| | Improvement in Aerobic Fitness During Rehabilitation After Hip FractureAbstract Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture. ObjectiveTo evaluate the effect of an upper-body exercise program on cardiorespiratory fitness in older adults with hip fracture during inpatient rehabilitation. DesignRandomized controlled trial using a convenience sample. SettingAn inpatient rehabilitation unit. ParticipantsTwenty older patients (age, 81.3±7.2y; 14 women). InterventionPatients were randomly assigned to a control group (n=10) or a training group (n=10). Both groups attended physical and occupational therapy sessions 5 times a week during rehabilitation (mean length of stay, 32.9±5.3d). Patients in the training program used an arm crank ergometer 3 times a week for 4 weeks. Main Outcome MeasurePeak oxygen consumption (Vo2peak). ResultsVo2peak increased significantly in the training group (8.9±1.4 to 10.8±1.7mL·kg−1·min−1) and did not change in the control group (8.9±1.2 to 8.8±1.6mL·kg−1·min−1). At discharge, both groups were significantly improved in all functional outcome measures (Timed Up & Go [TUG] test, Berg Balance Scale [BBS], FIM instrument, two-minute walk test [2MWT], and ten-minute walk test [10MWT]). The training group performed significantly better in mobility (TUG, 2MWT, 10MWT) and balance (BBS) compared with the control group. There was a significant correlation between Vo2peak and the 2MWT (r=.81) and 10MWT (r=.85) in the training group at discharge. ConclusionsThe upper-body exercise program had a significant effect on aerobic power. Our results suggest that aerobic endurance exercise should be integrated into standard rehabilitation to enhance patients’ aerobic fitness and mobility after hip fracture surgery. HIP FRACTURE IS A PRIMARY cause of morbidity, premature institutionalization, and mortality in older adults,1, 2 with its world incidence projected to rise from 1.7 million people in 1990 to approximately 6.3 million by 2050.3 Mortality is estimated to be 24% at 12 months after hip fracture.4, 5 A significant number of patients with hip fracture do not return to their prefracture functional status by 1 year after surgery.6, 7 In addition, 55% of patients report that they cannot walk as well as they did before the fracture even after rehabilitation.8, 9 At 12 months postfracture, fewer than 50% of survivors can walk unaided, and only 40% can perform activities of daily living (ADLs) independently.7, 10 With such high morbidity rates, it is clear that hip fracture patients require intensive rehabilitation to achieve a quality of life (QOL) similar to what they experienced before the fracture. Some studies11, 12 have questioned what is the best location for rehabilitation; however, a significant proportion of older adults receive care in various geriatric and rehabilitation units.13 Aerobic fitness, a determinant of functional independence, describes the overall function of the cardiovascular and respiratory systems.14 The aerobic fitness level of older adults is a primary determinant of health and morbidity and thus serves as a powerful predictor of QOL and independent living.14, 15 Exercise training in older adults improves physical fitness and provides protection against several chronic diseases related to aging.16, 17 Such training may also help older patients regain an independent lifestyle.16 Intervention trials that have used rehabilitation programs have consistently shown improvement in physical function after hip fracture.13, 18, 19, 20, 21, 22, 23, 24, 25 Other research13, 22, 26, 27 has suggested that after hip fracture in older adults, functional performance can be substantially affected by small improvements in physiologic capacity (including improvements in muscle strength), by early mobilization, and by more intensive rehabilitation programs (increased physical therapy [PT] treatments). An increase in fitness may thus be a predictor of rehabilitation outcomes and function. In patients who have had elective hip arthroplasty, exercise training has been effective in improving cardiopulmonary function.28, 29 Cardiorespiratory fitness typically is not measured in settings where hip fracture is treated. To our knowledge, there have been no studies of the effect of an aerobic component in rehabilitation programs in restoring patients with hip fracture to an optimal functional status. Most patients with hip fracture can ambulate a few days after surgery, but precautions are taken to protect the surgical repair and hence, certain movements are restricted. In addition, pain may limit lower-extremity exercise and consequently, alternate exercise modalities must be considered. In this study, we evaluated the effect of an upper-body arm crank exercise–training program on cardiorespiratory fitness and physical function of older adults with hip fracture during an inpatient rehabilitation program. Our primary purpose was to compare aerobic capacity (Vo2peak) between the training group (upper-body exercise plus standard care rehabilitation) and the control group (standard rehabilitation care only). We hypothesized that the training group would show greater improvements in Vo2peak and physical function compared with the control group. A secondary purpose was to determine relationships between the primary