SOURCE: American Physical Therapy Association

August 01, 2005 15:33 ET

High-Intensity Exercises Performed at Home Are Safe for Elderly With Hip Fractures

ALEXANDRIA, VA -- (MARKET WIRE) -- August 1, 2005 -- Moderate- to high-intensity exercise performed in the home are safe for elderly people with hip fractures, according to a study published in the August issue of Physical Therapy (Journal of the American Physical Therapy Association). The study indicates that those without accessibility to regular physical therapy visits or a gym may perform exercises -- resistance exercise and aerobic exercise -- in their home without adverse effects. The study indicates that those without accessibility to regular physical therapist visits or a gym may engage in exercise -- specifically resistance exercises and aerobic exercises -- in their home without adverse effects.

Physical therapists Kathleen Kline Mangione, PT, PhD, GCS, Rebecca Craik, PT, PhD, FAPTA, Susan Tomlinson, PT, DPT, and Kerstin Palombaro, PT, MS, of Arcadia University, Glenside, Pennsylvania, conducted the study.

"Most patients who have a hip fracture don't return to the level of function they had before the fracture," said Mangione. "We know that exercise and physical activity can be effective in reducing problems in elderly people who are healthy -- but we also know that elderly people with disabilities often don't have access to exercise facilities. The purpose of our study was to determine effects and feasibility of a home-based program of moderate- or high-intensity exercise among patients with a hip fracture."

The research findings were based on home-based exercise programs that were designed and implemented under the supervision of a physical therapist.

To participate in the study, patients needed to have a successful partial or total hip replacement or surgical fixation to repair the hip fracture, be 65 years of age or older, live at home, be willing to come to the university for testing, and have been discharged from physical therapy. Patients were excluded if they had a medical history of such conditions as unstable angina, stroke with residual paralysis, and Parkinson disease.

Thirty-three subjects met eligibility requirements and participated in the 12-week study. The participants were randomly divided and assigned to three separate groups: resistance exercise, aerobic exercise, and control (no exercise intervention) groups.

Participants (24 women and 9 men, mean age of 78.6 years) all had received some form of fixation technique and had some type of comorbidity, such as high blood pressure, high cholesterol, heart disease, osteoarthritis, osteoporosis, diabetes, cancer, congestive heart failure, and depression. All were also relatively independent in basic activities of daily living (bathing, grooming, etc.) but required some assistance in more complex activities such as maintaining the home or shopping.

Twelve participants completed aerobic exercise, 11 completed resistance exercise, and 10 were in the control group.

Aerobic exercise consisted of walking on level surfaces and, if the patient was able, on stairs, with increased heart rate at 65% to 75% of age-predicted maximum for 20 continuous minutes. Resistance exercise targeted bilateral hip extensor, hip abductor, knee extensor, and plantar-flexor muscles because of their importance to functional activities. Using body weight and a portable progressive-resistance exercise machine with latex bands, patients performed 3 sets of 8 repetitions at maximum intensity based on a training routine that has previously been demonstrated to increase muscle strength in elderly people.

Study results showed that rate of adherence to exercising, as measured by number of sessions attended, divided by total number of possible sessions, was 98%.

Subjects were able to attain target intensity without reporting muscle soreness or shortness of breath for 95% of sessions, and 96% of sessions were provided routinely and were not altered because of non-muscular pain. Isometric lower-extremity strength, 6-minute-walk distance, free gait speed, and self-reported physical function improved with time among all groups.

Although the study was a relatively small sample, improvement in strength was greater for exercise groups than for the control group.

"Our data showed what appears to be a relationship between depression and outcome following exercise, as measured by the six-minute-walk test and gait speed," said Craik. "That is, people who were depressed did not do as well, walking a shorter distance and more slowly after exercise than those who were not depressed. Future research should consider depressive symptoms when they're looking at walking as an outcome among elderly patients."

Study authors noted that patients who volunteer for exercise studies may already believe that exercise will help them, and giving subjects positive verbal feedback after completing a task during testing may affect outcomes.

"Our study showed that a frail, home-dwelling sample of elderly people who have had a hip fracture can safely tolerate a moderate- to high-intensity home exercise program with physical therapist-supervision," said Mangione. "Adherence was excellent." Mangione, Craik, Tomlinson, and Palombaro are members of the American Physical Therapy Association (APTA).

The American Physical Therapy Association (APTA) is a national professional organization representing more than 66,000 physical therapists, physical therapist assistants, and students. Its goal is to foster advancements in physical therapy practice, research, and education.

Contact Information