Feasibility of progressive strength training shortly after hip fracture surgery

Abstract

AIM:To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients. METHODS:This prospective, single-blinded cohort study evaluated 31 community-dwelling patients from four outpatient geriatric health centres aged 60 years or older, who started a 6-wk programme at a mean of 17.5 ± 5.7 d after hip fracture surgery. The intervention consisted primarily of progressive fractured kneeextension and bilateral leg press strength training (twice weekly), with relative loads commencing at 15 and increasing to 10 repetitions maximum (RM), with three sets in each session. The main measurements included progression in weight loads, hip fracture-related pain during training, maximal isometric knee-extension strength, new mobility score, the timed up and go test, the 6-min walk test and the 10-meter fast speed walk test, assessed before and after the programme. RESULTS:Weight loads in kilograms in the fractured limb knee-extension strength training increased from 3.3 ± 1.5 to 5.7 ± 1.7 and from 6.8 ± 2.4 to 7.7 ± 2.6, respectively, in the first and last 2 wk (P < 0.001). Correspondingly, the weight loads increased from 50.3 ± 1.9 to 90.8 ± 40 kg and from 108.9 ± 47.7 to 121.9 ± 54 kg in the bilateral leg press exercise (P < 0.001). Hip fracture-related pain was reduced, and large improvements were observed in the functional outcome measurements, e.g. , the 6-min walk test improved from 200.6 ± 79.5 to 322.8 ± 68.5 m (P < 0.001). The fractured limb knee-extension strength deficit was reduced from 40% to 17%, compared with the non-fractured limb. Ten patients reported knee pain as a minor restricting factor during the last 10 RM knee-extension strength-training sessions, but with no significant influences on performance. CONCLUSION:Progressive strength training, initiated shortly after hip fracture surgery, seems feasible and does not increase hip fracture-related pain. Progressive strength training resulted in improvement, although a strength deficit of 17% persisted in the fractured limb compared with the non-fractured limb. Core tip: The recovery of strength and function in patients with hip fractures is an on-going challenge. We aimed to evaluate the feasibility of a 6-wk progressive lower limb strength-training programme. To our knowledge, this was the first study to implement such a program successfully in an outpatient geriatric setting within 2-3 wk after hip fracture surgery. Training loads, muscle strength and functional performances improved without an increase in hip fracture-related pain, which

Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture: A randomised controlled trial

“…This calls for an increased focus on ST for patients with trochanteric fractures, as strength deficits are associated with larger functional deficits after HF surgery in general [1,8]. …”

Interrater Reliability of the 6-Minute Walk Test in Women With Hip Fracture

“…The age of the participants and the distribution of fracture types are considered representative compared with individuals in other studies. 11 , 50 In addition, monitoring the use of pain medication and hip pain before, during, and after the test is considered a strength of this study because pain seems to infl uence the estimates obtained in a demanding performance test such as the 6MWT, 11 as confi rmed in the present study.…”

“…On the basis of a study conducted at a municipalitybased health care center, Overgaard and Kristensen 11 reported that hip fracture-related pain seems to infl uence performance in the 6MWT approximately 2 weeks after hip fracture surgery. Therefore, a later time point of 3 to 8 weeks postsurgery was chosen in the present study, and the participants attended outpatient rehabilitation at a municipality-based health care center.…”

“…In addition, this procedure was used for the 6MWT in the previously mentioned outpatient hip fracture study. 11 Only 1 patient was using a walker at the time of testing in the present study ( Table 2 ).…”

Orthogeriatrics and Hip Fractures

“…Importantly it appears that progressive strength training should be started in hospital (83) and carried out into the rehab setting. A 6-week strength training program started after surgery was associated with decreased pain and an increase in 6-minute walk test speed (84). A 12-week resistance program resulted in improvements in gait speed, gait distance and self-rated health (85).…”