outcome measure (Vo2peak) and secondary (functional outcome) measures. Methods  Participants All patients admitted from September 2006 through July 2007 to a specialized inpatient musculoskeletal rehabilitation program in London, ON, Canada, were screened for participation in the study. Inclusion criteria were that a patient had a unilateral hip fracture and a weight-bearing status of at least 25%, as determined by an orthopedic surgeon. Patients were excluded if they had limited cognitive function (Mini-Mental State Examination [MMSE] score of <24), unstable cardiovascular disease (eg, New York Heart Association class 2–4 congestive heart failure, uncontrolled hypertension, unstable angina), unstable chronic obstructive lung disease, limited visual capacity, unstable metabolic disease (eg, uncontrolled diabetes mellitus), language, vision, or hearing barriers that could limit participation, or any medical problems other than the hip fracture that could interfere with their rehabilitation and the required measurements of function. Our university and hospital review boards for ethical research in humans approved the study and all patients gave their written informed consent prior to their participation. Design and Procedure Subjects performed an incremental exercise test to volitional exhaustion on a custom-built arm crank ergometer twice within 48 hours of admission (to establish reproducibility and/or stability of subjects and to control for any learning effect), and once within 48 hours before discharge. All secondary outcome measures of function were performed within 48 hours after admission and again 48 hours before discharge. After the initial incremental exercise test, we used a balanced randomization technique to assign subjects into a training group (n=10 [3 men, 7 women]) that received standard rehabilitation care plus upper-body exercise, or a control group (n=10 [3 men, 7 women]) that received only standard rehabilitation care. Subjects were randomly assigned to either the control or training group by drawing labels out of an envelope. Labels numbered 1 (n=10) or 2 (n=10) were placed in an envelope. Once a label was drawn and the subject assigned, the label was not placed back into the envelope. Subjects were informed before the exercise test that they would be assigned to 1 of the 2 groups, but there was no way for them to know whether the training group would have a better outcome than the control group. Both groups were admitted to a standard rehabilitation care program after being discharged from acute care or short-term convalescent care. Intensive rehabilitation sessions (including PT and occupational therapy [OT]) were conducted Monday through Friday (≈45min/session) for a period of 4 weeks. Each session included range of motion, flexibility, and strengthening exercises, balance, gait, and stair retraining, plus training in ADLs (eg, assistive device use, coordination, dressing, grooming, eating and drinking, transferring in and out of bed, rising from a chair, going up and down stairs). Incremental arm crank ergometer exercise test All subjects performed an incremental maximal exercise test in a fully upright sitting position using a custom-built arm crank ergometer (modified from a supine exercise cycle for cardiac patients) that was interfaced with a computer to control the exercise work rate. Subjects were instructed not to perform any vigorous exercise 24 hours before the exercise assessments, and to abstain from caffeinated beverages or nicotine for at least 2 hours before each test. The height of the crank axis was individually adjusted to heart level at a distance that caused a slight flexion of the elbow in the extended arm.30 All tests began with 2 minutes of seated rest, followed by a 3-minute warm-up with no load, during which the subjects became familiar with the working position. After a further 2 minutes of seated rest, exercise began at a power output of 0W for 1 minute, then with increments of 5W (men) and 2W (women) every minute. The cadence for arm cranking was 60 revolutions per minute (rpm). The load was increased until the subject was exhausted, for example, when he/she could no longer maintain the rate of arm cranking (a decrease of more than 5rpm despite verbal encouragement). Oxygen uptake (V̇o2), carbon dioxide production, respiratory exchange ratio (RER), and heart rate were measured using a portable, breath-by-breath, metabolic unit (Cosmed K4b2).a The Cosmed K4b2 is a lightweight (925g) system worn on the subject’s torso and includes a facemask and turbine flowmeter that allows real-time data collection of oxygen consumption. A validation study comparing the Cosmed K4b2 to the Douglas bag method over a wide range of cycling exercise intensities reported no significant differences in V̇o2 between the K4b2 and the Douglas bag method at rest or at 250W, thus suggesting that this portable unit is acceptable for measuring oxygen uptake.31 The Cosmed K4b2 was calibrated immediately before each test. Heart rate was continuously monitored and recorded during the test via a telemetry system (Polar Vantage NV).b At the end of the test, subjects provided a rating of perceived exertion (RPE) score, using the Borg 0 to 10 category-ratio scale.32 Blood pressure was measured before the exercise