Background Mechanistic factors on the pathway to improving independent ambulatory ability among hip fracture patients by a multicomponent home-based physical therapy intervention that emphasized aerobic, strength, balance, and functional training are unknown. The aim of this study was to determine the effects of two different home-based physical therapy programs on muscle area and attenuation (reflects muscle density) of the lower extremities, bone mineral density, and aerobic capacity. Methods Randomized controlled trial of home-based 16 weeks of strength, endurance, balance, and function exercises (PUSH, n=19) compared to seated active range-of-motion exercises and transcutaneous electrical neuro-stimulation (PULSE, n=18) in community-dwelling adults >60 years of age within 26 weeks of hip fracture. Results In PUSH and PULSE groups combined, the fractured leg had lower muscle area and muscle attenuation and higher subcutaneous fat than the non-fractured leg (P<0.001) at baseline. At 16-weeks, mean muscle area of the fractured leg was higher in the PUSH than PULSE group (P=0.04). Changes in muscle area were not significantly different when compared to the comparative PULSE group. There was a clinically relevant difference in change in femoral neck BMD between groups (P=0.05) that showed an increase after PULSE and decrease after PUSH. There were generally no between-group differences in mean VO2peak tests at 16-week follow-up, except the PUSH group reached a higher max incline (P=0.04). Conclusions The treatment effects of a multicomponent home-based physical therapy intervention on muscle composition, BMD, and aerobic capacity were not significantly different than an active control intervention in older adults recovering from hip fracture.

中文翻译：

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多成分家庭干预对髋部骨折后肌肉成分、体能和骨密度的影响

背景 通过强调有氧、力量、平衡和功能训练的多成分家庭物理治疗干预来改善髋部骨折患者独立行走能力的机制因素尚不清楚。本研究的目的是确定两种不同的家庭物理治疗方案对下肢肌肉面积和衰减（反映肌肉密度）、骨矿物质密度和有氧能力的影响。方法 为期 16 周的家庭力量、耐力、平衡和功能练习（PUSH，n=19）与坐位主动活动范围练习和经皮电神经刺激（PULSE，n=18）进行比较的随机对照试验髋部骨折 26 周内年龄大于 60 岁的社区居住成年人。结果 在 PUSH 和 PULSE 组中，基线时骨折腿比未骨折腿具有更低的肌肉面积和肌肉衰减以及更高的皮下脂肪（P＜0.001）。16 周时，PUSH 组骨折腿的平均肌肉面积高于 PULSE 组（P=0.04）。与对比 PULSE 组相比，肌肉面积的变化没有显着差异。各组之间股骨颈 BMD 的变化存在临床相关差异（P=0.05），显示 PULSE 后增加，PUSH 后减少。16 周随访时，平均 VO2peak 测试总体上没有组间差异，但 PUSH 组达到了更高的最大坡度（P=0.04）。结论 对于从髋部骨折中恢复的老年人来说，多成分家庭物理治疗干预对肌肉成分、骨密度和有氧能力的治疗效果与主动控制干预没有显着差异。