title: Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial.
abstract: BACKGROUND
  Excess mortality and residual disability are common after hip fracture.
  
  
  OBJECTIVE
  Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture.
  
  
  METHODS
  Randomized, controlled, parallel-group superiority study.
  
  
  METHODS
  Outpatient clinic
  
  
  METHODS
  Patients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007.
  
  
  METHODS
  Twelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support.
  
  
  RESULTS
  Functional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization.
  
  
  RESULTS
  Risk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04-0.91]; P < .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04-0.64]; P < .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P < .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P < .0001-.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P < .0001-.05).
  
  
  CONCLUSIONS
  The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care.
authors.affiliation: Department of Aged Care, Balmain and Royal Prince Alfred Hospitals, Balmain and Camperdown, Australia.
authors.forename: Nalin A
authors.initials: NA
authors.lastname: Singh
authors.forename: Susan
authors.initials: S
authors.lastname: Quine
authors.forename: Lindy M
authors.initials: LM
authors.lastname: Clemson
authors.forename: Elodie J
authors.initials: EJ
authors.lastname: Williams
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Williamson
authors.forename: Theodora M
authors.initials: TM
authors.lastname: Stavrinos
authors.forename: Jodie N
authors.initials: JN
authors.lastname: Grady
authors.forename: Tania J
authors.initials: TJ
authors.lastname: Perry
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Lloyd
authors.forename: Emma U R
authors.initials: EU
authors.lastname: Smith
authors.forename: Maria A Fiatarone
authors.initials: MA
authors.lastname: Singh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009026:Mortality / Q000639:trends*; D009517:New South Wales / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D055070:Resistance Training / Q000379:methods*; D055948:Sarcopenia