and again after the postexercise cool down. Because the traditional criteria for maximal V̇o2 (V̇o2max) are not met during arm ergometry because of localized fatigue,33 the criteria for terminating an exercise test included the subject’s inability to maintain an increasing heart rate, volitional stopping, or any of the American College of Sports Medicine guidelines for stopping an exercise test.34 In our study, the highest attained V̇o2 value was termed Vo2peak. Exercise Training Intervention The exercise-training program included 3 sessions a week for 4 weeks. Each session included a warm-up period (5min) at no resistance (0W), an endurance phase (20min), and a cool-down period (5min) at 0W. The work rate that elicited 65% of baseline Vo2peak, based on the incremental arm crank ergometer test, was used as the intensity for the endurance phase of the exercise program.33 The average work rate for the training group was 19.6±8.3W (range, 11−45W), 13.1±2.8W for women and 39.2±7.9W for men. Outcome Measures The primary outcome measure was Vo2peak as determined from the incremental arm crank ergometer test. Secondary outcome measures included the Timed Up & Go (TUG) test,35 Berg Balance Scale (BBS),36 FIM instrument,37 two-minute walk test (2MWT), and the ten-minute walk test (10MWT).38, 39 All secondary outcome measures were also assessed on admission and discharge from the rehabilitation unit. The admission medical examination included the MMSE and Geriatric Depression Scale (GDS). We used the Falls Efficacy Scale (FES)40 and Prefracture Physical Function Questionnaire (PFPFQ)41 to provide measures of prefracture falls self-efficacy and physical functioning, respectively. Statistical Analysis Data were analyzed with SPSSc for Windows. The level of significance was set at P less than .05 for all statistical tests. Descriptive statistics were determined for appropriate variables. Two-way repeated-measures analysis of variance (ANOVA) tests were used to assess changes in Vo2peak, FIM instrument, TUG, BBS, 2MWT, and 10MWT scores from admission to discharge. We used Scheffé post hoc tests to identify locations of any significant main effects or interactions. Cohen d values were calculated as a measure of effect size.42 Confidence intervals (CIs) for within- and between-group differences were obtained from paired and unpaired t tests, respectively. Test-retest reliability of subject reproducibility and stability for Vo2peak was determined using intraclass correlation coefficients, model 2,1 (ICC2,1) calculated from results of the 2-way repeated-measures ANOVA tests. Vincent43 described ICC values below .80 as questionable for physiologic data, while values of .80 to .89 reflect moderate reliability, and values greater than .90 are considered high. Pearson r correlations were computed for all combinations of Vo2peak with the FIM instrument, TUG, BBS, 2MWT, and 10MWT to determine relationships between scores on admission, discharge, and change scores. All data are reported as means ± standard deviations (SDs). Pearson correlations were characterized according to Colton’s criteria44: .00 to .25, no relationship; .25 to .50, fair; .50 to .75, moderate to good; and greater than .75, very good to excellent. Results Fifty-six patients with hip fracture were assessed for eligibility for the study. Twenty subjects were randomized (14 women, 6 men; mean age, 81.3±7.2y; range, 66−91y) and their full data were collected, except for the TUG test data of 2 subjects. Sixteen of the 56 patients did not meet the inclusion criteria: 2 had broken arms as a result of the fall that caused the hip fracture and were thus limited in performing an upper-body exercise, 3 did not speak English, 5 had chronic obstructive pulmonary disease and were using supplemental oxygen, and 6 had MMSE scores under than 24. Before randomization, 11 patients refused to participate, 5 declined after the initial visit, and 4 asked to stop after 2 or 3 minutes of exercise during the initial Vo2peak testing protocol. Figure 1 provides the CONSORT flowchart showing details of subject participation. The training and control groups were similar in sex, age, length of stay (LOS), fracture type, surgical repair, residence, medical comorbidities, and weight-bearing status; consequently, both groups were considered equivalent on admission (table 1). Admission Data Hip fractures were first time events for all patients. Sixteen (80%) subjects reported more than 2 comorbidities; 13 (65%) had more than 3; 5 (25%) had more than 5; and only 4 (20%) subjects had 1 comorbidity. The most common comorbidities were those related to the cardiovascular (eg, hypertension), musculoskeletal (eg, arthritis, previous wrist or ankle fracture, or knee replacement), and endocrine (eg, type 2 diabetes mellitus) systems. Only 3 subjects reported a history of osteoporosis (1 man, 2 women). Before admission, 19 subjects lived at home—7 lived alone and 12 lived with a spouse, another family member, or hired help. The remaining subject lived in a retirement home (see table 1). Eleven (55%) subjects reported that they normally did not use assistive devices before the fracture; 5 (25%) used a cane, 2 (10%) used a rollator walker (8.54cm wheels), and 2 (10%) used a cane for short distances and a rollator walker for