Intensive physical training in geriatric patients after severe falls and hip surgery

BACKGROUND: Intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents. There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery. OBJECTIVE: To assess the feasibility, safety and efficacy of intensive, progressive physical training in rehabilitation after hip surgery. DESIGN: Prospective, randomised, placebo-controlled intervention study of a 3-months training intervention and a 3-months' follow-up. SETTING: Physical training 6-8 weeks after hip surgery. SUBJECTS: Twenty-eight (15 intervention, 13 control) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement. METHODS: Progressive resistance and functional training to improve strength and functional performance. RESULTS: No training-related medical problems occurred in the study group. Twenty-four patients (86%) completed all assessments during the intervention and follow-up period. Adherence was excellent in both groups (intervention: 93, 0+/-13, 5% versus control: 96, 7+/-6, 2%). Training significantly increased strength, functional motor performance and balance and reduced fall-related behavioural and emotional problems. Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training. Patients in the control group showed no change in strength, functional performance and emotional state during intervention and follow-up. CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls. Because part of the training improvements were lost after stopping the training, a continuing training regime should be established.