Randomized controlled trial of quadriceps training after proximal femoral fracture

Mitchell, Sarah; Stott, David J.; Martin, B. J.; Grant, S.

doi:10.1191/026921501676849095

Cited by 83 publications

(116 citation statements)

References 18 publications

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“…Hip fractures are associated with poorer survival [1] , a greater than 50% loss of fractured lower limb strength within a few week after surgery [2][3][4] and the return of only poor functional mobility within 4 mo [5] . Knee extensor muscle strength is an independent predictor of falls within 6 mo of hip fracture [6] .…”

Section: Introductionmentioning

confidence: 99%

“…Some trials have suggested the benefits of exercise after hip fracture [8] , but studies have most often commenced as extended programmes after standard physical therapy has ceased, 6 to 8 wk after fracture at the earliest [9][10][11][12][13][14][15][16] . To our knowledge, only one study has evaluated the effects of early 6-wk (median of 15 d postsurgery) strength training after hip fracture as an inpatient rehabilitation programme [3] . However, no similar studies have been conducted in community-dwelling geriatric patients with hip fractures or have succeeded in promoting the regaining of symmetrical lower limb muscle strength.…”

Section: Introductionmentioning

confidence: 99%

“…However, no similar studies have been conducted in community-dwelling geriatric patients with hip fractures or have succeeded in promoting the regaining of symmetrical lower limb muscle strength. In addition, most strength intervention studies have based their training intensity on the one repetition maximum (RM) level [3,[10][11][12][15][16][17] , which requires further calculations before use in clinical practice, as well as new one-RM measurements for the subsequent adjustment of training intensity. Such one-RM-based programmes challenge progressive exercise in comparison with, e.g., programmes that start with 12 repetitions and a 12-RM intensity, which in principal, allows physiotherapists to adjust weight loads after each set.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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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

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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“…During the last decades, resistance training has emerged as an effective method to induce muscle hypertrophy and increase muscle strength and functional performance in frail elderly (12,21) and in patients with chronic diseases (10,23,26). Furthermore there is increasing evidence that resistance training used in the late postoperative phase is an effective method to restore muscle function in elderly patients (22,34,42). Despite this, resistance training is still rarely used in the rehabilitation of elderly patients and especially in the elderly who have been hospitalized.…”

mentioning

confidence: 99%

Resistance training induces qualitative changes in muscle morphology, muscle architecture, and muscle function in elderly postoperative patients

Suetta

Andersen²,

Dalgas³

et al. 2008

Journal of Applied Physiology

155

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Magnusson SP, Kjaer M. Resistance training induces qualitative changes in muscle morphology, muscle architecture, and muscle function in elderly postoperative patients. J Appl Physiol 105: 180 -186, 2008. First published April 17, 2008 doi:10.1152/japplphysiol.01354.2007.-Although the negative effects of bed rest on muscle strength and muscle mass are well established, it still remains a challenge to identify effective methods to restore physical capacity of elderly patients recovering from hospitalization. The present study compared different training regimes with respect to muscle strength, muscle fiber size, muscle architecture, and stair walking power in elderly postoperative patients. Thirty-six patients (60 -86 yr) scheduled for unilateral hip replacement surgery due to hip osteoarthritis were randomized to either 1) resistance training (RT: 3/wk ϫ 12 wk), 2) electrical stimulation (ES: 1 h/day ϫ 12 wk), or 3) standard rehabilitation (SR: 1 h/day ϫ 12 wk). All measurements were performed at baseline, at 5 wk and 12 wk postsurgery. After 12 wk of resistance training, maximal dynamic muscle strength increased by 30% at 60°/s (P Ͻ 0.05) and by 29% at 180°/s (P Ͻ 0.05); muscle fiber area increased for type I (ϩ17%, P Ͻ 0.05), type IIa (ϩ37%, P Ͻ 0.05), and type IIx muscle fibers (ϩ51%, P Ͻ 0.05); and muscle fiber pennation angle increased by 22% and muscle thickness increased by 15% (P Ͻ 0.05). Furthermore, stair walking power increased by 35% (P Ͻ 0.05) and was related to the increase in type II fiber area (r ϭ 0.729, P Ͻ 0.05). In contrast, there was no increase in any measurement outcomes with electrical stimulation and standard rehabilitation. The present study is the first to demonstrate the effectiveness of resistance training to induce beneficial qualitative changes in muscle fiber morphology and muscle architecture in elderly postoperative patients. In contrast, rehabilitation regimes based on functional exercises and neuromuscular electrical stimulation had no effect. The present data emphasize the importance of resistance training in future rehabilitation programs for elderly individuals.aging; muscle power; exercise SARCOPENIA HAS LONG BEEN RECOGNIZED as a major cause of loss in muscle strength with old age. In fact, aging and disuse are two of the main conditions leading to skeletal muscle atrophy in humans. In both conditions, the loss of muscle mass leads to a decrease in muscle force production, and recent evidence suggests that a significant additional contribution might come from changes in muscle architecture (38,39). However, only a few studies have examined changes in muscle architecture and muscle fiber morphology in response to aging and physical training, and although the results suggest that a significant plasticity exists, there is generally a lack of data as to what extent different conditioning stimuli may affect muscle architecture in elderly individuals recovering from hospitalization.The loss of muscle mass with aging accelerates from the sixth decade onword, partly owing to a de...

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“…Interestingly, it has been suggested that increasing muscle strength and power by resistance training may also reduce pain in osteoarthritis 35 . Supervised progressive resistance training is feasible and effective within a few months in healthy older women 28 , in frail older people 36 , and in clinical populations 35 , even shortly after surgery 37 or hip fracture 38 . In addition, it may be beneficial for mobility in people with mobility limitation [35][36][37][38][39] and may therefore be a potentially effective intervention when included in the rehabilitation protocol.…”

Section: Discussionmentioning

confidence: 99%