Section 3: Exercise after a hip fracture

In Your Manual

Basics: Page 192-193 | Clinical: Page 208-209

A recent Cochrane review of mobilization strategies post osteoporotic hip-fracture suggested (Hadoll, 2007):

  • 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 et al., 2004; Hauer et al., 2002):

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 found

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
CASEINPOINT1_positive trials for hip rehab

More recent work has revealed:

  • Higher intensity, weight-bearing exercise are not better than lower intensity seated or lying exercises for mobility and balance (Moseley et al., 2009)
  • Increased muscle strength and power with 2x/wk supervised resistance training for 12 wks (Portegijs et al., 2008)
  • Arm ergometry + inpatient rehabilitation improved aerobic fitness, mobility and balance (Mendelsohn et al., 2008)

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Binder E.F., Brown, M., Sinacore, D.R., Steger-May, K., Yarasheski, K.E., Schechtman, K.B. (2004).Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial.JAMA, 292 (7), 837-46.

Handoll, H.H., Sherrington, C. (2007). Mobilisation strategies after hip fracture surgery in adults.Cochrane Database Syst Rev, 24; (1):CD001704

Hauer, K. Specht, N., Schuler, M., Bartsch, P., Oster, P. (2002). Intensive physical training in geriatricpatients after severe falls and hip surgery. Age Ageing, 31(1): 49-57.

Mendelsohn, M.E., Overend, T.J., Connelly, D.M., Petrella, R.J. (2008). Improvement in aerobic fitnessduring rehabilitation after hip fracture. Arch Phys Med Rehabil, 89(4): 609-17.

Moseley, A.M., Sherrington, C., Lord, S.R., Barraclough, E., St George, R.J., Cameron, I.D.(2009). Mobility training after hip fracture: a randomized controlled trial. Age Ageing, 38(1): 75-80.

Portegijs, E., Kallinen, M., Rantanen, T., Heinonen, A., Sihvonen, S., Alen, M., Kiviranta, I., Sipila, S. (2008). Effects of resistance training on lower-extremity impairments in older people with hip fracture. Arch Phys Med Rehabil, 89(9): 1667-74