Highlights
- •We found that 6 out of 10 younger hip fracture patients had a PA score below WHO recommendations, this is twice as many as in the general population.
- •A PA score below WHO recommendations was associated with higher ASA, worse HRQoL and weaker hand grip strength.
- •About 90% had a DXA scan indicating osteopenia or osteoporosis, regardless of PA.
Abstract
Background
The World Health Organization recommends a minimum of 150 min of moderate intensity
exercise per week or 75 min of strenuous activity weekly for adults. Younger hip fracture
patients are often assumed less active than the general population, however, knowledge
on physical activity (PA) and health-related quality of life (HRQoL) in younger hip
fracture patients is limited.
Objectives
We aimed to 1) investigate the variation in pre-fracture PA for adult patients with
hip fractures under the age of 60; and 2) to quantify the association with patient
characteristics, including outcomes of HRQOL and handgrip strength.
Design and methods
A prospective multicenter cohort study of 207 adult hip fracture patients under 60
years admitted to four study hospitals from July 2015 to December 2018. Data was collected
through medical records, questionnaires, physical tests and interviews. PA level was
assessed using a validated questionnaire from the Swedish National Board of Health
and Welfare, providing a total score from 3 to 19. A score ≥11 corresponds to fulfillment
of the WHO recommendation for weekly PA. Handgrip strength was measured in kilograms
using a handheld dynamometer following a standardized protocol. Recall pre-fracture
HRQoL was assessed using the EQ-5D-3L questionnaire.
Results
59% had a PA score ≤10 out of these 46% had an ASA grade of 3 or 4, 38% had a BMI
over 25 and 81% had a low energy fracture. A PA score ≤10 was associated with a lower
HRQoL compared to those who had a PA score ≥11. PA score ≤10 points was associated
with weaker hand grip strength and a worse health status (higher ASA-grade) p<0.001.
Conclusion
We found that close to two-thirds of the patients had a pre-fracture PA level below
WHO recommendations. Being more active was associated with better handgrip strength,
HRQoL, and ASA score. Our findings indicate that individuals under 60 years who sustain
a hip fracture form a heterogeneous group, some severely comorbid and others highly
active and seemingly healthy. This suggests a more nuanced approach to rehabilitation,
as the more active patient might need a more individualized plan than the standard
program can offer.
Keywords
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Article info
Publication history
Accepted:
January 19,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd.
