title: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00390741.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, 21201, USA. dorwig@epi.umaryland.edu
authors.forename: Denise L
authors.initials: DL
authors.lastname: Orwig
authors.forename: Marc
authors.initials: M
authors.lastname: Hochberg
authors.forename: Janet
authors.initials: J
authors.lastname: Yu-Yahiro
authors.forename: Barbara
authors.initials: B
authors.lastname: Resnick
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkes
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.forename: J Richard
authors.initials: JR
authors.lastname: Hebel
authors.forename: Perry
authors.initials: P
authors.lastname: Colvin
authors.forename: Ram R
authors.initials: RR
authors.lastname: Miller
authors.forename: Justine
authors.initials: J
authors.lastname: Golden
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D015397:Program Evaluation; D016896:Treatment Outcome