A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture

Objective: To compare the effects of weight-bearing and non-weight-bearing home exercise programs and a control program on physical ability (strength, balance, gait, functional performance) in older people who have had a hip fracture. Design: Randomized controlled trial with 4-month follow-up. Setting: Australian community-dwellers (82%) and residents of aged care facilities who had completed usual care after a fall-related hip fracture. Participants: One hundred twenty older people entered the trial, 40 per group (average age +/- standard deviation, 79+/-9y) and 90% completed the 4-month retest. Intervention: Home exercise prescribed by a physical therapist. Main Outcome Measures: Strength, balance, gait, and functional performance. Results: At the 4-month retest, there were differences between the groups in the extent of improvement since the initial assessment for balance (F-10,F-196 = 2.82, P<.001) and functional performance (F-6,F-200=3.57, P<.001), but not for strength (F-12,F-190=1-09, P=.37) or gait (F-8,(200)=.39, P=.92). The weight-bearing exercise group showed the greatest improvements in measures of balance and functional performance (between-group differences of 30%-40% of initial values). Conclusions: A weight-bearing home exercise program can improve balance and functional ability to a greater extent than a non-weight-bearing program or no intervention among older people who have completed usual care after a fall-related hip fracture.