Design and Implementation of a Home-based Exercise Program Post-hip Fracture: the Baltimore Hip Studies Experience

Overview

Journal PM R

Publisher Wiley

Specialties Emergency Medicine
Rehabilitation Medicine

Date 2009 Jul 25

PMID 19627913

Citations 14

Authors

Janet A Yu-Yahiro

Barbara Resnick

Denise Orwig

Gregory Hicks

Jay Magaziner

Affiliations

Soon will be listed here.

Abstract

Objective: The objectives are to describe for the first time a home-based exercise intervention for frail elderly hip fracture patients and to describe the feasibility of this exercise program.

Design: A home-based exercise program was used in a randomized controlled trial in which the authors investigated exercise intervention versus no exercise intervention in patients after hip fracture.

Setting: This program was implemented at the patients' own home or place of residence after discharge.

Participants: Women 65 years of age or older were recruited within 15 days of hip fracture. Eligible patients were those with a nonpathologic fracture who were admitted within 72 hours of injury, had surgical repair of the hip fracture, and met medical inclusion criteria. Participants initially were randomized to exercise groups and then assigned to exercise trainers.

Intervention: The exercise contained strength training and aerobic components. Participants were expected to exercise 5 days per week by performing a combination of supervised and independently performed exercise sessions. Intensity and duration were increased gradually by trainers in a standardized way. The frequency of the supervised sessions decreased as participants became more independent. Treatment fidelity visits ensured that the intervention was being delivered as intended across trainers and across participants.

Main Outcome Measurement: This work describes the feasibility and challenges of administering an intensive home-based exercise program in this population of older adults.

Results: Of those patients randomized to exercise, 82% were followed by a trainer and almost all advanced to higher levels in both aerobic and strength programs. Overall, participants received an average of 44 (78.5%) of the prescribed visits by the trainer.

Conclusions: This study showed that it was possible to engage a frail older population of post-hip fracture patients in a program of aerobic and strength training exercise with a high rate of participation.

Citing Articles

Emerging trends and prospects in telerehabilitation for hip fracture: Bibliometric and visualization study.

Wang L, Wang X, Zhang R, He C Digit Health. 2024; 10:20552076241255465.

PMID: 38798887 PMC: 11128182. DOI: 10.1177/20552076241255465.

Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials.

Phang J, Lim Z, Yee W, Tan C, Kwan Y, Low L BMC Musculoskelet Disord. 2023; 24(1):417.

PMID: 37231406 PMC: 10210378. DOI: 10.1186/s12891-023-06512-9.

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map.

Welch V, Mathew C, Babelmorad P, Li Y, Ghogomu E, Borg J Campbell Syst Rev. 2023; 17(3):e1175.

PMID: 37051456 PMC: 8988637. DOI: 10.1002/cl2.1175.

Effects of Exercise or Mechanical Stimulation on Bone Development and Bone Repair.

Song L Stem Cells Int. 2022; 2022:5372229.

PMID: 36213684 PMC: 9534715. DOI: 10.1155/2022/5372229.

Interventions for improving mobility after hip fracture surgery in adults.

Fairhall N, Dyer S, Mak J, Diong J, Kwok W, Sherrington C Cochrane Database Syst Rev. 2022; 9:CD001704.

PMID: 36070134 PMC: 9451000. DOI: 10.1002/14651858.CD001704.pub5.

References

Binder E, Brown M, Sinacore D, Steger-May K, Yarasheski K, Schechtman K . Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA. 2004; 292(7):837-46. DOI: 10.1001/jama.292.7.837. View

Sherrington C, Lord S, Herbert R . A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Arch Phys Med Rehabil. 2004; 85(5):710-6. DOI: 10.1016/s0003-9993(03)00620-8. View

Buchner D, Cress M, Wagner E, de Lateur B, Price R, Abrass I . The Seattle FICSIT/MoveIt study: the effect of exercise on gait and balance in older adults. J Am Geriatr Soc. 1993; 41(3):321-5. DOI: 10.1111/j.1532-5415.1993.tb06711.x. View

Resnick B, DAdamo C, Shardell M, Orwig D, Hawkes W, Hebel J . Adherence to an Exercise Intervention Among Older Women Post Hip Fracture. J Clin Sport Psychol. 2010; 2(1):41-56. PMC: 2859720. DOI: 10.1123/jcsp.2.1.41. View

Binder E, Schechtman K, Ehsani A, Steger-May K, Brown M, Sinacore D . Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc. 2002; 50(12):1921-8. DOI: 10.1046/j.1532-5415.2002.50601.x. View

Barnes B, Dunovan K . Functional outcomes after hip fracture. Phys Ther. 1987; 67(11):1675-9. DOI: 10.1093/ptj/67.11.1675. View

McKee K, Orbell S, Austin C, Bettridge R, Liddle B, Morgan K . Fear of falling, falls efficacy, and health outcomes in older people following hip fracture. Disabil Rehabil. 2002; 24(6):327-33. DOI: 10.1080/09638280110093686. View

Sherrington C, Lord S . Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial. Arch Phys Med Rehabil. 1997; 78(2):208-12. DOI: 10.1016/s0003-9993(97)90265-3. View

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

10.

Handoll H, Sherrington C, Parker M . Mobilisation strategies after hip fracture surgery in adults. Cochrane Database Syst Rev. 2004; (4):CD001704. DOI: 10.1002/14651858.CD001704.pub2. View

11.

Braithwaite R, Col N, Wong J . Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003; 51(3):364-70. DOI: 10.1046/j.1532-5415.2003.51110.x. View

12.

Healy B . Weak and feeble bones no more: the National Osteoporosis Foundation speaks out. J Womens Health. 1998; 7(9):1067-8. DOI: 10.1089/jwh.1998.7.1067. View

13.

Madsen O, Lauridsen U . Knee extensor and flexor strength in elderly women after recent hip fracture: assessment by the Cybex 6000 dynamometer of intra-rater inter-test reliability. Scand J Rehabil Med. 1995; 27(4):219-26. View

14.

Tinetti M, Baker D, Gottschalk M, Garrett P, McGeary S, Pollack D . Systematic home-based physical and functional therapy for older persons after hip fracture. Arch Phys Med Rehabil. 1997; 78(11):1237-47. DOI: 10.1016/s0003-9993(97)90338-5. View

15.

Dirschl D, Henderson R, Oakley W . Accelerated bone mineral loss following a hip fracture: a prospective longitudinal study. Bone. 1997; 21(1):79-82. DOI: 10.1016/s8756-3282(97)00082-3. View

16.

Fransen M, McConnell S, Bell M . Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev. 2003; (3):CD004286. DOI: 10.1002/14651858.CD004286. View

17.

Rose S, Maffulli N . Hip fractures. An epidemiological review. Bull Hosp Jt Dis. 2000; 58(4):197-201. View

18.

Resnick B, Orwig D, Yu-Yahiro J, Hawkes W, Shardell M, Hebel J . Testing the effectiveness of the exercise plus program in older women post-hip fracture. Ann Behav Med. 2007; 34(1):67-76. DOI: 10.1007/BF02879922. View

19.

Halm E, Magaziner J, Hannan E, Wang J, Silberzweig S, Boockvar K . Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Arch Intern Med. 2003; 163(1):108-13. DOI: 10.1001/archinte.163.1.107. View

20.

Mangione K, Craik R, Tomlinson S, Palombaro K . Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?. Phys Ther. 2005; 85(8):727-39. View