MASTER Program: Preventing Falls and Disability in Older Adults After Hip Fracture
Summary
Patients who have suffered a first hip fracture have a higher risk of falling and sustaining another hip fracture compared with age-matched adults who did not fracture. Although exercise is key to reversing this pattern, there have been very few trials that aimed to improve muscle strength and balance as well as enhance bone health following hip fracture. Therefore, we propose to conduct an RCT that delivers either 12 months of standard care or standard care plus graduated exercise program for older women who have sustained a recent hip fracture.
Description
We propose a 1-year RCT of graduated exercise program for older women after a hip fracture versus standard care alone. We will investigate the effect of exercise on fall reduction, functional mobility and bone microarchitecture.
Primary Outcome:
Fall rate, measured by self-reported daily fall diaries, will be collected monthly at the exercise classes and followed up by a blinded, independent investigator.
Secondary Outcome:
All measures will be collected at three times over the one year program except the Physical Activities Scale for the Elderly questionnaire which will be collected on a monthly basis.
i. Functional Outcome: We will track participants' ability to perform basic and instrumental activities of daily living (ADL). Bone health: We will use conventional methods (DXA) to assess bone mineral density at the non-fractured hip and Xtreme CT to describe adaptations in bone microarchitecture in both tibiae. Physical Activity: Self-report: All participants will be asked to complete a monthly Physical Activities Scale for the Elderly questionnaire. Accelerometry. We will use uni-axial accelerometers (GT1M ActiGraph, LLC, Fort Walton Beach, FL) to obtain an objective measure of physical activity for 5 days. Muscle strength and balance: Upper and lower extremity isometric muscle strength will be tested.
Intervention Description:
PHASE 1. For the first 6 months after fracture, the MASTER program will be delivered at the Centre for Hip Health (CHH) Exercise Prescription Suite (EPS). Programs will be individualized and progressive based on the entry level competency of each participant. Resistance exercises will utilize body weight, elastic bands and free weights. The number of sets participants complete and the resistance for each exercise will be recorded at every session. All participants will be asked to wear hip protectors during exercise classes at the CHH.
PHASE 2. After the initial four month supervised exercise program, participants will transition into a home-based exercise rehabilitation program. This program will consist of 30-minutes of exercises, twice a week designed to increase and maintain participants' balance and muscle strength. Exercises will be a logical progression of the PHASE 1 program and Theraband and free weights will be provided for home use. During the home-based exercise phase, a research assistant will visit each participant in their home 5 times to aid in the progression of the program and to provide feedback and encouragement.
Study Design
Allocation: Randomized, Control: Active Control, Intervention Model: Single Group Assignment, Masking: Single Blind (Investigator), Primary Purpose: Supportive Care
Conditions
Hip Fracture
Intervention
Exercise intervention: Strength training, Standard Care for people after hip fracture
Location
Centre for Hip Health & Mobility - Vancouver Coastal Health Research Institute
Vancouver
British Columbia
Canada
V5Z 1M9
Status
Recruiting
Source
University of British Columbia
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00795028
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Resistance Training
A type of strength-building exercise program that requires the body muscle to exert a force against some form of resistance, such as weight, stretch bands, water, or immovable objects. Resistance exercise is a combination of static and dynamic contractions involving shortening and lengthening of skeletal muscles.
Physical Education And Training
Instructional programs in the care and development of the body, often in schools. The concept does not include prescribed exercises, which is EXERCISE THERAPY.
Exercise Tolerance
The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an EXERCISE TEST.
Standard Of Care
The minimum acceptable patient care, based on statutes, court decisions, policies, or professional guidelines.
Exercise Test
Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate.
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