Effects of Multicomponent Home-Based Intervention on Muscle Composition, Fitness and Bone Density after Hip Fracture.

BACKGROUND: Mechanistic factors on the pathway to improving independent ambulatory ability among hip fracture patients by a multicomponent home-based physical therapy intervention that emphasized aerobic, strength, balance, and functional training are unknown. The aim of this study was to determine the effects of two different home-based physical therapy programs on muscle area and attenuation (reflects muscle density) of the lower extremities, bone mineral density, and aerobic capacity. .

METHODS: Randomized controlled trial of home-based 16 weeks of strength, endurance, balance, and function exercises (PUSH, n=19) compared to seated active range-of-motion exercises and transcutaneous electrical neuro-stimulation (PULSE, n=18) in community-dwelling adults >60 years of age within 26 weeks of hip fracture.

RESULTS: In PUSH and PULSE groups combined, the fractured leg had lower muscle area and muscle attenuation and higher subcutaneous fat than the non-fractured leg (P<0.001) at baseline. At 16-weeks, mean muscle area of the fractured leg was higher in the PUSH than PULSE group (P=0.04). Changes in muscle area were not significantly different when compared to the comparative PULSE group. There was a clinically relevant difference in change in femoral neck BMD between groups (P=0.05) that showed an increase after PULSE and decrease after PUSH. There were generally no between-group differences in mean VO2peak tests at 16-week follow-up, except the PUSH group reached a higher max incline (P=0.04).

CONCLUSIONS: The treatment effects of a multicomponent home-based physical therapy intervention on muscle composition, BMD, and aerobic capacity were not significantly different than an active control intervention in older adults recovering from hip fracture.