A systematic review of evidence for older adults' sedentary behavior and physical activity after hip fracture

Objective: To synthesize evidence on older adults' sedentary behavior and physical activity during rehabilitation and recovery for hip fracture (1) across the care continuum and (2) from clinical interventions. Design: We conducted a systematic review of peer-reviewed publications using CINAHL, Embase, Ovid MEDLINE, PsycINFO, and SportDiscus (last search: 17 October 2017). Study selection: We included studies that measured sedentary behavior and physical activity of older adults with hip fracture using activity monitors (e.g. accelerometers). We identified literature at Level 1 (title and abstract) and Level 2 (full text), and conducted forward and backward searches. We assessed observational studies' adherence to reporting guidelines and intervention studies' risk of bias. Results: We included 14 studies (882 participants). Four studies reported sedentary behavior data, while all studies reported information on physical activity. Settings included hospital, rehabilitation centers, and the community. Nine studies were observational; five were experimental design. Older adults had excessive sedentary time (>10hours/day) and low physical activity. Participants' average upright time differed across settings. During hospital stay, it ranged 16-52minutes/day, while in the community, it ranged 51-261minutes/day. Data from five interventions reported on physical activity change: two studies increased between 14 and 27minutes/day. Another study reported participants accumulated 6994 steps/day at the end of the intervention, but for two other interventions, activity was below 5000 steps/day. Conclusion: Based on available evidence, older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery.