Individual nutrition therapy and exercise regime: A controlled trial of injured, vulnerable elderly (INTERACTIVE trial)

Susie K Thomas¹ , Karen J Humphreys¹ , Michelle D Miller² , Ian D Cameron³^,4 , Craig Whitehead¹ , Susan Kurrle⁴ , Shylie Mackintosh⁵ and Maria Crotty¹

¹Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, South Australia, Australia

²Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia

³Rehabilitation Studies Unit, University of Sydney, New South Wales, Australia

⁴Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia

⁵School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia

author email corresponding author email

BMC Geriatrics 2008, 8:4doi:10.1186/1471-2318-8-4


Published:	26 February 2008

Abstract

Background

Proximal femoral fractures are amongst the most devastating consequences of osteoporosis and injurious accidental falls with 25–35% of patients dying in the first year post-fracture. Effective rehabilitation strategies are evolving however, despite established associations between nutrition, mobility, strength and strength-related functional outcomes; there has been only one small study with older adults immediately following fragility fracture where a combination of both exercise and nutrition have been provided. The aim of the INTERACTIVE trial is to establish whether a six month, individualised exercise and nutrition program commencing within fourteen days of surgery for proximal femur fracture, results in clinically and statistically significant improvements in physical function, body composition and quality of life at an acceptable level of cost and resource use and without increasing the burden of caregivers.

Methods and Design

This randomised controlled trial will be performed across two sites, a 500 bed acute hospital in Adelaide, South Australia and a 250 bed acute hospital in Sydney, New South Wales. Four hundred and sixty community-dwelling older adults aged > 70 will be recruited after suffering a proximal femoral fracture and followed into the community over a 12-month period. Participants allocated to the intervention group will receive a six month individualised care plan combining resistance training and nutrition therapy commencing within 14 days post-surgery. Outcomes will be assessed by an individual masked to treatment allocation at six and 12 months. To determine differences between the groups at the primary end-point (six months), ANCOVA or logistic regression will be used with models adjusted according to potential confounders.

Discussion

The INTERACTIVE trial is among the first to combine nutrition and exercise therapy as an early intervention to address the serious consequence of rapid deconditioning and weight loss and subsequent ability to regain pre-morbid function in older patients post proximal femoral fracture. The results of this trial will guide the development of more effective rehabilitation programs, which may ultimately lead to reduced health care costs, and improvements in mobility, independence and quality of life for proximal femoral fracture sufferers.

Trial registration

Australian Clinical Trials Registry: ACTRN12607000017426.