Vol. 47 - No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 297 Physical exercise after hip fracture: an evidence overview Growing problem of hip fracture I mproving strategies for hip fracture rehabilitation among older people is an urgent public health challenge. 1 The increasing proportion of older peo- ple in the global population 2 will result in increas- ing numbers of falls and fractures. Globally there are already more than 1.3 million hip fractures each year and this igure may increase to as many as 21 mil- lion by 2050. 3 Residual lifetime risk of fracture (after adjusting for competing risk of death) for women and men from age 60 is 44% (95% CI 40-48) and 25% (95% CI 19-31), respectively. 4 Physical outcomes after fracture are often poor “Some loss of function is expected” after hip frac- ture. 3 Recent analysis of data from close to 3 000 people after hip fracture 5 revealed that up to 50% of survivors who were able to complete core activities of daily living (eating, dressing, washing and toilet- ing) independently prior to their fracture had per- sistent loss of independence for at least one of these activities six months after fracture. Not surprisingly, large population-based studies have found health- related quality of life decreases in women after a 1 Musculoskeletal Division, George Institute for Global Health, University of Sydney, Sydney, Australia 2 Rehabilitation Studies Unit University of Sydney, Sydney, Australia EUR J PHYS REHABIL MED 2011;47:297-307 C. SHERRINGTON 1 , A. TIEDEMANN 1 , I. D. CAMERON 2 Improving strategies for hip fracture rehabilitation among older people is an urgent public health chal- lenge due to the increasing proportion of older peo- ple in the global population and therefore the in- creasing numbers of falls and fractures. Most older people who suffer a hip fracture experience a perma- nent decrease in physical functioning. It is now clear in the general older population that muscle strength and balance can be improved and falls can be pre- vented by well-designed exercise programs. Physical exercise has the potential to improve physical out- comes after hip fracture in older people. Increas- ingly, clinicians are being urged to seek guidance from clinical trials in order to make clinical deci- sions. This article presents: 1) an overview of clini- cal practice guidelines and systematic reviews about rehabilitation after hip fracture and 2) an overview of randomised trials of exercise for people after hip fracture indexed on the Physiotherapy Evidence Da- tabase (PEDro). The lack of well-designed large-scale trials of exercise after hip fracture means that cur- rent guidelines do not include detailed recommenda- tions about exercise after hip fracture. The Cochrane reviews covering this ield also do not draw irm con- clusions. However, several individual trials have had promising indings and indicate some beneits of ex- ercise after hip fracture. KEY WORDS: Hip fractures - Physical therapy modalities – Physical exercise. Congresses.—None. Funding.—Salary funding for all three authors is provided by the Australian National Health and Medical Research Council. Conlicts of interest.—None. Epub ahead of print on May 10, 2011. Corresponding author: C. Sherrington, Musculoskeletal Division, George Institute for Global Health, PO Box M201, Missenden Road NSW 2050, Australia. E-mail: csherrington@george.org.au MINERVA MEDICA COPYRIGHT® This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary tion of the Publisher.