Effects of Multi-Modal Exercise Intervention Post Hip Fracture

这一拟议的优点扩展将继续1983年启动的一系列研究，该研究已演变为 国际公认的项目，巴尔的摩髋关节研究(BHS)，致力于识别、开发、 以及评估策略以优化髋部骨折后的康复。这个Merit扩展有两个 组件，将扩展先前的功勋奖研究和其他BHS项目的发现，证明 髋部骨折导致肌肉、脂肪质量和肌肉力量、骨密度和力量发生显著变化， 骨转换标志物，血清激素和炎症标志物水平，以及步行能力和 功能的其他方面。我们的目标是：1)研究途径上的一些关键机制 多模式运动干预(MMEI)对社区步行能力的影响 这一脆弱和残疾的老年人群体(构成部分一)；和2)初步测试，通过 对不同患者样本的试点/可行性研究，添加蛋白质补充剂的额外好处 在MMEI会议之后，以确定是否在骨骼、肌肉、炎症和 功能(第二部分)。MMEI正在最近资助的第三阶段随机临床试验中进行测试 (1R01AG035009)，是一项以家庭为基础的计划，旨在解决 耐力，力量，平衡和功能，通过40个监督会议。这样做的主要结果是 RCT是在社区中独立走动的能力。 这一功绩扩展的第一部分将作为第三阶段随机对照试验的辅助研究进行，方法是增加 对马里兰州巴尔的摩临床站点招募的患者进行机械性测量(最低 注册人数=60人；每组30人)。第二部分将再招募30名患者，并提供乳清 在完成每一次MMEI会议后立即补充蛋白质和氨基酸 检查增加的机械效益和可行性。这两个部分的参与者都将事先进行评估 随机化(髋部骨折住院后2个月内)，4个月和10个月后再次 以检查干预措施的直接影响(主要结果)和持续效益。 我们还将与一个国际专家组合作，确定加快发展和 对经历这一突然致残事件的这群老年人的干预措施进行测试。

This proposed Merit Extension will continue a line of research initiated In 1983 that has evolved into an internationally recognized program, the Baltimore Hip Studies (BHS), dedicated to identifying, developing, and evaluating strategies to optimize recovery following hip fracture. This Merit Extension, which has two components, will extend findings from prior Merit Award studies and other BHS projects demonstrating that hip fracture results In dramatic changes in muscle, fat mass and muscle strength, bone density and strength, bone turnover markers, serum levels of hormones and inflammatory markers, as well as walking ability and other aspects of function. The goals are to: 1) study some of the key mechanisms on the pathway to changes in community ambulation in response to a Multi-modal Exercise Intervention (MMEI) delivered to this frail and disabled group of older persons (Component I); and 2) test, in a preliminary manner through a pilot/feasibility study of a different sample of patients, the additional benefit of adding a protein supplement following MMEI sessions to determine if there are important changes in bone, muscle, inflammation, and function (Component II). The MMEI, being tested in a recently funded Phase III randomized clinical trial (1R01AG035009) of 300 patients In three centers, is a home-based program that addresses deficits in endurance, strength, balance and function through 40 supervised sessions. The primary outcome of that RCT is the ability to ambulate independently in the community. Component I of this Merit Extension will be conducted as an ancillary study to the Phase III RCT by adding mectianistic measurements to the patients recruited in the Baltimore, Maryland clinical site (Minimum number enrolled = 60; 30 per group). Component II wiil recruit 30 additional patients and provide a whey based protein and amino acid supplement immediately after completing each ofthe MMEI sessions to examine added mechanistic benefits and feasibility. Participants in both components will be assessed prior to randomization (within 2 months post hospitalization for hip fracture), and again 4 and 10 months later in order to examine the immediate effects (primary outcome) and the sustained benefits of interventions. We also will work with an international group of experts to identify strategies to accelerate development and testing of interventions for this group of older persons who experience this sudden disabling event.