Efficacy of a Post-Rehabilitation Exercise Intervention

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DESCRIPTION (provided by applicant): The overall objective of this project is to determine if the significant functional problems that remain for many hip fracture patients after rehabilitation ends can be reduced or eliminated by a simple, easily disseminated program. The specific aim of this study is to demonstrate if functional improvement can be achieved after formal hip fracture rehabilitation ends through the use of a practical, home-based exercise program, called Strong for Life (SFL). The SFL intervention incorporates cognitive training and behavioral reinforcements with exercise training to achieve high levels of adherence. Relevance to the missions of NIA and NCMMR: This project addresses the missions of these agencies by investigating an innovative, multidisciplinary approach to enhance the independence, well-being and quality of life of older adults with a disability. In previous randomized clinical trials with older adults with functional limitations, the SFL participants have achieved a high level of adherence, and improved strength, mobility and reduced disability with minima contact from a therapist. This proposed study will extend previous work by demonstrating this program's safety and effectiveness in a sample of adults who have received formal rehabilitation services following hip fracture and who display limitations in their physical function at the end of their normal course of rehabilitation. Participants will be randomized either to receive the SFL program for 6 months, or an attention control intervention (nutrition counseling). SFL participants will receive exercise and cognitive training and follow-up behavioral reinforcements from a physical therapist. Blinded outcome assessors will evaluate the program's impact on physical function and disability using physical performance tests and self- report measures at 6- and 9-month follow-up. All analyses will be by intention to treat. Relevance to public health: After rehabilitation for a hip fracture ends, many people continue to have problems walking and doing their daily activities. This study will find out whether an exercise program that people can do in their own home after their rehabilitation ends which includes special techniques to increase people's motivation and confidence helps them to be more independent. This low-cost program could be used by many people after hip fracture, and could potentially help to reduce the number of people who need to move to a nursing home or need long term home help.