inclusion started in February 2011, and the last 1-year follow-up is performed in March 2014. Broad inclusion criteria and physiotherapy-guided home-based exercises may facilitate the participation from frail patients and thereby increase the generalizability of the findings. Development and completion of the intervention within routine clinical practice will enlighten the implementation of results into clinical practice. Results may add new insight into how physiotherapy can improve gait and thereby activity and functioning in everyday life and have implications on future content and organization of physiotherapy after a hip fracture.

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Progressive strength training in older patients after hip fracture: a randomised controlled trial

Cited by 103 publications

References 30 publications

Feasibility of progressive strength training shortly after hip fracture surgery

Feasibility of progressive strength training shortly after hip fracture surgery

Interventions for improving mobility after hip fracture surgery in adults

Effectiveness of Task Specific Gait and Balance Exercise 4 Months After Hip Fracture: Protocol of a Randomized Controlled Trial — The Eva‐Hip Study

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