Hip fracture is a major public health problem. More than 50% of patients do not return to pre-fracture functional levels one year post fracture. Recovery following hip fracture has been shown to be greatly improved by rehabilitation services and exercise. In older adults, regular exercise prevents disease, decreases the risk of falling, reduces disability, improves sleep, and enhances mood and general well-being. Specifically for older adults post hip fracture, exercise can improve mobility (speed and weight-bearing ability), strength, functional performance, and prevent future falls. Unfortunately, the majority of older adults do not exercise regularly, and approximately 50% of those who begin exercise programs drop out by six months. The major aim of this study is to test the effectiveness of a home delivered self-efficacy based intervention, the Exercise Plus Program, on increasing exercise behavior in older adults post hip fracture. Participants will be randomly assigned to one of the four groups defined by the 2 X 2 design: (1) Exercise Trainer component which includes regular home visits by an exercise trainer to implement an exercise program with patients; (2) Plus Component only which includes motivational interventions but without an exercise trainer to exercise with; (3) the full Exercise Plus program which includes the Plus Component (motivational interventions) and the Exercise Trainer component; or (4) routine care. Five acute care facilities participating in the Baltimore Hip Studies will be used to recruit participants. A total of 240 (60 per group) older adults will be included in the study. Baseline testing will be done in the acute care setting, and the intervention implemented in the home setting when traditional inpatient rehabilitation services are completed. Efficacy expectations related to exercise, exercise behavior, activity, functional performance, health status, pain, mood, fear of falling, falls, and injuries related to falls will be measured at baseline, and then at two, six, and twelve months post hip fracture. The primary outcomes will be efficacy expectations, exercise behavior, and activity; secondary outcomes will focus on the benefits of exercise (such as improved function). Generalized estimating equations will be used to perform the analyses with both binary and continuous outcome measures as dependent variables. The investigators state that this study will contribute to the understanding of what interventions improve exercise behavior in the older adult post hip fracture, and add to the current base of knowledge regarding the benefits of exercise in frail older persons.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
Project #
Application #
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Stahl, Sidney M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Maryland Baltimore
Schools of Nursing
United States
Zip Code
Resnick, Barbara; Beaupre, Lauren; McGilton, Katherine S et al. (2016) Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review. J Am Med Dir Assoc 17:200-5
Alley, Dawn E; Hicks, Gregory E; Shardell, Michelle et al. (2011) Meaningful improvement in gait speed in hip fracture recovery. J Am Geriatr Soc 59:1650-7
Orwig, Denise L; Hochberg, Marc; Yu-Yahiro, Janet et al. (2011) Delivery and outcomes of a yearlong home exercise program after hip fracture: a randomized controlled trial. Arch Intern Med 171:323-31
Casado, Banghwa Lee; Resnick, Barbara; Zimmerman, Sheryl et al. (2009) Social support for exercise by experts in older women post-hip fracture. J Women Aging 21:48-62
Yu-Yahiro, Janet A; Resnick, Barbara; Orwig, Denise et al. (2009) Design and implementation of a home-based exercise program post-hip fracture: the Baltimore hip studies experience. PM R 1:308-18
Resnick, Barbara; D'Adamo, Christopher; Shardell, Michelle et al. (2008) Adherence to an Exercise Intervention Among Older Women Post Hip Fracture. J Clin Sport Psychol 2:41-56
Resnick, Barbara; Orwig, Denise; Yu-Yahiro, Janet et al. (2007) Testing the effectiveness of the exercise plus program in older women post-hip fracture. Ann Behav Med 34:67-76
Resnick, Barbara (2005) Reliability and validity of the Outcome Expectations for Exercise Scale-2. J Aging Phys Act 13:382-94
Resnick, Barbara; Orwig, Denise; Wehren, Lois et al. (2005) The Exercise Plus Program for older women post hip fracture: participant perspectives. Gerontologist 45:539-44
Resnick, Barbara; Magaziner, Jay; Orwig, Denise et al. (2002) Evaluating the components of the Exercise Plus Program: rationale, theory and implementation. Health Educ Res 17:648-58

Showing the most recent 10 out of 13 publications