Delivery and Outcomes of a Yearlong Home Exercise Program After Hip Fracture
| Autor: | Michelle Shardell, Janet A. Yu-Yahiro, Perry L. Colvin, Barbara Resnick, Denise Orwig, William G. Hawkes, J. Richard Hebel, Sheryl Zimmerman, Ram R. Miller, Justine Golden, Marc C. Hochberg, Jay Magaziner |
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| Rok vydání: | 2011 |
| Předmět: |
Program evaluation
medicine.medical_specialty medicine.medical_treatment Psychological intervention Physical exercise Article law.invention Randomized controlled trial law Internal Medicine medicine Humans Aged Aged 80 and over Hip fracture Rehabilitation Hip Fractures business.industry medicine.disease Exercise Therapy Treatment Outcome Physical therapy Lean body mass Feasibility Studies Female business Delivery of Health Care Psychosocial Program Evaluation |
| Zdroj: | Archives of Internal Medicine. 171 |
| ISSN: | 0003-9926 |
| Popis: | Hip fracture is a common problem with devastating consequences. At present, more Than 310 000 hip fractures occur annually in the United States,1 with an estimated cost of between $14 and $20 billion.2-7 By 2050, the number of hip fractures is expected to in crease to 700 000 in the United States and almost to 4 million worldwide.8 Between 16% and 32% of patients die with in a year.9-12 Among survivors, 50% need assistance to walk and 90% need assistance to climb stairs after 1 year.13 Furthermore, there are substantial changes in body composition;including loss of bone mineral density (BMD) of 4% to 7% per year, loss of lean body mass up to 6% within 2 months, and increase in fat mass of 3% to 4% in a year.13-16 On the basis of these findings under conditions of usual hip fracture care, it is important to identify novel interventions that older patients will comply with to ameliorate significant postfracture changes in order for gains to be realized beyond the 6-month recovery plateau observed for most functioning after hip fracture.17 Exercise is generally well tolerated by older adults after hip fracture with few serious adverse events18-20 and has the potential for increasing BMD and strength. Research has shown that weight-bearing, aerobic-type exercises alone or in combination with resistance exercises can slow or halt the rate of BMD loss in postmenopausal women.21-26 Unfortunately, the success of exercise in hip fracture rehabilitation, specifically, has varied. It is notable that few previous programs with this patient group lasted more than a few months,19,20,27 most began late in the recovery period,18,28 and with few exceptions19,27,29-31 most were gym or clinic based, rather than home based, which can limit access. Therefore, we designed a yearlong exercise program that could be delivered in patients’ homes in order to overcome the limitations of an extended center-based exercise program. This study was designed to test the feasibility and identify preliminary indications of efficacy of the Exercise Plus Program, an aerobic and resistive exercise program administered after fracture by an exercise trainer in the home setting.32 We hypothesized that those randomized to the intervention, compared with those randomized to usual care (UC), would experience reduced losses in BMD, muscle mass, and strength; less increase in fat mass; greater increases in physical activity; improvements in ability to carry out physical and instrumental tasks of daily living; and increases in physical and psychosocial functioning. |
| Databáze: | OpenAIRE |
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