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Exercise prescription after fragility fracture in older adults: a scoping review

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Abstract

The purpose of this study is to identify and chart research literature on safety, efficacy, or effectiveness of exercise prescription following fracture in older adults. We conducted a systematic, research-user-informed, scoping review. The population of interest was adults aged ≥45 years with any fracture. “Exercise prescription” included post-fracture therapeutic exercise, physical activity, or rehabilitation interventions. Eligible designs included knowledge synthesis studies, primary interventional studies, and observational studies. Trained reviewers independently evaluated citations for inclusion. A total of 9,415 citations were reviewed with 134 citations (119 unique studies) identified: 13 knowledge syntheses, 95 randomized or controlled clinical trials, and 11 “other” designs, representing 74 articles on lower extremity fractures, 34 on upper extremity, eight on vertebral, and three on mixed body region fractures. Exercise prescription characteristics were often missing or poorly described. Six general categories emerged describing exercise prescription characteristics: timing post-fracture, person prescribing, program design, functional focus, exercise script parameters, and co-interventions. Upper extremity and ankle fracture studies focused on fracture healing or structural impairment outcomes, whereas hip fracture studies focused more on activity limitation outcomes. The variety of different outcome measures used made pooling or comparison of outcomes difficult. There was insufficient information to identify evidence-informed parameters for safe and effective exercise prescription for older adults following fracture. Key gaps in the literature include limited numbers of studies on exercise prescription following vertebral fracture, poor delineation of effectiveness of different strategies for early post-fracture mobilization following upper extremity fracture, and inconsistent details of exercise prescription characteristics after lower extremity fracture.

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Acknowledgments

This study was funded in part by a Canadian Institutes of Health Research (CIHR) Knowledge Synthesis Grant (FRN 86244). The principal investigator for this study is Susan R. Harris.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    L. M. Feehan, S. R. Harris, D. L. MacIntyre & L. C. Li

  2. Woodward Library, University of British Columbia, Vancouver, BC, Canada

    C. A. Beck

  3. Arthritis Research Centre of Canada, 895 West 10th Ave, Vancouver, BC, V5Z 1L7, Canada

    L. M. Feehan

Authors
  1. L. M. Feehan
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  2. C. A. Beck
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  3. S. R. Harris
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  4. D. L. MacIntyre
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  5. L. C. Li
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Corresponding author

Correspondence to L. M. Feehan.

Appendices

 

OSTEO-FX Team/Collaborators (O)steoporosis (S)tudy (T)eam: (E)xercise after (O)steoporotic (FX)fracture

Research assistants

  • Cynthia MacDonald. Graduate Programs in Rehabilitation Sciences, University of British Columbia. Vancouver, BC, Canada

  • Amy Kirkham. School of Human Kinetics, University of British Columbia. Vancouver, BC, Canada

Canadian Physiotherapy Association (CPA)/Decision Making Partner

  • Carol Miller. CPA Central Office. Ottawa, Ontario.

  • National Membership Survey Participants

  • National Teleconference Participants

Researcher/academic collaborators

  • Meena Sran. British Columbia Women’s Health Centre. Vancouver, BC, Canada

  • William Miller. Department of Occupational Sciences and Occupational Therapy. University of British Columbia. Vancouver, BC, Canada

  • Darlene Reid. Department of Physical Therapy, University of British Columbia. Vancouver, BC, Canada

  • Marie Westby. Graduate Programs in Rehabilitation Sciences, University of British Columbia. Vancouver, BC, Canada

Cochrane collaboration—musculoskeletal group collaborators

  • Jill Hayden. Department of Community Health & Epidemiology, Dalhousie University. Halifax. NS. Canada

  • Jessie McGowan. Institute of Population Health, Ottawa Health Research Institute, Ottawa, ON, Canada

  • Peter Tugwell. Department of Epidemiology & Community Medicine. University of Ottawa. Ottawa. ON. Canada

Consumer collaborators—Osteoporosis Society of Canada (North Vancouver Chapter)

  • Dorothy McNaughton. Vancouver, BC, Canada

  • Ethel Cook. Vancouver, BC, Canada

Physiotherapy clinician collaborators

  • Alison Hoens. Physical Therapist, Providence Health Care, Vancouver, BC, Canada

  • Fatima Inglis. Physical Therapist. Providence Health Care, Vancouver, BC, Canada

  • Chris Palmer. Physical Therapist. Vancouver Coastal Health, Vancouver, BC, Canada

Translation partners

  • Sarah Ewald (Zurich, Switzerland): Danish, German, Finnish

  • Lisolette Clark (Vancouver, Canada): Danish

  • Tanja Mayson (Vancouver, Canada); French and German

Appendix

Table 5 Complete listing of the final 134 citations included in this scoping review
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Feehan, L.M., Beck, C.A., Harris, S.R. et al. Exercise prescription after fragility fracture in older adults: a scoping review. Osteoporos Int 22, 1289–1322 (2011). https://doi.org/10.1007/s00198-010-1408-x

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  • DOI: https://doi.org/10.1007/s00198-010-1408-x

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