Systematic review found that following hip fracture surgery in older adults, a structured exercise program improved physical function, mobility and independence with ADLs compared to no exercise or regular physical activity. The certainty of evidence ranged from moderate to very low.

A decline in physical function and mobility and loss of skeletal muscle are commonly associated with aging and lead to increased falls risk. This systematic review aimed to examine the effects of a structured exercise program for older adults following surgery for a hip fracture.

Eight databases were searched for randomised controlled trials (RCTs) published in English and Chinese. Eligible studies included older adults following surgery for hip fracture who had no significant co-morbidities (severe cardiovascular disease; musculoskeletal, cognitive or acute neurological impairments; unstable chronic disease; terminal illness; or major depression). The intervention was any structured exercise program (resistance, weight-bearing, strength, endurance, power, balance or aerobic) labelled as ‘intense’ exercise by the authors. Intense exercise were defined as those performed > 5 days/week; at an intensity of > 60% 1 repetition maximum and > 3 sets of 8 repetitions; for > 30 minutes. The comparator was no exercise or regular, pre-trial physical activities. Physical function was the primary outcome with secondary outcomes being mobility, balance, independence with activities of daily living (ADLs) and hospital length of stay. Study selection and assessment of methodological quality, using the Cochrane Collaboration Risk of Bias tool, were performed by two authors. Evidence certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. A meta-analysis pooled the trials, with forest plots used to summarise and compare trials. A random effects model was used if significant heterogeneity was found (I2>50%). Subgroup analyses were performed according to time from surgery (<3 months, 3-6 months and 6 months – 7 years).

Fifteen trials, involving 1317 participants were included. Nine (60%) trial interventions included a combination of exercise types and eight (53%) commenced within 3 months post-fracture. Unclear or high risk of bias was present due to lack of concealed allocation (6 trials); blinding of participants or personnel (7 trials); and blinding of outcome assessors (5 trials).

There was moderate certainty evidence that compared to no exercise or regular physical activities, structured exercise programs improved physical function (SMD 0.74, 95% CI: 0.25, 1.23, n = 1019, 11 trials, I2= 58.3%); gait speed (SMD 0.15, 95% CI: 0.01, 0.30, n = 742, 8 trials, I2= 0%); timed-up and go test time (MD -4.34 s, 95% CI: -6.74, -1.94, n = 477, 6 trials, I2= 80%) and independence (SMD 0.55, 95% CI: 0.24, 0.87, n = 577, 6 trials, I2= 68%). Low certainty evidence existed for the effects of structured exercise programs on balance. There were no significant between-group differences for six-minute walk test distance or hospital length of stay (very low and low certainty evidence, respectively). Subgroup analyses revealed significant between-group differences for physical function in only the group commencing within 3 months post-operatively.

Following surgery for a hip fracture, structured exercise programs may improve physical function, mobility, and ADL independence compared to no exercise or regular physical activities. Structured exercise programs may be most effective when initiated within 3-months post-operatively.

Bai F, Leng M, Zhang Y, Guo J, Wang Z. Effectiveness of intensive versus regular or no exercise in older adults after hip fracture surgery: A systematic review and meta-analysis. Braz J Phys Ther. 2023 Jan-Feb;27(1):100482. doi: 10.1016/j.bjpt.2023.100482.

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PEDro acknowledges Dr Lara Edbrooke and Piotr Lewandowski for preparing this summary.

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