longer distances (see table 1). In both groups, a subanalysis of the PFPFQ scores found that low scores were in the domain of balance, with subjects reporting that balance was their limiting factor before the hip fracture. Subjects were considered cognitively intact on admission (MMSE score, 28.5±2.1 out of 30; range, 24–30).45 The mean GDS score was 2.5±1.3 out of 15 (range, 1–6), showing that the group was not depressed (see table 1). All patients had to request admission to the rehabilitation program. Thus, all were motivated to participate and were not limited in their rehabilitation for behavioral reasons. Discharge Data The average LOS was 32.9±5.3 days (range, 25–47d). Eighteen subjects could bear weight as tolerated at discharge, while 2 subjects were restricted to 50% weight bearing. No patients were discharged as non-weight bearing. All subjects were discharged with assistive devices; 15 with a rollator walker, 2 with a nonwheeled walker, and 3 with a cane. Nineteen (95%) subjects returned to their prefracture residence. Only 1 subject went from living with a family member to living in a nursing home; this was because the family member also had functional problems. Training was well tolerated by the subjects: no adverse effects were reported. There was a 97% compliance rate with the training program; only 4 subjects missed between 1 and 2 sessions because of medical or personal appointments. Between-Groups Comparisons Primary outcome measure All subjects performed the exercise test until volitional exhaustion. They showed high test-retest reliability43 for Vo2peak (ICC2,1=.94) within 48 hours of admission. Table 2 shows the results at admission and discharge for both the training and control groups. At admission, both groups responded similarly in all peak values measured. In the training group, heart rate was recorded during each exercise training session. Heart rate at the final (20th) minute of training was lower at discharge, compared with the rate at admission (109±7bpm vs 113±6bpm, P=.042). At discharge, Vo2peak (P<.01, Cohen d=.48), exercise duration (P=.002), ventilation (P=.011), and power output (in watts) (P=.027) were significantly higher in the training group than in the control group. Secondary outcome measures Table 3 presents a summary of the results of the secondary outcome measures (TUG, BBS, FIM instrument, 2MWT, 10MWT). TUG scores are reported for 9 subjects in each group (TUG tests were not performed on admission by 2 subjects who were restricted to 50% weight bearing). At admission, there were no significant differences between groups. At discharge, the training group had significantly better balance (BBS) (P=.002, Cohen d=1.81) and walked faster (TUG) (P=.012, Cohen d=1.53), and for a longer distance (2MWT, 10MWT) (P<.01, Cohen d=3.41; P=.037, Cohen d=1.2, respectively) compared with the control group. Correlations between Vo2peak and outcome measures At admission, there were no significant correlations between Vo2peak, and the physical function outcome measures for either group. At discharge, there were no significant correlations between the primary and secondary outcome measures for the control group. For the training group at discharge, there was a significant correlation between Vo2peak and the 2MWT (r=.81, P=.032). Also, there was a significant correlation between Vo2peak and the 10MWT (r=.85, P=.019). The strength of these associations, characterized according to Colton,44 is considered very good to excellent. There were no other significant correlations between Vo2peak and the physical function outcome measures at either admission or discharge. Discussion To our knowledge, this study is the first to assess the effect on aerobic fitness and physical function of older adults with hip fracture of an upper-body arm crank exercise training program added to standard inpatient rehabilitation care. The main result was that the training group improved significantly more than the control group in mobility and balance measures. The upper-body exercise induced a significant improvement in aerobic fitness as well as in all physical function outcome measures. Changes in Vo2peak On admission, there was no difference in arm Vo2peak between the training and control groups, indicating that both groups were similar in their aerobic fitness levels. During their 4-week stay in the rehabilitation unit, the training group performed upper-body exercise using an arm crank ergometer in addition to the standard rehabilitation care program. After the program, the training group showed a significant increase in Vo2peak while the control group showed a nonsignificant decrease. The effect size for the change in Vo2peak was 1.48, described as “large” by Cohen.42 An additional marker of training effect, heart rate at the final (20th) minute of training, was lower on discharge versus admission for the training group further suggesting an improvement in aerobic fitness. Unpublished data from our lab provided normative Vo2peak values for community-dwelling healthy older adults (n=22 volunteers; 11 men, 11 women; mean age, 69.5±5.1y; range, 61−78y) during arm cranking exercise. In this study, Vo2peak values on admission for both the training group (8.9±1.4mL·kg−1·min−1) and control group (8.9±1.2mL·kg−1·min−1) were significantly