Early Maximal Strength Training Improves Leg Strength and Postural Stability in Elderly Following Hip Fracture Surgery

Ole Kristian Berg; Jens-Meinhard Stutzer; Jan Hoff; Eivind Wang

doi:10.1177/21514593211015103

Early Maximal Strength Training Improves Leg Strength and Postural Stability in Elderly Following Hip Fracture Surgery

Geriatr Orthop Surg Rehabil. 2021 Apr 30:12:21514593211015103. doi: 10.1177/21514593211015103. eCollection 2021.

Authors

Ole Kristian Berg^{1

2}, Jens-Meinhard Stutzer², Jan Hoff^{3

4

5}, Eivind Wang^{1

3}

Affiliations

¹ Faculty of Health and Social Sciences, Molde University College, Molde, Norway.
² Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway.
³ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Norway.
⁵ The Exercise Clinic at Myworkout, Trondheim, Norway.

Abstract

Introduction: Hip fractures predominantly occur in the geriatric population and results in increased physical inactivity and reduced independency, largely influenced by a downward spiral of ambulatory capacity, related to loss of skeletal muscle strength and postural stability. Thus, effective postoperative treatment, targeting improvements in muscle strength, is sought after.

Materials & methods: Twenty-one hip fracture patients (>65 yr) were randomized to 8 weeks of either conventional physiotherapy control group (CG), or leg press and hip abduction maximal strength training (MST) 3 times per week. MST was performed applying heavy loads (85-90% of 1 repetition maximum; 1RM) and 4-5 repetitions in 4 sets. Maximal strength (bi- and unilateral 1RM), postural stability (unipedal stance test; UPS), and DEXA-scan bone mineral content/ density (BMC/BMD) were measured before and after the 8-week rehabilitation.

Results: Both MST and conventional physiotherapy improved bilateral leg press 1RM by 41 ± 27 kg and 29 ± 17 kg, respectively (both p < 0.01), while unilateral leg press 1RM only increased after MST (within group and between groups difference: both p < 0.05). MST also resulted in an increase in abduction 1RM in both the fractured (5 kg, 95%CI: 2-7; p < 0.01) and healthy limb (6 kg, 95%CI: 3-9; p < 0.01), while no such improvement was apparent in the CG (between groups difference: p < 0.01). Finally, MST improved UPS of the fractured limb (p < 0.05). No differences were observed in BMC or BMD following the 8 weeks.

Discussion: Early postoperative MST improved lower extremities maximal muscle strength more than conventional physiotherapy and was accompanied by improvements in postural stability.

Conclusion: Implementing MST in early rehabilitation after hip fracture surgery should be considered as a relevant treatment to curtail the downward spiral of reduced ambulatory capacity typical for this patient group, possibly reducing the risk of recuring falls and excess mortality.

Trial registration: https://clinicaltrials.gov/ct2/show/NCT03030092.

Keywords: abduction; balance; hip fracture; leg press; strength.

Associated data

ClinicalTrials.gov/NCT03030092