PM&R
Volume 1, Issue 4 , Pages 308-318, April 2009

Design and Implementation of a Home-Based Exercise Program Post-Hip Fracture: The Baltimore Hip Studies Experience

  • Janet A. Yu-Yahiro, PhD

      Affiliations

    • Department of Orthopaedic Research, The Union Memorial Hospital, 3333 N. Calvert Street, Suite 400, Baltimore, MD 21218†
    • Corresponding Author InformationAddress correspondence to J.A.Y.-Y, c/o Grace Nasrallah, Assistant Editor
    • ,
  • Barbara Resnick, PhD

      Affiliations

    • Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD‡
    • ,
  • Denise Orwig, PhD

      Affiliations

    • Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD§
    • ,
  • Gregory Hicks, PhD

      Affiliations

    • Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD
    • ,
  • Jay Magaziner, PhD

      Affiliations

    • Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD∥

Received 26 June 2008; accepted 6 February 2009.

Objective

The objectives are to describe for the first time a home-based exercise intervention for frail elderly hip fracture patients and to describe the feasibility of this exercise program.

Design

A home-based exercise program was used in a randomized controlled trial in which the authors investigated exercise intervention versus no exercise intervention in patients after hip fracture.

Setting

This program was implemented at the patients' own home or place of residence after discharge.

Participants

Women 65 years of age or older were recruited within 15 days of hip fracture. Eligible patients were those with a nonpathologic fracture who were admitted within 72 hours of injury, had surgical repair of the hip fracture, and met medical inclusion criteria. Participants initially were randomized to exercise groups and then assigned to exercise trainers.

Intervention

The exercise contained strength training and aerobic components. Participants were expected to exercise 5 days per week by performing a combination of supervised and independently performed exercise sessions. Intensity and duration were increased gradually by trainers in a standardized way. The frequency of the supervised sessions decreased as participants became more independent. Treatment fidelity visits ensured that the intervention was being delivered as intended across trainers and across participants.

Main Outcome Measurement

This work describes the feasibility and challenges of administering an intensive home-based exercise program in this population of older adults.

Results

Of those patients randomized to exercise, 82% were followed by a trainer and almost all advanced to higher levels in both aerobic and strength programs. Overall, participants received an average of 44 (78.5%) of the prescribed visits by the trainer.

Conclusions

This study showed that it was possible to engage a frail older population of post-hip fracture patients in a program of aerobic and strength training exercise with a high rate of participation.

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  • † Disclosure: 7A, Aussio Pharmaceuticals Study;8A, HIP Fracture Study, NIA-R01AG018668.
  • ‡ Disclosure: nothing to disclose.
  • § Disclosure: nothing to disclose.
  •  Disclosure: nothing to disclose.
  • ∥ Disclosure: 2A, Consulted Merck and Navartis, DSMB Member on Hip Fracture Project; 7A, Novartis Zoledronic Acid Study; 8A, Hip Fracture Study NIA-R01-AG018668).

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 This work was supported by the National Institutes of Health NIA Grant RO1 AG17082-01, Principal Investigator Barbara Resnick, PhD, CRNP, FAAN, FAANP, and the National Institutes of Health NIA Grant R37 AG09901, Principal Investigator Jay Magaziner, PhD, MSHyg. The work was also supported by the Claude D. Pepper Center at the University of Maryland (Health, Exercise, and Rehabilitation) and was funded by Grant P60 AG12583 from the National Institutes on Aging.

PII: S1934-1482(09)00144-0

doi:10.1016/j.pmrj.2009.02.008

PM&R
Volume 1, Issue 4 , Pages 308-318, April 2009

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