Research Summary: Hip Fractures & Exercise

3.3.1 Post Hip Fracture Exercise

A recent Cochrane review²¹ of mobilization strategies post osteoporotic hip-fracture suggested:

• There is insufficient evidence overall to establish the effectiveness of the reviewed mobilization strategies used in rehabilitation after hip fracture surgery (including physiotherapy, treadmill, resistance training & electrical stimulation)
• Limited number of trials, limited power
• Little information about persistence

Two positive RCT studies (Binder ³, Hauer ²²):

Concluded that improved mobility occurred with intensive, supervised ongoing exercise/therapy, specifically with significant differences between the exercise and control groups in the following measurements:

• Improved walking velocity
• Less need of walking aid
• Improved measures on the Physical Performance Test
• Improved Stair climbing
• Increased leg extensor strength, decreased fear of falling, improved balance

Interestingly, no change in BMD was found²

What were the characteristics of these two positive trials?

• Exercise was prescribed for 3x/wk for 3 months or 6 months
• Patients were supervised in an outpatient centre, using machines
• Progressive resistive training at 70-90% or 65% max
• Included functional training – walking, stepping, balance activities

More recent work has revealed:

• Higher intensity, weight-bearing exercise are not better than lower intensity seated or lying exercises for mobility and balance ⁴⁰
• Increased muscle strength and power with 2x/wk supervised resistance training for 12 wks ⁴³
• Arm ergometry + inpatient rehabilitation improved aerobic fitness, mobility and balance ³⁸

3.3.2. Conflicting Reviews on Walking Benefits

Cochrane Review:  Exercise for preventing and treating osteoporosis in postmenopausal women^4,5

• 3 studies utilizing walking programs
• comparison to control groups
• walking program: high intensity, 3x/wk, 30-45 minutes
• analyzed results showed walking to have a positive effect on the BMD of spine 1.31[95%CI (-0.03 to 2.65)] and the hip 0.92 [95%CI(0.21 to1.64)]

Author’s conclusion: Walking resulted in statistically significant improvements of BMD in lumbar spine and hip. The authors suggest that this program may be easiest, simplest and best program for implementation long-term.

Meta-analysis of walking for preservation of bone mineral density in postmenopausal women³⁴

• Meta-analysis carried out in line with Cochrane Collaboration guidelines
• 8 walking studies reviewed – 5 RCT studies and 3 non-randomized trials
• All utilized control groups
• Walking program amongst 8 studies varied (self-paced, brisk pace, pace based on heart rate, treadmill walking & outdoor walking)
  • 8 showed relative change in lumbar spine BMD of 0.39%
  • 5 studies examined femoral neck BMD – a relative change of 0.35%

Author’s conclusions: walking as a singular exercise intervention is not sufficient to preserve BMD at the spine or hip in post-menopausal women. The effects on BMD may be clinically too small to impact reduction of fractures.