Table 1.

Trials showing benefits from exercise programs after hip fracture.

Author, date, Country	Interventions	Results	Sample size	PEDro scale [100] quality score
Interventions started in the inpatient setting
Bischoff-Ferrari et al., 2010 [47]; Switzerland	Comparison of extended physiotherapy (PT) (supervised 60 min/day during acute care plus an unsupervised home program) versus standard PT (supervised 30 min/day during acute care plus no home program; single-blinded). All patients also received cholecalciferol. The PT interventions were provided for approximately 7 days.	Extended versus standard PT reduced the rate of falls by 25% (95% CI −44%, —1%) but had no effect on hospital readmissions.	173	6/10
Sherrington et al., 2003 [57]; Australia	Comparison of either weight- bearing (n=40) ornon-weight- bearing (n = 40) exercise prescribed by a physiotherapist. Both interventions were conducted on a daily basis for 2 weeks.	Both groups improved markedly (in the order of 50%) on measures of physical ability however there was no significant difference between the groups in the extent of improvement. Additional strength benefits were found for the non-weight-bearing group and additional functional benefits were found for the weight-bearing group who also needed less supportive walking aids (p = 0.045).	80	7/10
Mitchell et al., 2001 [50]; Scotland	Randomised controlled trial comparing the addition of 6 weeks quadriceps training (training; n = 40 patients) with standard PT alone (control; n = 40 patients). The training group exercised twice weekly for 6 weeks, with 6 sets of 12 repetitions of knee extension (both legs), progressing up to 80% of their one-repetition maximum.	Leg extensor power increased significantly in the training group compared with the control group. Significant benefits were maintained at 16 weeks. Quadriceps training resulted in a greater increase in elderly mobility scale score compared with standard rehabilitation (between-group difference of 2.5 (95% CI 1.1, 3.8) at week 6 and 1.9 (0.4, 3.4) at week 16). Barthel score increased significantly from week 0–6 in the training group compared with controls (Mann-Whitney U-test p = 0.05). Patients in the training group scored significantly better in the energy sub-score of the Nottingham Health Profile at the end of follow-up (Mann- Whitney U-test p = 0.0185).	80	5/10
Trials started after discharge from hospital or at the end of usual care
Sylliaas et al., 2012 [55]; Norway	The intervention group (n = 48) underwent a 3 month progressive strength training program with one session at an outpatient clinic and another session at home. The control group (n = 47) was asked to maintain their current lifestyle.	There were no statistically significant differences between groups in the primary outcome Berg Balance Scale. The intervention group showed significant improvements in strength, gait speed and gait distance, instrumental activities of daily living and self-rated health.	95	8/10
Sylliaas et al., 2011 [54]; Norway	The intervention group (n = 100) received a 3-month strength training program conducted by a physiotherapist twice a week with a home session to be completed once per week. The control group was asked to maintain their current lifestyle.	At follow-up, the intervention group showed highly significant improvements both in the primary endpoint (Berg Balance Scale, mean difference 4.7 points) and in secondary end- points of sit-to-stand, 6 min walk test, gait speed, step height, timed up and go and instrumental activities of daily living.	150	8/10
Mangione et al., 2010 [56], USa	Exercise and control participants received interventions by physical therapists twice weekly for 10 weeks. The exercise group received high intensity leg strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery.	Isometric force production (p < 0.01), usual and fast gait speed (p= 0.02 & 0.03, respectively), 6 min walk distance (p < 0.01), and modified physical performance test (p < 0.01) improved at one year post fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for modified physical performance test scores, 0.56 for gait speed, 0.49 for 6 min walk, and 0.30 for SF-36 scores.	26	7/10
Portegijs et al., 2008 [52]; Finland	12 week intensive progressive strength-power training program twice a week for 1– 1.5 h (n = 24) Control group (n = 22) encouraged to maintain their pre-study level of physical activity during the 12-week trial.	Asymmetric leg extension power deficit decreased (p= 0.010) after training compared with the control group. Leg extension power of the stronger leg, asymmetric knee extension strength deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training.	46	6/10
Mard et al., 2008 [51]; Norway	The intervention group (n = 23) underwent a 12-week supervised and progressive muscle strength and power training program twice a week. The control group (n = 20) was encouraged to maintain their pre-study level of physical activity during the 12-week trial.	14 subjects in the training group and only 2 controls felt that their mobility had improved during the intervention period (p= 0.002). Training had no significant effect on TUG, chair rise and stair climbing time and walking time.	43	7/10
Sherrington et al., 2004 [59]; Australia	Compared the effectsofweight- bearing (n = 40) and non- weight-bearing (n = 40) home exercise programs and a control program (n = 40). 5 and 8 exercises were prescribed to be carried out daily for a period of 4 months.	At the 4-month retest, there were between-group differences compared to the initial assessment for the measures of balance and functional performance but not for strength or gait. The weight-bearing exercise group showed the greatest improvements in measures of balance and functional performance (between-group differences of 30%-40% of initial values).	120	7/10
Binder et al., 2004 [48]; USA	Participants were randomly assigned to 6 months of supervised PT and progressive resistance exercise training (n = 46) or home exercise control (n = 44). The exercise intervention sessions lasted for 45–90 min and were conducted 3 times per week. Control participants were instructed to complete their home program of flexibility exercises 3 times per week also.	PT participants had improved physical performance and less self-reported disability than control participants at the final follow-up evaluation. Changes over time in the Physical Performance Test (PPT) and Functional Status Questionnaire (FSQ) scores favoured the PT group (p= 0.003 and p= 0.01, respectively). PT also had significantly greater improvements than the control condition in measures of muscle strength, walking speed, balance, and perceived health but not bone mineral density or fat-free mass.	90	7/10
Hauer et al., 2002 [49]; Germany	Intervention group (n = 15) performed progressive resistance and functional training to improve strength and functional performance 3 days a week for 12 weeks. Control group (n = 13) met 3 times a week for 1 h and engaged in placebo motor activities such as seated calisthenics, games and memory tasks.	Training significantly increased strength, functional motor performance and balance and reduced fall-related behavioural and emotional problems. Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training. Patients in the control group showed no change in strength, functional performance and emotional state during intervention and follow-up.	28	6/10