Home-based exercise reduces fall risk in older adults with mild cognitive impairment who have sustained a hip fracture: A 6-month randomized controlled trial

Objectives: Falls cause more than 85% of hip fractures in older adults. Older adults with cognitive impairment have been largely excluded from research on people who have sustained a hip fracture. As a consequence, whether exercise reduces fall risk in this high-risk population is unknown. We address this gap by examining the effect of a home-based exercise program on fall risk in older adults with mild cognitive impairment after hip fracture. Methods: This was a 6-month randomized controlled trial comparing the effect of the Otago Exercise Program (OEP) versus standard care (SC) on fall risk measured with the Physiological Profile Assessment. Participants with mild cognitive impairment (Montreal Cognitive Assessment score <26/30 and no dementia) who sustained a hip fracture were included. Secondary outcomes included the Short Physical Performance Battery, gait speed, Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test immediate and delayed recall, and Clinical Frailty Scale. Results: Sixty participants, mean age 80 years (SD 7 years), were randomized (OEP, n = 30; SC, n = 30). At 6 months, compared with SC participants, OEP participants had significantly better Physiological Profile Assessment performance (estimated mean difference −0.73; 95% CI [−1.45, −0.11]; p = 0.048), delayed recall performance (estimated mean difference 1.11; 95% CI [0.14, 2.09]; p = 0.025), and Clinical Frailty scores (estimated mean difference −0.71; 95% CI [−1.40, −0.01]; p = 0.046). There were no effects of the intervention on other secondary outcomes at 6 months. Conclusions: The Otago Exercise Program was efficacious at reducing fall risk in older adults with mild cognitive impairment after hip fracture. Exercise also improved cognitive function and frailty, highlighting its critical role in recovery after hip fracture in this high-risk population.