Exercise interventions, physical function, and mobility after hip fracture: a systematic review and meta-analysis

Purpose: To investigate the effects of different exercise components on physical function and mobility in adults after hip fracture. Methods: Pubmed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched up to March 2021. Randomized controlled trials investigating the effects of exercise interventions on physical function and mobility in adults after hip fracture were included. Results: Fifteen studies (12 trials) were included (n = 1198, age = 80 ± 8 years). Exercise interventions had a moderate effect on overall physical function after hip fracture compared to non-exercise (SMD = 0.46, 95% CI = 0.27–0.65). Among different exercise components, progressive resistance exercise showed the largest effect (SMD = 0.48, 95% CI = 0.27–0.69), while aerobic exercise alone had no effect (SMD 0.41, 95% −0.44 to1.26) on physical function. Exercise had a small effect on mobility (SMD = 0.28, 95% CI = 0.12–0.43). Specifically, functional exercise showed a moderate effect (SMD = 0.41, 95% CI = 0.16–0.65) on mobility. Conclusions: Available evidence supports that exercise interventions improve physical function and mobility in older adults after hip fracture; specifically, resistance exercise with progressive load of 60–80% 1RM, and functional exercise may be critical intervention components respectively. Future high-quality research is needed to establish best practices.IMPLICATIONS FOR REHABILITATION Progressive resistance exercise with 60–80% 1RM resulted in the largest improvement in physical function after hip fracture. Functional exercise appears to be a critical component for improving mobility after hip fracture. Functional exercise plus resistance and balance exercises was the most effective intervention for enhancing mobility. Exercise should be supervised by a trainer or a physiotherapist, and self-reported exercise may not result in the same benefits.