Exercise Program Following Hip Fracture Linked to Improved Functional Ability in Older Adults

A secondary analysis of the HIPFRA trial indicates participation in a home-based exercise program was associated with increased functional ability and physical performance in adult patients recovering from hip fracture.

A secondary analysis of data from a randomized clinical trial suggests participation in home-based exercise programs could aid in improving functional abilities following hip fracture in older patients.

An analysis of the HIPFRA trial, which assessed the effects of a 12-month home-based, physiotherapist-supervised exercise program, results of the study indicate participation in such a program was associated with improved physical performance and ability to complete daily living activities among patients aged 60 years or older.

“It is worthwhile to invest in rehabilitation exercise for older people after hip fracture. Better functioning benefits the individual and also society,” said lead investigator Paula K. Soukkio, MSc, of the South Karelia Social and Health Care District in Finland, in a statement.

A parallel-group randomized controlled trial, the Effects of Long-term Intensive Home-based Physiotherapy on Older People With an Operated Hip Fracture or Frailty (HIPFRA) study was conducted from December 9, 2014-December 31, 2019 with the aim of comparing the effects of exercise and usual care in patients from southern Finland. With a population of 121 randomized patients, the trial’s primary analyses concluded participation in an exercise program was not associated with a significant increase in days lived at home or mortality at 24 months between the study arms. For the secondary analyses, HIPFRA investigators sought to assess the effects of randomization to the 12-month home-based physiotherapist-supervised, progressive exercise program on functioning performance and physical activity compared to randomization to usual care.

As part of the trial’s protocol, patients underwent assessment at baseline and again at months 3, 6, and 12. These assessments included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity, which served as the primary outcomes of interest for the secondary analyses. Investigators pointed out these were analyzed using mixed-effects models.

At baseline, the exercise arm and usual care arm had the mean IADL scores of 17.1 (SD, 4.5) and 17.4 (SD, 5.1), mean SPPB scores of 3.9 (SD, 1.6) and 4.2 (SD, 1.8), and handgrip strength of 17.7 (SD, 8.9) kg and 20.8 (SD, 8.0) kg, respectively.

Upon analysis, results indicated the age- and sex-adjusted mean changes in IADL at 12 months were 3.7 (95% CI, 2.8 to 4.7) in the exercise arm and 2.0 (95% CI, 1.0 to 3.0) in the usual care arm (between-group difference, P=.016). For SPPB, the age- and sex-adjusted mean changes at 12 months were 4.3 (95% CI, 3.6 to 4.9) in the exercise arm and 2.1 (95% CI, 1.5 to 2.7) in the usual care arm (between-group difference, P <.001). For handgrip strength, the age- and sex-adjusted mean changes at 12 months were 1.2 kg (0.3 to 2.0) in the exercise arm and 1.0 kg (-1.9 to 0.2) in the usual care arm (between-group difference, P <.001). Investigators pointed out there were no significant differences observed in regard to changes from baseline in frequency of leisure-time activity sessions between the study arms.

In their conclusion, investigators listed considerations for future trials and underlined the importance of further research into the effects of different exercise-based interventions in subgroups of patients with hip fracture.

“Future trials should include longer follow-up periods to determine whether booster exercise sessions every few months, for example, would help maintain the effects on functioning achieved by exercise interventions,” wrote investigators. “In addition, future trials should evaluate the effects of alternative home-based exercise implementation strategies, such as remote rehabilitation or exercise programs, on functioning and physical performance in patients with surgical repair of hip fracture."

This study, “Effects of a 12-month home-based exercise program on functioning after hip fracture–Secondary analyses of an RCT,” was published in the Journal of the American Geriatrics Society.