Physical activity in hospitalised older adults after hip fracture

Participants will be prescribed a physical activity protocol dependent on their physical ability at the time. For those who are able to stand and walk, a standing strengthening and functional exercise program will be prescribed in addition to ambulation (aiming maximal tolerance) and functional standing (assisted by gait aid with or without additional hands on assistance as appropriate). This will be aimed at three times per day Monday - Friday, with the prescription of an independent exercise program to be completed independently on the weekend. Physiotherapy exercises will be prescribed by the treating physiotherapist and carried out by either a physiotherapist or an allied health assistant in one to one individual treatment sessions. These sessions will be approximately 20 minutes in duration and completed until hospital discharge. Attendance at and adherence to exercise protocols will be recorded by their treating physiotherapist/allied health assistant. Exercises will be encouraged at set number of repetitions per the protocol, to fatigue/discomfort. Difficulty will be progressed as the participant progresses in ability. Participants will also be invited to wear an activity monitor attached to their thigh. The PAL2 and activPAL are accelerometers that have previously been validated in older adults (Raymond et al 2015, Klenk et al 2016). These devices will record participants’ activity levels continuously for 3-5 days on weekdays only. Twice daily skin checks will be undertaken by the physiotherapy/allied health assistants on the wards. These are for comfort and to monitor skin irritation. Participants will wear only one monitor, which will be assigned to each participant that agrees to monitoring - this will be assigned alternatively (i.e. PAL2, then ActivPAL, then PAL2, then ActivPAL etc). Final physical and discharge outcome measures will be taken 24-48 hours prior to discharge, completed by an assessor blinded to group allocation. Participants and their families, as well as therapy staff will be invited to take part in a semi-structured interview focussing on satisfaction and participation during the project. Seven participants (and families) and involved ward therapy staff (physios and allied health assistants) will be interviewed. Physiotherapy will be offered three times per day Monday to Friday: once a day by the treating physiotherapist and twice a day by an allied health assistant, under instruction by the treating physiotherapist. Participants who are able to stand and transfer with assistance of at most one person will be offered a weight-bearing (standing) exercise program. Standing exercises will be aimed at one to two sets of eight to 12 repetitions (high intensity) of some or all of the following (as prescribed by the physiotherapist): • hip abduction (affected leg) • hip flexion (affected leg) • hip extension (affected leg) • squats • heel raises • sit to stand • step ups • side/forward walking at rails Upper Limb Exercises (+/- weights) • biceps curls • shoulder press • chest press • triceps from chair (pushing up from chair) These exercises will be prescribed in addition to: standing balance (unaided +/- reaching out of base of support), and ambulation with gait re-education, distance encouraged to maximal tolerance, with rests as required. For those who are unable to walk, participants will be prescribed a supine and seated exercise program as well as sitting out of bed (with or without standing, and assisted if required). These exercises may include some or all of the following, at 2x 8-12 repetition maximum: Supine with slideboard as appropriate: *Quads over fulcrum *Static quads *hip/knee flexion/extension *hip abduction *bridging *ankle dorsiflexion/plantar flexion Seated: *knee extension *static glutes *upper limb exercises as per the ‘weightbearing protocol’ Participants undertaking both protocols will be encouraged to stand to tolerance (with gait aid/assistance where appropriate and practical), as well as sitting out of bed as medical stability and patient ability allows.