lower than those of the healthy community-dwelling older adults (11.1±3.6mL·kg−1·min−1), perhaps reflecting the effects of surgery and bedrest since their fracture. On discharge, the training group’s Vo2peak (10.8±1.7mL·kg−1·min−1) was not significantly different from the healthy community-dwelling group, while the control group’s Vo2peak remained significantly lower. The goal of rehabilitation after hip fracture is to return patients to their prefracture function. Thus, it appears that with respect to achieving aerobic fitness, a specific aerobic training program is necessary for patients after a hip fracture. Changes in Secondary Outcome Measures There was a significant improvement from admission to discharge in all functional outcome measures (TUG, BBS, FIM instrument, 2MWT, 10MWT) for both groups. The training group performed significantly better than the control group in the TUG, BBS, 2MWT, and 10MWT. Significant correlations were found in the training group between Vo2peak and the mobility outcome measures (2MWT, 10MWT). This suggests that an improvement in cardiorespiratory fitness may result in an increase in mobility. The control group also improved in mobility, but the training group improved to a greater extent. The increase in aerobic fitness, an independent marker of functional independence,15 suggests that the training group may have better long-term independence and health after a standard rehabilitation program, compared with the control group. These results provide evidence that upper-body exercise may result in improvements in both cardiorespiratory function and walking ability. These findings are consistent with those of previous research46, 47 that found improvements in walking performance were achieved through upper-body aerobic exercise training in patients with peripheral arterial disease.46, 47 Other investigators28, 46, 47, 48, 49, 50, 51 have speculated that physiologic adaptations are indicative of a transfer effect, which is defined as the phenomenon that occurs after unilateral training when the untrained limb shows some of the same training effects as the training limb.50 It is generally thought that transferable effects are more likely due to a central mechanism (cardiorespiratory), while nontransferable effects are limited to the trained muscles and therefore account for local adaptations.49, 51 It has been suggested that training effects may only occur in the trained muscle and are not transferred to untrained muscles.48, 49 Conversely, transfer effects have been reported in upper-body exercise capacity after endurance training in which only the lower body was used.51, 52, 53 Similarly, increases in lower-body capacity can result from upper-body exercise.48, 49, 51 Improvements in the lower limbs after upper-body exercise training may result from systemic cardiovascular effects (central adaptations) rather than localized metabolic or peripheral changes.51 Maire et al28 suggested that transfer effects may have occurred in patients recovering from total hip arthroplasty who trained using upper-body arm ergometry, as evidenced by improvements in their walking capacity. A recent study by Nyquist-Battie et al54 determined the safety and efficacy of upper-body exercise training in 7 subjects with heart failure (mean age, 68±4y). V̇o2max (in mL·kg−1·min−1) pretest was 9.8±2.3 and 10.1±1.9mL·kg−1·min−1 for the post-test (mean difference, .36±1.26mL·kg−1·min−1). While V̇o2max did not improve after the upper-body exercise training, test duration increased by 22% (507±179s vs 622±182s) and RER increased by 10% (1.09±0.10 vs 1.21±0.11). Although the study lacked a control group, Nyquist-Battie54 suggested that 3 months of upper-body exercise training is safe and feasible for people with heart failure. Maire28 evaluated the effect of an upper-limb interval-training program on cardiorespiratory fitness and walking ability during rehabilitation after total hip joint arthroplasty. Subjects with osteoarthritis (age, 75.1±4.8y; range, 67–81y) were randomly assigned to either a training group (n=7, standard rehabilitation plus exercise training program with an arm crank ergometer) or to a control group (n=7, standard rehabilitation only). The incremental exercise tests were completed 1 month before and 2 months after surgery, and a six-minute walk test (6MWT) was performed 2 months after surgery. Vo2peak increased significantly in the training group from 10.6 to 11.8mL·kg−1·min−1, but did not change in the control group (8.6 to 7.9mL·kg−1·min−1). The training group could walk significantly further (396m) compared with the control group (268m) in the 6MWT.28 The lower Vo2peak values found in our sample than in Maire’s subjects could be explained by the fact that our patients were older and participated in a shorter training program. Apart from this study and those by Maire,28, 29 there are no other reports in the literature that support the clinical importance of the measured differences in Vo2peak after upper-body exercise training. It is reasonable to suggest that increases in Vo2peak may have some clinical significance. Inpatient rehabilitation programs must consider a patient’s level of function required for successful independent living. Patients who return to independent community living may benefit from