There is insufficient evidence from randomised trials to establish the best strategies for enhancing mobility after hip fracture surgery.
Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial.
To determine the effect of a home exercise program on strength, postural control, and mobility following hip fracture.
                Randomized controlled trial of 1 month's duration.
                Daily exercise carried out within the subjects' home environments.
                Forty-two people 64 to 94 years of age, 35 of whom were living independently in the community and 7 of whom were residing in institutional care. Subjects were recruited on average 7 months after a fall-related hip fracture and randomly allocated to either the intervention or the control group (n = 21 each). The groups were well matched in terms of medical conditions, medication use, disability, and activity levels.
                A "home-based" program of weight-bearing exercise established at a visit by a physiotherapist.
                Quadriceps strength, postural sway, functional reach, weight-bearing ability, walking velocity, and self-rated fall risk. The subjects undertook these assessments at the beginning and end of the trial.
                At pretest, exercisers and controls performed similarly in all tests. At the end of the trial, the intervention group showed significantly greater quadriceps strength in the affected (hip-fractured) leg and increased walking velocity. The intervention subjects also improved their weight-bearing ability and reported reduced subjective falls risk. In contrast, there were no significant improvements in any of the test measures in the controls. Within the intervention group, improvements in quadriceps strength were significantly associated with improved performances in the weight-bearing test measures and with increased walking velocity.
                This exercise program improved strength and mobility following hip fracture. Further research is needed to ascertain whether the extent of this improvement in these fall risk factors is sufficient to prevent falls.