Impact of Exercise on Hip Fracture Recovery in Women

The recent results from a multi-center, randomized controlled trial, known as the STEP-HI (Starting a Testosterone and Exercise Program after Hip Injury) study, highlight the significant impact of supervised exercise on recovery outcomes for older women who have experienced a hip fracture. Conducted with a focus on personalized rehabilitation strategies, the study has provided vital data on the efficacy of combining testosterone therapy with exercise for improved mobility.

Background on Hip Fractures in Older Women

Hip fractures represent a critical health concern for older women, often resulting from osteoporosis, a condition characterized by decreased bone density. Dr. George Kuchel, director of the UConn Center on Aging, emphasized the severe consequences of hip fractures, stating: “Nearly 3 out of 4 older women fail to regain their previous level of function following a hip fracture, even when following standard rehabilitation protocols.”

These fractures are particularly serious as they entail substantial pain, loss of muscular and bone strength, reduced mobility, and an increased risk of mortality. An overview of the consequences following hip fracture is outlined in the table below:

Study Findings and Interventions

Published in JAMA Network Open, the STEP-HI trial included 129 women aged 65 and older who had undergone surgical repair for a hip fracture. Participants were randomly assigned to receive either a regimen of supervised exercise alone or combined with testosterone therapy.

Key findings from the STEP-HI trial revealed:

• **24 weeks of supervised exercise alone significantly improved long-distance mobility** compared to the combined treatment of testosterone and exercise.
• The intervention involving testosterone showed positive effects on **short-distance mobility and balance** improvements.
• Participants receiving testosterone had a **reduced need for assistive walking devices** by the study's conclusion.

The study underscores the potential limitations of testosterone therapy as an adjunct to exercise for enhancing endurance in older women recovering from hip fractures.

Implications for Future Research

The STEP-HI study's findings have prompted considerations for further research into the functional benefits of exercise, especially in light of the unexpected results regarding testosterone. The study co-author Dr. Jenna M. Bartley noted, “While we did not see improvements with testosterone in endurance activities, these findings are important for our understanding of how older women can best recover from hip fractures.”

Following the study's findings, future investigations should focus on:

• Assessing the long-term impact of supervised exercise on overall health and mobility.
• Exploring the mechanisms by which testosterone influences short-distance mobility.
• Comparative studies on the efficacy of various exercise protocols, particularly strength training, in enhancing post-fracture recovery.

“Our findings confirm that more intense and sustained exercise protocols are well-tolerated by older women and can result in substantial functional improvements.” – Dr. George Kuchel

Strength Training as a Key Component of Recovery

A notable aspect of the STEP-HI trial was the emphasis placed on progressive resistance training. Dr. Bartley remarked on the ability of older women to perform these exercises effectively: “What was most striking... was how well the older women performed the progressive resistance training and how much they improved over the course of the study.”

To illustrate the improvements observed among participants, the following table summarizes the exercise-related enhancements:

Conclusion and Recommendations

In conclusion, the STEP-HI clinical trial provides valuable insights into the recovery strategies for older women following hip fractures. While the addition of testosterone therapy did not enhance long-distance mobility, its interaction with exercise yielded positive outcomes in functional domains such as short-distance mobility and balance. The findings advocate for the promotion of exercise as a vital component of recovery protocols in this demographic.

For further information about the STEP-HI study, refer to the original publication: Combining Exercise Training and Testosterone Therapy in Older Women After Hip Fracture: The STEP-HI Randomized Clinical Trial in JAMA Network Open (2025).