either progressive home exercises,10, 55 or community-based group exercise programs56 in order to maintain gains achieved during inpatient rehabilitation. Upper-body exercise was well tolerated in our patient cohort because no new health conditions or injuries were reported. This, and other alternative exercise training modalities such as all-extremity exercise, could be useful strategies for improving cardiorespiratory function during the later stages of an outpatient rehabilitation program, when the patient no longer experiences lower-limb discomfort. All extremity exercise has been shown to be reliable and valid, and a preferred modality of exercise in community-dwelling older adults.57, 58 Study Limitations One limitation of our study was its small sample size. A second limitation was the inclusion criteria of relatively high cognitive and physically functioning persons. These limitations affect the generalizability of the results and also reduce the statistical power of our analyses. A post hoc power calculation indicated that 42 subjects (21 per group) would have been required for our baseline comparisons in to achieve a statistical power of 80% for our comparisons of the TUG, BBS, FIM instrument, 2MWT, and 10MWT. Our study sample, however, has provided initial data that suggest that upper-body exercise should be incorporated into standard hip fracture rehabilitation programs and aerobic fitness should be one of the outcome measures to monitor patients’ progress. A third limitation was the conflict between scheduled PT and OT sessions and our testing and training schedule. Vo2peak testing and upper-body aerobic exercise training could not always be conducted before the rehabilitation training. On occasion, Vo2peak testing and upper-body exercise training were done after the rehabilitation training. The fatigue that subjects experienced from the rehabilitation program may have adversely altered Vo2peak scores on those sessions. No systematic effect was observed, however, because the number of times this happened was equally distributed between the groups. For training, 79% of the training group’s exercise sessions were done after PT. Thus, there may have been greater improvements had patients been tested or trained consistently before their therapy sessions. A fourth limitation was that there was no increase in intensity, duration, or frequency of training during the training program. An increase in any of these criteria may have further improved the Vo2peak outcome. Because patients were quite deconditioned at baseline, however, we considered it important to have them participate at an appropriate training intensity to increase compliance and minimize the possibility of injury. Recommendations for Future Study Future research should include a larger randomized controlled trial to support these initial results and convince clinicians to incorporate our results into their practice. Also, there should be a longitudinal follow-up period to determine whether gains in cardiorespiratory and physical function outcome variables are maintained, improved, or lost after discharge from inpatient rehabilitation. Clinical Implications The rehabilitation program focused on strengthening, balance, and gait retraining, all of which contribute to mobility. Standard care rehabilitation, however, does not appear to have an impact on cardiorespiratory function, as evidenced by a lack of change in Vo2peak in the control group. It appears that the increase in Vo2peak in the training group was clinically significant because it correlated with increases in functional outcome measures. To further assess the change in Vo2peak, we calculated a minimal detectable change score (MDC95 = 95% CI × √2) using the standard error (SE) of measurement59, 60, 61 and the 95% CI (CI = SE of measurement × 1.96).62 The resultant MDC95 value was .95mL·kg−1·min.−1 This is less than the actual change in Vo2peak in the training group (1.9mL·kg−1·min−1), which suggests that this change was indeed a true change, and not attributable to measurement error. This study has thus shown that upper-body aerobic training may enhance standard rehabilitation care because the training group showed greater improvements in aerobic fitness and all physical function measures. Clinicians should consider incorporating an upper-body exercise intervention in their standard rehabilitation care for patients with hip fractures. Our results indicate that an upper-body exercise training program plus standard care rehabilitation significantly improved aerobic fitness and mobility compared with standard care rehabilitation only in older adults after hip fracture. The training group patients also made significant improvements in functional outcome measures. The results suggest that aerobic endurance exercise should be integrated into standard rehabilitation programs to enhance aerobic fitness and mobility for patients after hip fracture surgery. Suppliers References 1. 1Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. 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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. PII: S0003-9993(07)01842-4 doi:10.1016/j.apmr.2007.09.036 © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved. | |
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