Elsevier

Injury

Volume 49, Issue 3, March 2018, Pages 697-701
Injury

Trajectory of physical activity after hip fracture: An analysis of community-dwelling individuals from the English Longitudinal Study of Ageing

https://doi.org/10.1016/j.injury.2018.02.010Get rights and content

Abstract

Introduction

To analyse physical activity participation in a community-dwelling people in England with hip fracture the interval prior to fracture, in the fracture recovery period, and a minimum of two years post-fracture.

Materials and methods

215 individuals were identified from the English Longitudinal Study of Ageing cohort (2002–2014) who sustained a hip fracture following a fall and for whom data were available on physical activity participation relating to the period pre-fracture, within-fracture recovery phase and post-fracture (minimum of two years). Physical activity was assessed using the validated ELSA physical activity questionnaire. Prevalence of ‘low’ physical activity participation was calculated and multi-level modelling analyses were performed to explore physical activity trajectories over the follow-up phase, and whether age, depression, gender and frailty were associated with physical activity participation.

Results

Prevalence of low physical activity participation within two years prior to hip fracture was 16.7% (95% Confidence Intervals (CI): 11.6% to 21.8%). This increased at the final follow-up phase to 21.3% (95% CI: 15.1% to 27.6%). This was not a statistically significant change (P = 0.100). Age (P = 0.005) and frailty (P < 0.001) were statistically significant explanatory variables (P = 0.005) where older age and greater frailty equated to lower physical activity participation. Neither gender (P = 0.288) nor depression (P = 0.121) were significant explanatory variables.

Conclusion

Physical activity levels do not significantly change between pre-fracture to a minimum of two years post-hip fracture for community-dwelling individuals. This contrasts with previous reports of reduced mobility post-hip fracture, suggesting that ‘physical activity’ and ‘mobility’ should be considered as separate outcomes in this population.

Introduction

Hip fractures are a major challenge for individuals who sustain them and for health services worldwide. Approximately 65,000 hip fractures occur each year in England, Wales and Northern Ireland [1]. Patients who sustain a hip fracture are typically elderly and frail, and their one-year post fracture mortality is reported to be as high as 30% [[1], [2]].

Physical activity can been defined as any bodily movement produced by skeletal muscle that requires energy expenditure [3], and is a fundamental factor contributing to an individuals’ health and wellbeing. Physical inactivity is the fourth leading risk factor for mortality globally [3]. Physical activity has been advocated to improve bone mineral density, reduce the risk of developing type 2 diabetes, breast cancer, dementia, obesity and depression [4]. Public Health England [5] recommend that people over the age of 65 years participate in at least 150 min of moderate intensity activity per week. However only 58% of men and 52% of women aged 65 to 74 years old, and 43% of men and 21% of women aged 75–84 years old in England meet these recommendations [6].

The United Kingdom National Health Survey has shown that physical activity levels decline with age [6]. Patients with hip fracture are particularly vulnerable to inactivity with previous literature demonstrating that mobility reduces following hip fracture [7]. This decline has been estimated where approximately 43% of people following hip fracture do not reach their pre-fracture level of mobility [7]. However, it remains unclear whether physical activity per se, rather than just mobility, changes before compared to after a hip fracture and how these may change over time, and what pre-fracture patient characteristics may be associated with post-fracture physical activity levels. The purpose of this study was to answer these questions using data from the English Longitudinal Study of Ageing (ELSA).

Section snippets

ELSA cohort

Data were drawn from the ELSA cohort. The ELSA cohort study was initiated in 2002. This is a prospective cohort study of English community-dwelling adults born on or before February 29th 1952, and was designed to examine the relationship between health, economic position and activity, social participation, productivity, networks and support [[8], [9]].

From the 2002/2003 inception, participants are contacted every two years for a follow-up interview. It is a nationally representative sample of

Results

Of the 11,391 participants at inception, 280 single hip fractures were surgically managed during the study time-frame. Of these, full data were avaliable at the three follow-up phases for 215 participants. Accordingly 65 participants were excluded from the analysis due to missing data. The demographic characteristics of these participants is presented in Table 1. This included 80 males and 135 females with a mean age of 71.8 years. The mean ELSA Frailty Index at pre-fracture assessment was 0.23

Discussion

The results of this analysis indicate that there is no significant difference in physical activity levels two years following a hip fracture for individuals compared to levels reported two years prior to fracture. Approximately 40% of people are physically inactive within two years after hip fracture. Physical activity levels were shown to decrease with age. Whilst frailty was shown to be a significant explanatory variable, where increased frailty leads to less physical activity, depression was

Conclusion

This study has shown that overall physical activity does not decrease following a hip fracture in the non-institutionalised population. However, approximately 40% of people are physically inactive within two years after hip fracture. Increasing age and frailty was associated with declining physical activity participation. This population should therefore be targeted toward physical activity interventions to ensure that they have specific support to increase overall physical and psychological

Conflicts of interest

Tariq Aboelmagd, Jack Dainty, Alex MacGregor, and Toby Smith declare that they have no conflict of interest (11th January 2018).

Funding

No project funding was received in relation to this paper. Dr Toby Smith is supported by funding from the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR.

Ethical approval

Ethical approval was obtained from the National Research Ethics Service (MREC/01/2/91).

Acknowledgements

None.

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