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Training-Induced Strength and Functional Adaptations After Hip Fracture

HH Host, PT, PhD, is Research Technician II/Lecturer, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, St Louis, MO 63108 (USA)
DR Sinacore, PT, PhD, FAPTA, is Associate Professor, Program in Physical Therapy and Department of Internal Medicine, Washington University School of Medicine
KL Bohnert, MS, is Research Patient Coordinator, Program in Physical Therapy, Washington University School of Medicine
K Steger-May, MA, is Senior Statistical Data Analyst in the Division of Biostatistics, Washington University School of Medicine
M Brown, PT, PhD, FAPTA, is Professor, Physical Therapy Program, University of Missouri-Columbia, Columbia, Mo
EF Binder, MD, is Assistant Professor of Medicine, Department of Internal Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine

Address all correspondence to Dr Host at: hosth{at}msnotes.wustl.edu

Background and Purpose: At 3 months after hip fracture, most people are discharged from physical therapy despite residual muscle weakness and overall decreased functional capabilities. The purposes of this study were: (1) to determine, in frail elderly adults after hip fracture and repair, whether a supervised 6-month exercise program would result in strength gains in the fractured limb equivalent to the level of strength in the nonfractured limb; (2) to determine whether the principle of specificity of training would apply to this population of adults; and (3) to determine the relationship between progressive resistance exercise training (PRT) intensity and changes in measures of strength and physical function.

Subjects: The study participants were 31 older adults (9 men and 22 women; age [±SD], 79±6 years) who had surgical repair of a hip fracture that was completed less than 16 weeks before study enrollment and who completed at least 30 sessions of a supervised exercise intervention.

Methods: Participants completed 3 months of light resistance and flexibility exercises followed by 3 months of PRT. Tests of strength and function were completed at baseline, before PRT, and after PRT.

Results: After PRT, the subjects increased knee extension and leg press 1-repetition maximum by 72%±56% and 37%±30%, respectively. After 3 and 6 months of training, lower-extremity peak torques all increased. Specificity of training appeared to apply only to the nonfractured limb after PRT. Strong correlations were observed between training intensity and lower-extremity strength gains as well as improvements in measures of physical function.

Discussion and Conclusion: Frail elderly adults after hip fracture can benefit by extending their rehabilitation in a supervised exercise setting, working at high intensities in order to optimize gains in strength and physical function.