# Exercise as it relates to Disease/Can resistance training improve muscle strength, mobility and balance in older people with hip fracture?

This is a critique of the article: Effects of Resistance Training on Lower-Extremity Impairments in Older People With Hip Fracture, A randomized controlled trial. Erja Portegijs, Mauri Kallinen, Taina Rantanen, Ari Heinonen, Sanna Sihvonen, Markku Alen, Ilkka Kiviranta, Sarianna Sipilä.

## Contents

* 1What is the background to this research?
* 2Where is the research from?
* 3What kind of research was this?
* 4What did the research involve?
* 5What were the basic results?
* 6What conclusions can we take from this research?
* 7Practical advice
* 8Further information/resources
* 9References

## What is the background to this research?[edit | edit source]

Quality of life for older people is highly affected by their ability to walk and the ability to do essential work, and hip fractures in old age are a major cause morbidity and morality, hip fractures in old age result in death of 20% of the people . Hip fractures have shown to increase sedentary behavior in older people, which has been linked with all cause mortality, morbidity, and increase in fall risk.
The aim of this study is to find out the effects of progressive resistance training in relation to muscle strength, balance, and mobility in older adults with previous hip fractures. There have been similar previous studies but some of these studies didn't show the its effect on mobility, whereas some studies did not take into account the asymmetry in muscle strength of the previously fractured leg. This particular study has taken the changes in mobility into account, and has also worked on minimizing the strength difference between the two asymmetric legs.

## Where is the research from?[edit | edit source]

This research was conducted in Finland and was supported by Finnish Ministry of Education. It was presented to the International Conference on Strength Training on October 20, 2006 in Odense, Denmark, to the Congress of the European College of Sport Sciences on July 12, 2007 in Jyväskylä, Finland, and was published by Archives of Physical Medicine and Rehabilitation in 2008. Some authors from this research paper have previously published many more research articles and have a good reputation in this field. There was no commercial organization that had direct financial interest in the results of this research.

## What kind of research was this?[edit | edit source]

This was a randomized trial controlled trail, it has participants aged between 60 to 85 years who had hip fracture in previous 6months to 7 years. The participants were divided into two groups, training and control, the training group underwent 12 weeks of progressive strength training, whereas the control group was told to continue with their regular routine for next 12 weeks. Other similar studies support the findings of this research, they have shown decrease in mortality, improvement in strength, and ease in doing daily activities.

## What did the research involve?[edit | edit source]

The participants were divided into two groups, training and control. The control group continued their daily routine for 12 weeks and the training group was given 12 week intensive progressive strength training program, which begin with a clinical examination to check their health status. Max voluntary isometric knee extension of both legs, hand grip strength of dominant hand, LEP, and dynamic balance was also tested. The weaker leg was trained more intensively to reduce asymmetry. The participants trained twice a week for around 1-1.5 hours. The 1RM of the participants was tested after first 2 session of familiarization with the equipment, same 1RM test was repeated in week 6 to 8. For power, 3-4 sets of 12 reps for weaker leg at 40%-50% of 1 RM, and 2-3 sets of 12 reps for stronger leg using same percentage of 1RM were performed. For strength, 2-3 sets of 8 reps for weaker leg and 1-2 sets of 8 for stronger legs with resistance of 60%-80% of 1RM for weaker leg and 50%-70% of 1RM was used.
The methodology used was better approach than previous studies as this research focused more on the weaker leg thus improving the asymmetry between legs, there was progressive increase in training intensity with progression of the weeks. This research also aimed at finding the improvement in mobility and balance, the parameters that were ignored by previous studies.
On major limitation of this study was the small sample size, the program could have been longer than 12 weeks for more clear results. The maximal strength and power were also underestimated due pain and fear of pain in the participant.

