Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?
OBJECTIVE
The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery.


METHODS
Thirty-three elderly people (24 women, 9 men; mean = 78.6 years of age, SD = 6.8, range = 64-89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group.


METHODS
Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes.


RESULTS
Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed.


CONCLUSIONS
High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained.
Mangione
Kathleen K
KK
Arcadia University, Department of Physical Therapy, Health Sciences Center, Glenside, PA 19038, USA. mangione@arcadia.edu
Craik
Rebecca L
RL
Tomlinson
Susan S
SS
Palombaro
Kerstin M
KM
D000203:Activities of Daily Living; D000222:Adaptation, Physiological; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D006233:Persons with Disabilities / Q000534:rehabilitation; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005684:Gait; D015577:Geriatric Assessment / Q000379:methods; D015438:Health Behavior; D006620:Hip Fractures / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking