To determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy.
Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020.
Randomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers.
Data were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies.
Seventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes.
Adherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.
List of abbreviations:OR (odds ratio), SMD (standardized mean difference), WHO (World Health Organization)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- A systematic review of hip fracture incidence and probability of fracture worldwide.Osteoporos Int. 2012; 23: 2239-2256
- Estimating hip fracture morbidity, mortality and costs.J Am Geriatr Soc. 2003; 51: 364-370
- The association of race, gender, and comorbidity with mortality and function after hip fracture.J Gerontol A Biol Sci Med Sci. 2008; 63: 867-872
- The 1-year mortality of patients treated in a hip fracture program for elders.Geriatr Orthop Surg Rehabil. 2010; 1: 6-14
- Hip fracture types in men and women change differently with age.BMC Geriatr. 2010; 10: 12
- Hip fracture incidence and hospitalisations in Australia 2015-16.AIHW, Canberra2018
- Stand up and be counted: measuring time spent upright after hip fracture and comparison with community dwelling older people.Physiotherapy. 2005; 91: 215-222
- Recovery from hip fracture in eight areas of function.J Gerontol A Biol Sci Med Sci. 2000; 55: M498-M507
- Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial.JAMA. 2004; 292: 837-846
- Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression.Br J Sports Med. 2016; 50: 346-355
- Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial.J Am Med Dir Assoc. 2015; 16: 350
- Exercise, nutrition and managing hip fracture in older persons.Curr Opin Clin Nutr Metab Care. 2014; 17: 12-24
- Interventions for improving mobility after hip fracture surgery in adults.Cochrane Database Syst Rev. 2011; 3CD001704
- Predictors of adherence to home-based physical therapies: a systematic review.Disabil Rehabil. 2017; 39: 519-534
- Adherence to exercise programs in older adults: informative report.Gerontol Geriatr Med. 2019; 52333721418823604
- Adherence to long-term therapies: evidence for action.WHO, Geneva2003
- Fall-risk assessment and management in clinical practice: views from healthcare providers.J Am Geriatr Soc. 2004; 52: 1522-1526
- Adherence to home-based rehabilitation in older adults with diabetes after hip fracture.Nurs Res. 2019; 68: 383-389
- Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review.Spine J. 2013; 13: 1940-1950
- Adherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics.Prev Med. 2012; 55: 262-275
- Assessment of compliance with prescribed activity by hemiplegic stroke patients after an exercise programme and physical activity education.Ann Phys Rehabil Med. 2010; 53: 250-265
- Older hip fracture patients: three groups with different needs.BMC Geriatr. 2010; 10: 65
- Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.BMJ. 2005; 331: 1374
- Preventing fractures in elderly people.BMJ. 2003; 327: 89-95
ANZHFR annual report of hip fracture care 2019. Australian and New Zealand Hip Fracture Registry; 2019.
- Higgins J Thomas J Chandler J Li T Page M Welch V Cochrane handbook for systematic reviews of interventions. 2nd ed. John Wiley & Sons, Chichester2019
- Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies.BMC Med Res Methodol. 2006; 6: 9
- Methods for meta-analysis in medical research.Wiley, Chichester, New York2000
- Metaprop: a Stata command to perform meta-analysis of binomial data.Arch Public Health. 2014; 72: 39
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae.BMC Public Health. 2014; 14: 1203
- An empirical study using permutation-based resampling in meta-regression.Syst Rev. 2012; 1: 18
- Effects of a rehabilitation program on perceived environmental barriers in older patients recovering from hip fracture: a randomized controlled trial.BioMed Res Int. 2013; 2013769645
- Effects of a multicomponent home-based physical rehabilitation program on mobility recovery after hip fracture: a randomized controlled trial.J Am Med Dir Assoc. 2014; 15: 361-368
- Physical activity after a hip fracture: effect of a multicomponent home-based rehabilitation program-a secondary analysis of a randomized controlled trial.Arch Phys Med Rehabil. 2017; 98: 981-988
- Effects of a home-based physical rehabilitation program on tibial bone structure, density, and strength after hip fracture: a secondary analysis of a randomized controlled trial.J Bone Miner Res. 2019; 3: e10175
- Effects of resistance training on lower-extremity impairments in older people with hip fracture.Arch Phys Med Rehabil. 2008; 89: 1667-1674
- Sense of coherence: effect on adherence and response to resistance training in older people with hip fracture history.J Aging Phys Act. 2014; 22: 138-145
- Adherence to an exercise intervention among older women post hip fracture.J Clin Sport Psychol. 2008; 2: 41-56
- Testing the effectiveness of the exercise plus program in older women post-hip fracture.Ann Behav Med. 2007; 34: 67-76
- Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?.Phys Ther. 2005; 85: 727-739
- Systematic home-based physical and functional therapy for older persons after hip fracture.Arch Phys Med Rehabil. 1997; 78: 1237-1247
- Effect of telerehabilitation on mobility in people after hip surgery: a pilot feasibility study.Int J Rehabil Res. 2018; 41: 244-250
- Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial.PLoS One. 2019; 14e0224971
- Intensive physical training in geriatric patients after severe falls and hip surgery.Age Ageing. 2002; 31: 49-57
- Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial.Clin Rehabil. 2016; 30: 1108-1119
- Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.JAMA. 2014; 311: 700-708
- Home-based leg-strengthening exercise improves function 1 year after hip fracture: a randomized controlled study.J Am Geriatr Soc. 2010; 58: 1911-1917
- Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial.J Am Med Dir Assoc. 2012; 13: 24-30
- The effects of muscle strength and power training on mobility among older hip fracture patients.Adv Physiother. 2008; 10: 195-202
- Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial.Arch Phys Med Rehabil. 1997; 78: 208-212
- Effect of a multicomponent home-based physical therapy intervention on ambulation after hip fracture in older adults: the CAP randomized clinical trial.JAMA. 2019; 322: 946-956
- Delivery and outcomes of a yearlong home exercise program after hip fracture: a randomized controlled trial.Arch Intern Med. 2011; 171: 323-331
- Program-related factors are associated with adherence to group exercise interventions for the prevention of falls: a systematic review.J Physiother. 2013; 59: 81-92
- Adherence to community based group exercise interventions for older people: a mixed-methods systematic review.Prev Med. 2016; 87: 155-166
- Patient perspectives on engagement in recovery after hip fracture: a qualitative study.J Aging Res. 2017; 20172171865
- Self-reported home exercise adherence: a validity and reliability study using concealed accelerometers.J Orthop Sports Phys Ther. 2018; 48: 943-950
- Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review.Age Ageing. 2012; 41: 16-23
- The national clinical audit of falls and bone health-secondary prevention of falls and fractures: a physiotherapy perspective.Physiotherapy. 2010; 96: 38-43
- National physical activity recommendations for older Australians: discussion document.Australian Government Department of Health and Ageing, Canberra2006
- Impact of tai chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial.Arch Phys Med Rehabil. 2012; 93: 1400-1407
- Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review.J Physiother. 2013; 59: 227-235
- Exercise for preventing falls in older people living in the community.Cochrane Database Syst Rev. 2019; 1CD012424
- Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the emergency department with a fall: A randomised controlled trial.PLoS Med. 2019; 16e1002807
- Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-year follow-up of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) randomised controlled trial.Heart. 2009; 95: 468-475
- The problem of osteoporotic hip fracture in Australia.Australian Institute of Health and Welfare, Canberra2010
- A group-based mobile application to increase adherence in exercise and nutrition programs: a factorial design feasibility study.JMIR Mhealth Uhealth. 2016; 4: e4
Published online: February 07, 2022
Accepted: January 4, 2022
Received in revised form: December 14, 2021
Received: September 30, 2021
PROSPERO Registration No.: CRD42020150454.
Disclosure: Maureen Ashe is a Section Editor at Archives of Physical Medicine and Rehabilitation. The other authors have nothing to disclose.
© 2022 by the American Congress of Rehabilitation Medicine.