Delivery and outcomes of a yearlong home exercise program after hip fracture: a randomized controlled trial

Abstract

Background: Hip fracture affects more than 1.6 million persons worldwide and causes substantial changes in body composition, function, and strength. Usual care (UC) has not successfully restored function to most patients, and prior research has not identified an effective restorative program. Our objective was to determine whether a yearlong home-based exercise program initiated following UC could be administered to older patients with hip fracture and improve outcomes.

Methods: A randomized controlled trial of 180 community dwelling female patients with hip fracture, 65 years and older, randomly assigned to intervention (n = 91) or UC (n = 89). Patients were recruited within 15 days of fracture from 3 Baltimore-area hospitals from November 1998 through September 2004. Follow-up assessments were conducted at 2, 6, and 12 months after fracture. The Exercise Plus Program was administered by exercise trainers that included supervised and independently performed aerobic and resistive exercises with increasing intensity. Main outcome measures included bone mineral density of the contralateral femoral neck. Other outcomes included time spent and kilocalories expended in physical activity using the Yale Physical Activity Scale, muscle mass and strength, fat mass, activities of daily living, and physical and psychosocial functioning. The effect of intervention for each outcome was estimated by the difference in outcome trajectories 2 to 12 months after fracture.

Results: More than 80% of participants received trainer visits, with the majority receiving more than 3 quarters (79%) of protocol visits. The intervention group reported more time spent in exercise activity during follow-up (P < .05). Overall, small effect sizes of 0 to 0.2 standard deviations were seen for bone mineral density measures, and no significant patterns of time-specific between-group differences were observed for the remaining outcome measures.

Conclusion: Patients with hip fracture who participate in a yearlong, in-home exercise program will increase activity level compared with those in UC; however, no significant changes in other targeted outcomes were detected.

Trial registration: clinicaltrials.gov Identifier: NCT00390741.

Figure 1

Follow-up data available over 12 months by group. *Patient died before any follow-up visits. †Patient died after providing follow-up data.

Figure 2

Yale exercise time in hours (A) and Yale exercise kilocalories (B) expended over time in the intervention and control groups. The P value indicated on the graph pertains to a test on the null hypothesis of no between-group difference in the 2- to 12-month trajectories.

Figure 3

Effect of intervention on Yale physical activity measures. Data are given as standard effect size for exercise relative to control, with 95% confidence intervals.

Figure 4

Effect of intervention on bone and muscle (A), activities of daily living (B), performance measures (C), and 36-Item Short Form Health Survey (SF-36) subscales (D). Data are given as standard effect size for exercise relative to control, with 95% confidence intervals. BMD indicates bone mineral density; IADL, Instrumental Activities of Daily Living; LEGS, Lower Extremity Gain Scale; and LPADL, Lower Extremity Physical Activities of Daily Living.