Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT

Background Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Methods Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged >= 60 years, Mini-Mental State Examination (MMSE) score of >= 12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Results Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. Conclusion A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.Peer reviewe

Effects of home-based physical exercise on days at home, healthcare utilization and functional independence among patients with hip fractures : a randomized controlled trial

Objective To evaluate the effects of a physical exercise program on days lived at home, the use and costs of healthcare and social services mortality and functional independence among patients with hip fractures. Design Randomized controlled trial with parallel two-group design, consisting of a 12-month intervention and 12-month registry follow-up. Setting Home-based intervention. Participants Patients with operated hip fracture, living at home, aged ≥60 years, randomized into physical-exercise (n=61) or usual-care (n=60) groups. Intervention Supervised physical exercise twice a week. Main Outcome Measures The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of healthcare and social services and mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. Results Over 24 months there was no significant difference between the groups in terms of days lived at home (Incidence Rate Ratio [IRR] 1.01 [95% CI 0.90–1.14]) or mortality (Hazard Ratio [HR] 1.01 [95% CI 0.42–2.43]). The mean total costs of healthcare and social services did not differ between the groups: over 12 months the costs per person-year were 1.26-fold (95% CI 0.87–1.86) and over 24 months 1.08-fold (95% CI 0.77–1.70) greater in the physical-exercise than in the usual-care group. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI 0.5–8.5, p=0.029) in favor of the physical-exercise group. Conclusions Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but significantly more in the physical-exercise group than in the usual-care group.peerReviewe