Original Study Effect of Lower-Limb Progressive Resistance Exercise After Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies Sang Yoon Lee MD, PhD a , Byung-Ho Yoon MD, PhD b , Jaewon Beom MD, PhD c , Yong-Chan Ha MD, PhD d , Jae-Young Lim MD, PhD e, f, * a Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea b Department of Orthopeadic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea c Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea d Department of Orthopeadic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea e Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea f Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Keywords: Resistance training postoperative hip fracture rehabilitation meta-analysis abstract Objective: Although several studies have reported the effect of progressive resistance exercise (PRE) after hip fracture surgery, little is known about the functional efficacy of PRE. Thus, we conducted a meta- analysis to evaluate whether PRE can improve (1) mobility and (2) other physical functions in elderly patients after hip fracture surgery. Methods: Eight randomized controlled trials investigating the effects of PRE after hip fracture surgery were retrieved from a PubMed, Embase, and Cochrane Library search. Our pair-wise meta-analysis used a fixed or random effects model. Results: PRE significantly improved participants’ overall physical functions after hip fracture surgery compared with the control group (standardized mean difference ¼ 0.408; 95% confidence interval, 0.238- 0.578; P < .001). It was particularly effective in the areas of mobility (standardized mean difference ¼ 0.501; 95% confidence interval, 0.297-0.705; P < .001), activities of daily living, balance, lower-limb strength or power, and performance task. Conclusions: Our meta-analysis revealed that PRE after hip fracture surgery improves mobility, activities of daily living, balance, lower-limb strength or power, and performance task outcomes. Because of the small sample size in this meta-analysis and considering the increasing incidence of hip fractures, there is a need for large-scale randomized controlled trials to confirm the functional improvement and adverse effects of PRE. Ó 2017 AMDA e The Society for Post-Acute and Long-Term Care Medicine. The outcomes of elderly patients with hip fracture surgery (HFS) are enhanced by subacute care interventions that usually comprise usual care with geriatric intervention, early rehabilitation, and sup- ported discharge. Health maintenance interventions including physical therapy, occupational therapy, fall prevention, nutritional support, and environmental modification as well as orthopedic care with complication management have been shown to improve physical function 1 and quality of life 2 of patients after HFS. This multidisci- plinary intervention seemed cost-effective during 1 year after HFS although the index stay was more costly than the general orthopedic care stay. 3 Recently, many of these studies about comprehensive rehabilita- tion after HFS included lower-limb progressive resistance exercise (PRE) to their program to improve several functional outcomes. Indeed, rehabilitation programs including PRE after HFS could improve mobility, 4 balance, 5 and self-reported activities of daily living (ADLs). 6 However, the functional gain of PRE has not yet been fully investigated. Furthermore, the prescription of PRE is not practical for Sang Yoon Lee and Byung-Ho Yoon equally contributed to this work and should be considered co-first author. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HC15C1189). * Address correspondence to Jae-Young Lim, MD, PhD, Department of Rehabili- tation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon- gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea. E-mail address: drlim1@snu.ac.kr (J.-Y. Lim). JAMDA journal homepage: www.jamda.com https://doi.org/10.1016/j.jamda.2017.08.021 1525-8610/Ó 2017 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA xxx (2017) 1.e1e1.e8