Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Orthop. Oct 18, 2013; 4(4): 248-258
Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.248
Feasibility of progressive strength training shortly after hip fracture surgery
Jan Overgaard, Morten T Kristensen
Jan Overgaard, Department of Rehabilitation, Municipality of Lolland, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), DK-4930 Maribo, Denmark
Morten T Kristensen, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark
Author contributions: Overgaard J and Kristensen MT contributed to the study conception and design, data interpretation, manuscript preparation and final approval of the manuscript; Overgaard J contributed to the data collection; Kristensen MT contributed to the data analysis.
Supported by The Danish Physical Therapist’s Research Fund
Correspondence to: Jan Overgaard, PT, Department of Rehabilitation, Municipality of Lolland, Physical Medicine and Rehabilitation Research-Copenhagen, Sdr. Boulevard 84, DK-4930 Maribo, Denmark. overgaard_j@hotmail.com
Telephone: +45-611-21191 Fax: +45-546-76948
Received: May 15, 2013
Revised: July 15, 2013
Accepted: September 4, 2013
Published online: October 18, 2013

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 knee-extension 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.

Keywords: Hip fracture, Resistance training, Feasibility, Repetition maximum, Pain

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 is considered new and important knowledge for all professionals aiming to improve the rehabilitation outcomes of patients with hip fractures.