Robert A. Briggs PT PhD, Physical Therapy, David Grant Medical Center, 60th Medical Group, 101 Bodin Circle, Travis AFB, CA 94535, USA; email:
J Nutr Health Aging. 2018;22(3):431-438. doi: 10.1007/s12603-017-0977-1.
Post rehabilitation, older adults with hip fracture display low vertical ground reaction force (vGRF) on the involved lower extremity during a sit-to-stand task and low physical function. The purpose of this study was to test whether muscle performance, involved side vGRF during a sit-to-stand task, and physical function improved following multimodal high-intensity resistance training, when initiated after usual care (2 to 6 months after hip fracture).
Case series study, 12 weeks extended high-intensity strength training intervention following hip fracture.
University hospital outpatient facility.
Twenty-four community-dwelling older adults (mean age 78.4 years (SD 10.4), 16 female/8 male), 3.6 (SD 1.2) months post-hip fracture and discharged from physical therapy participated. Intervention/Measurement: All participants performed sit-to-stand tasks, muscle performance tests, and modified physical performance test (mPPT) before and after 12 weeks (3x/wk) of training. Variables were compared using paired t-tests.
The vGRF rate of force development (RFD) and magnitude of discrepancy between limb loading during rising phase of sit-to-stand task (AREA) variables improved post-training (RFD ratio = Pre: 0.78 - Post: 0.82, AREA ratio = Pre: 0.79 - Post: 0.86). Surgical leg extension power gains were large (65%) while strength gains were moderate (34%); yielding improved symmetry in both strength (Pre: 0.74 - Post: 0.88) and power (Pre: 0.75 - Post: 0.82). Physical function improved pre-training 25 (SD 5.2) to post training 30 (SD 4.3), (p < 0.001).
Unique to this study, participants recovering from hip fracture demonstrated improved symmetry in sit-to-stand vGRFs, muscle function, and physical function after training. However, a high percentage of patients continued to experience persistently low vGRF of the involved side compared to previous studies of healthy elderly controls. Developing alternative strategies to improve involved side vGRF may be warranted.
髋关节骨折后康复的老年人在从坐姿到站姿的转换过程中，患侧下肢的垂直地面反力（vGRF）较低，身体功能也较差。本研究的目的是测试在髋关节骨折后进行多模式高强度抗阻训练是否能改善肌肉表现、患侧下肢在从坐姿到站姿的转换过程中的 vGRF 以及身体功能，而这种训练是在常规治疗后（髋关节骨折后 2 至 6 个月）开始的。
髋关节骨折后 12 周的病例系列研究，进行扩展的高强度力量训练干预。
大学医院门诊。
24 名居住在社区的老年人（平均年龄 78.4 岁（标准差 10.4），16 名女性/8 名男性），在髋关节骨折后 3.6（标准差 1.2）个月并从物理治疗中出院后参加了研究。
干预/测量：所有参与者在 12 周（每周 3 次）的训练前后都进行了从坐姿到站姿的转换任务、肌肉表现测试和改良体能测试（mPPT）。使用配对 t 检验比较变量。
患侧下肢在从坐姿到站姿的转换过程中，vGRF 的力发展率（RFD）和肢体负荷差异的幅度（AREA）变量在训练后得到改善（RFD 比值=预：0.78-后：0.82，AREA 比值=预：0.79-后：0.86）。手术侧下肢伸肌力量的增加幅度较大（约 65%），而力量的增加幅度适中（约 34%），从而使力量和功率的对称性都得到了改善（预：0.74-后：0.88；预：0.75-后：0.82）。身体功能在训练前为 25（标准差 5.2），训练后为 30（标准差 4.3），（p < 0.001）。
与以往对健康老年人对照的研究相比，本研究中髋关节骨折康复的参与者在从坐姿到站姿的转换过程中患侧下肢的 vGRF、肌肉功能和身体功能的对称性得到了改善。然而，仍有很高比例的患者患侧下肢的 vGRF 持续较低。可能需要开发替代策略来提高患侧下肢的 vGRF。
