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.

Public Health Relevance

More than 325,000 hip fractures occur annually in the US. The goal of current practice is independent, household ambulation 2-3 months post surgery, yet dependency persists well beyond three months. This Merit Extension will evaluate the effect of a Multi-modal Exercise Intervention (MMEI) on underlying factors thought to be associated with ambulatory ability to obtain a more complete understanding of how exercise affects ambulation and to develop more effective interventions for these patients.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Method to Extend Research in Time (MERIT) Award (R37)
Project #
Application #
Study Section
Special Emphasis Panel (NSS)
Program Officer
Joseph, Lyndon
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Maryland Baltimore
Public Health & Prev Medicine
Schools of Medicine
United States
Zip Code
Salimi, Shabnam; Shardell, Michelle; Miller, Ram et al. (2018) Soluble Tumor Necrosis Factor Alpha Receptor 1, Bone Resorption, and Bone Mineral Density in the Year Following Hip Fractures: The Baltimore Hip Studies. J Bone Miner Res 33:1649-1656
Miller, Michael E; Magaziner, Jay; Marsh, Anthony P et al. (2018) Gait Speed and Mobility Disability: Revisiting Meaningful Levels in Diverse Clinical Populations. J Am Geriatr Soc 66:954-961
Rathbun, Alan M; Shardell, Michelle D; Stuart, Elizabeth A et al. (2018) Persistence of depressive symptoms and gait speed recovery in older adults after hip fracture. Int J Geriatr Psychiatry 33:875-882
Resnick, Barbara; Hebel, J Richard; Gruber-Baldini, Ann L et al. (2018) The impact of body composition, pain and resilience on physical activity, physical function and physical performance at 2 months post hip fracture. Arch Gerontol Geriatr 76:34-40
Rathbun, A M; Magaziner, J; Shardell, M D et al. (2018) Older men who sustain a hip fracture experience greater declines in bone mineral density at the contralateral hip than non-fractured comparators. Osteoporos Int 29:365-373
Orwig, D; Mangione, K K; Baumgarten, M et al. (2017) Improving community ambulation after hip fracture: protocol for a randomised, controlled trial. J Physiother 63:45-46
Gruber-Baldini, Ann L; Hosseini, Mina; Orwig, Denise et al. (2017) Cognitive Differences between Men and Women who Fracture their Hip and Impact on Six-Month Survival. J Am Geriatr Soc 65:e64-e69
Rathbun, Alan M; Shardell, Michelle; Orwig, Denise et al. (2016) Differences in the trajectory of bone mineral density change measured at the total hip and femoral neck between men and women following hip fracture. Arch Osteoporos 11:9
Resnick, Barbara; Gruber-Baldini, Ann L; Hicks, Gregory et al. (2016) Measurement of Function Post Hip Fracture: Testing a Comprehensive Measurement Model of Physical Function. Rehabil Nurs 41:230-47
Rathbun, Alan M; Shardell, Michelle; Orwig, Denise et al. (2016) Effects of Prefracture Depressive Illness and Postfracture Depressive Symptoms on Physical Performance After Hip Fracture. J Am Geriatr Soc 64:e171-e176

Showing the most recent 10 out of 70 publications