Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT

Paula K Soukkio, Sara A Suikkanen, Katriina T Kukkonen-Harjula, Hannu Kautiainen, Markku T Hupli, Eeva M Aartolahti, Sanna M Kääriä, Kaisu H Pitkälä, Sarianna Sipilä, Paula K Soukkio, Sara A Suikkanen, Katriina T Kukkonen-Harjula, Hannu Kautiainen, Markku T Hupli, Eeva M Aartolahti, Sanna M Kääriä, Kaisu H Pitkälä, Sarianna Sipilä

Abstract

Background: Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity.

Methods: Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged ≥60 years, Mini-Mental State Examination (MMSE) score of ≥12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months 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. Analyzed using mixed-effects models.

Results: Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions.

Conclusion: A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.

Keywords: functioning; hip fracture; home-based exercise; physical performance.

Conflict of interest statement

Authors Aartolahti, Kääriä, Pitkälä, Sipilä, and Kautiainen have no conflicts of interest. Authors Hupli, Kukkonen‐Harjula, Soukkio, and Suikkanen have been employed by the study implementer and financier, South Karelia Social and Health Care District (Eksote), Finland. As the principal investigator of the study and the head of the rehabilitation unit at the South Karelia Social and Health Care District, Hupli received funds for the study from The Social Insurance Institution of Finland and the State Research Funding for Academic Health Research (Ministry of Social Affairs and Health, through Helsinki University Hospital [HUS], Finland). Soukkio and Suikkanen also received personal research funds from Eksote.

© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study
FIGURE 2
FIGURE 2
Mean changes in Instrumental activities of daily living (IADL) (A), Short Physical Performance Battery (SPPB) (B), and handgrip strength (C) in Exercise (n = 61) and Usual care (n = 60) at 3, 6 and 12 months from baseline. Adjusted for age and sex. Whiskers represent 95% confidence intervals.
FIGURE 3
FIGURE 3
Mean changes in the weekly frequency of walking and other leisure‐time physical activities (for at least half an hour at a time) in Exercise (n = 61) and Usual care (n = 60) at 3, 6, and 12 months from baseline. Exercise intervention sessions are not included. Adjusted for age and sex. Whiskers denote 95% confidence intervals.

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