## What were the basic results?[edit | edit source]

| | Baseline | Baseline | Posttrial | Posttrial |
| Variable | Training Group | Control Group | Training Group | Control Group |
| KET weaker (Nm) | 38.3 (30.0–46.6) | 37.6 (29.5–45.7) | 42.7 (35.4–50.0) | 36.5 (29.2–43.8) |
| KET stronger (Nm) | 47.4 (38.4–56.3) | 45.4 (36.7–54.1) | 50.0 (41.1–58.8) | 44.9 (36.0–53.7) |
| LEP weaker (W) | 91.6 (74.2–109.0) | 82.0 (64.2–99.9) | 106.6 (85.9–127.4) | 86.5 (64.6–108.4) |
| LEP stronger (W) | 113.4 (89.6–137.1) | 99.7 (75.4–124.0) | 123.9 (99.0–148.9) | 112.3 (86.1–138.6) |
Difference in variable between baseline and post trial for training and control group.
Findings:
* Significantly greater mean improvement in KET of both legs for the training group as compared to control group.
* Significantly greater mean improvement in LEP in weaker leg for the training group as compared to the control group.
* Mean reduction in asymmetric LEP deficit significantly greater in training group as compared to the control group.
This showed increase in power and strength of participant who underwent the training program, and decrease in asymmetry between the weaker and stronger leg. There was no use of balance specific exercise, therefore there was not a significant improvement in balance and mobility, the not significant improvement in balance and mobility could be due to participants already being in well functioning condition, whereas if there were mobility-limited participant, there could have been a significant improvement in mobility using resistance training.

## What conclusions can we take from this research?[edit | edit source]

Resistance training can be vital in improving power and strength, this improvement in power and strength can play a very important role in decreasing mortality and morbidity. Progressive resistance training can also improve asymmetry between legs, but a longer program than 12 weeks could possible have improved the asymmetry to the point where there is a very small difference between KET and LEP of both the legs. Including balance training in the program could have also helped participants with significantly improving their balance.
Other researches have found similar results as this one, one study has shown that resistance training after hip fracture can increase overall strength and can also increase strength of the weaker leg such that it is almost as same as the stronger leg. Another study also found that progressive resistance training after hip fracture can increase strength and can improve mobility.

## Practical advice[edit | edit source]

Individual must first go through a clinical examination. Training session should begin with with a proper warm up, and maximal range of motion that can be achieved without any pain should be used for exercises. There should be slight increment in loads as the training progresses and the body adapts to training. For power training the concentric phase of the exercise should be performed as fast as possible, and for strength training the concentric phase should be performed a little slower. To improve participation, there should be an increase in education and awareness regarding the benefits of resistance training in improving not only the strength but also the quality of life, there should also be encouragement from close friends and family of the individual.

## Further information/resources[edit | edit source]

]https://www.safetyandquality.gov.au/sites/default/files/migrated/Hip-Fracture-Care-Case-for-Improvement.pdf
https://anzhfr.org/wp-content/uploads/2016/07/ANZ-Guideline-for-Hip-Fracture-Care.pdf
https://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf

## References[edit | edit source]

* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ 2. Cameron I, Cumming R, Easter S, Seymour J, Kurrle S, Quine S. Quality of life related to fear of falling and hip fracture in older women: a time trade off study [Internet]. https://www.bmj.com/. 2000 [cited 10 September 2021]. Available from: https://www.bmj.com/content/320/7231/341?maxt
* ↑ 3. Zusman E, Dawes M, Edwards N, Ashe M. A systematic review of evidence for older adults’ sedentary behavior and physical activity after hip fracture - Enav Z Zusman, Martin G Dawes, Nicola Edwards, Maureen C Ashe, 2018 [Internet]. SAGE Journals. 2017 [cited 10 September 2021]. Available from: https://journals.sagepub.com/doi/full/10.1177/0269215517741665
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Singh N, Quine S, Clemson L, Williams E, Williamson D, Stavrinos T et al. 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 [Internet]. https://www.sciencedirect.com. 2011 [cited 11 September 2021]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1525861011002738
* ↑ Edgren J, Rantanen T, Heinonen A, Portegijs E, Alén M, Kiviranta I et al. Effects of progressive resistance training on physical disability among older community-dwelling people with history of hip fracture* [Internet]. https://link.springer.com/. [cited 11 September 2021]. Available from: https://link.springer.com/content/pdf/10.1007/BF03325162.pdf
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M et al. ScienceDirect.com 2008
* ↑ Host H, Sinacore D, Bohnert K, Steger-May K, Brown M, Binder E. Training-Induced Strength and Functional Adaptations After Hip Fracture [Internet]. 2007 [cited 11 September 2021].
* ↑ SYLLIAAS H, BROVOLD T, WYLLER T, BERGLAND A. Progressive strength training in older patients after hip fracture: a randomised controlled trial [Internet]. 2011 [cited 11 September 2021].