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The effects of strength training on muscle strength, asymmetry in lower limb muscle strength and mobility in older men and women with a history of hip fracture
DOI 10.1186/ISRCTN34271567
ClinicalTrials.gov identifier
EudraCT number
Public title The effects of strength training on muscle strength, asymmetry in lower limb muscle strength and mobility in older men and women with a history of hip fracture
Scientific title
Acronym N/A
Serial number at source N/A
Study hypothesis Older people with a history of hip fracture often have generally low muscle strength and power in the lower limbs, especially on the fractured side, which may result in mobility limitations. This considerable asymmetrical deficit may further complicate balance and independent living.

Progressive strength-power training may increase muscle strength and power. Taking into account asymmetrical deficit in the lower limbs may lead to larger improvements in mobility function in older people than conventional strength training.
Lay summary Not provided at time of registration
Ethics approval The study was approved by the Ethical Committee of the Jyväskylä Central Hospital Board on 14/10/2004
Study design A randomised controlled trial; men and women randomised in blocks. Data collected in two phases using the exact same protocol equipment and staff.
Countries of recruitment Finland
Disease/condition/study domain Hip fracture
Participants - inclusion criteria Community-dwelling 60 - 85-year-old men and women living in the Jyvaskyla Central Hospital District that had an operation following a hip fracture, from six months to seven years earlier
Participants - exclusion criteria The criteria of American College of Sports Medicine (e.g. severe cardiovascular disease) were used to exclude people from participation in the randomized controlled trial. Additionally, severe progressive (e.g. cancer) or neurological disease (e.g. advanced Alzheimer's disease), lower limb amputation, inability to walk outside without assistance of another person and alcohol abuse were used as exclusion criteria for this study.
Anticipated start date 01/06/2004
Anticipated end date 31/12/2006
Status of trial Completed
Patient information material
Target number of participants 30 participants in each group (60 in total)
Interventions Participants assigned to the intervention groups, participated twice a week in a 12-week progressive strength-power training specifically designed to increase lower limb muscle strength and power and to reduce asymmetry in lower limb strength and power. Resistance equipment was used to train: leg press, knee flexion, hip abduction and adduction exercises, in addition, plantar flexion exercise was provided by means of a weighted vest. The one repetition maximum (1 RM; calculated from the observed 3-5 RM) for the exercises used in the training was assessed twice during the training. The resistance of the strength training (usual velocity) was progressively increased from 50 to 80 % of the 1RM of the respective leg. Leg press and plantar flexion exercises were trained in addition with high-velocity low-load resistance (power training). For these exercises, the number of repetitions was progressively increased. In order to equalise muscle strength and power asymmetry between the legs, the weaker leg was trained with more sets of repetitions and/or a higher percentage of resistance. The training was supervised by an experienced physiotherapist.

The participants assigned to the control group were encouraged to continue their lives as they were used to.
Primary outcome measure(s) 1. Maximal muscle strength and power in both legs:
1.1. Voluntary isometric knee extension strength
1.2. Rate of force production
1.3. Leg extension power (Nottingham power-rig)
2. The strength and power difference between the legs (asymmetry)
3. Mobility (habitual and maximal walking velocity and other walking parameters, such as step length and time
4. Time of walking a figure 8
5. Ability and time to climb stairs
6. Timed-up-go test
7. Chair rise ability and time
Secondary outcome measure(s) 1. Balance:
1.1. Static and dynamic balance measured on a force plate
1.2. Functional balance (Berg balance scale)
1.3. Self-assessed balance confidence (ABC scale)
2. Falls (collected retrospectively and by means of a prospective follow-up)
3. Disability
4. Pain in the legs
5. Bone density and geometry of tibia (peripheral computed tomography)
Sources of funding 1. Ministry of Education (Finland)
2. Finnish Cultural Foundation (Finland)
3. Juho Vainio Foundation (Finland)
Trial website http://www.jyu.fi/sport/laitokset/tutkimusyksikot/sgt/en/
Publications 1. 2008 results in http://www.ncbi.nlm.nih.gov/pubmed/18760151
2. 2012 results in http://www.ncbi.nlm.nih.gov/pubmed/22698990
Contact name Ms  Erja  Portegijs
  Address Finnish Centre for Interdisciplinary Gerontology
Department of Health Sciences
University of Jyväskylä
P.O. Box 35 (viv)
  City/town Jyväskylä
  Zip/Postcode FI-40014
  Country Finland
  Email erja.portegijs@sport.jyu.fi
Sponsor Ministry of Education Finland
  Address PL 29
00023 Valtioneuvosto
  City/town Helsinki
  Zip/Postcode FI-00023
  Country Finland
  Email opmkirjaamo@minedu.fi
  Sponsor website: http://www.minedu.fi
Date applied 01/06/2006
Last edited 06/02/2013
Date ISRCTN assigned 13/07/2006
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