Controlled Trial Of Exercise Research Articles

Tai chi exercise for treatment of pain and disability in people with persistent low back pain: A randomized controlled trial

To determine the effect of tai chi exercise on persistent low back pain. We performed a randomized controlled trial in a general community setting in Sydney, New South Wales, Australia. Participants consisted of 160 volunteers between ages 18 and 70 years with persistent nonspecific low back pain. The tai chi group (n = 80) consisted of 18 40-minute sessions over a 10-week period delivered in a group format by a qualified instructor. The waitlist control group continued with their usual health care. Bothersomeness of back symptoms was the primary outcome. Secondary outcomes included pain intensity and pain-related disability. Data were collected at pre- and postintervention and analyzed by intent-to-treat. Tai chi exercise reduced bothersomeness of back symptoms by 1.7 points on a 0-10 scale, reduced pain intensity by 1.3 points on a 0-10 scale, and improved self-report disability by 2.6 points on the 0-24 Roland-Morris Disability Questionnaire scale. The followup rate was >90% for all outcomes. These results were considered a worthwhile treatment effect by researchers and participants. This is the first pragmatic randomized controlled trial of tai chi exercise for people with low back pain. It showed that a 10-week tai chi program improved pain and disability outcomes and can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms.

Patients’ views of physical activity as treatment for depression: a qualitative study

This study explored patients’ views of physical activity for the treatment of depression in primary care. Patients were recruited from GP practices in Devon and Bristol, who were also participating in a pragmatic randomised controlled trial of exercise and depression.

Feasibility of Institutional Registry-Based Recruitment for Enrolling Newly Diagnosed Breast Cancer Patients in an Exercise Trial

The purpose of this study was to determine the feasibility of using a tumor registry to recruit newly diagnosed survivors into a randomized controlled exercise trial and to discuss issues related to this recruitment strategy. A tumor registry-based rapid ascertainment system was used to recruit breast cancer survivors into a 6-month home-based, telephone-administered intervention of moderate-to-vigorous intensity exercise or a usual care group. 468 newly diagnosed cases were identified. Of these, 50 women (15.4% of those for which screening calls were made) were enrolled in the study. Women were randomized, on average, 11 weeks after diagnosis (SD = 4.8). Sixty-four percent were randomized before beginning treatment or within the first week of treatment. Time required to obtain physician consent was the primary determinant of diagnosis-to-randomization latency. Enrolled women were more likely than nonenrolled women to be non-Hispanic White and to have a college degree (P < .05). Tumor registries present a feasible means of recruiting breast cancer survivors before or early in adjuvant treatment. The success of recruiting survivors promptly after diagnosis is largely dependent on ability to rapidly obtain physician consent. Specific effort is needed to counteract self-selection effects that may lead to under-representation of minorities.

Assessing Energy Expenditure in Male Endurance Athletes

The correct assessment of energy expenditure (EE) in athletes is important to ensure that dietary energy intake is sufficient. In general, athletes are individuals with especially high levels of total EE (TEE) and exercise-related EE (ExEE). The SenseWear Pro3 Armband (SWA) is a multisensor device for the individual assessment of EE, but data on the validity for higher exercise intensities are missing. The aim of the study was to validate the SWA for the assessment of TEE and ExEE in endurance athletes. The SWA was worn by 14 male endurance athletes for 7 d during a regular training period, and TEE was measured in parallel with the doubly labeled water method. Two controlled exercise trials (treadmill running=2.4-4.8 m·s, stationary bicycling=140-380 W) were performed, during which indirect calorimetry was used to assess ExEE. TEE assessed with the SWA and TEE measured with the doubly labeled water method were significantly correlated (r=0.73, P<0.01), but there were a proportional bias and considerably wide limits of agreement (-1368 to 1238 kcal·d). The error of TEE assessed with the SWA was related to the athletes' individual lactate thresholds (P<0.05). During running and bicycling, ExEE was significantly underestimated for most exercise intensities, and the underestimation increased with exercise intensity (P<0.001). According to our results, the SWA does not provide valid results of TEE and ExEE in endurance athletes because of the underestimation of EE at higher exercise intensities. It seems necessary to develop exercise-specific prediction equations to improve EE measurements in athletes.

Perceived Facilitators, Barriers, and Changes in a Randomized Exercise Trial for Obese Youth: A Qualitative Inquiry

Purpose was to examine experiences of obese youth aged 14 to 18 years during their participation in the Healthy Eating, Aerobic, and Resistance Exercise in Youth (HEARTY) randomized controlled exercise trial. A longitudinal qualitative approach was used to investigate youths' experiences across time points in the trial: 3-weeks (run-in phase; n = 44, 52% males), 3-months (midpoint; n = 25), and 6-months (end of intervention; n = 24). Participants completed telephone interviews on perceived exercise facilitators, barriers, outcomes, and program preferences. Responses were subject to content analyses and are reported as frequencies. Participants joined the trial initially to lose weight, but focused more on fitness over time. Exercise behavior was influenced by a sense of achieving results, and by family and peers (ie, supportive comments, transportation). At 6-months, the most commonly perceived changes were improved fitness (50%) and appearance (46%). Suggested changes to the HEARTY trial included initial guidance by a trainer, and more varied and group-based activity. Exercise facilitators, barriers and perceived changes in an exercise trial are reported. Access to a gym, initial direction by a trainer, variety, and group-based activities were reported as desired components of an exercise intervention. Findings also point to the importance of involving family and peer supports.

Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression.

BackgroundExercise may be effective in treating depression, but trials testing its effect in depressed women are rare.AimTo compare the effect of exercise of preferred intensity with exercise of prescribed intensity in thirty-eight women living with depression.MethodsA Pragmatic RCT of 12 sessions of exercise at preferred intensity compared with 12 sessions at prescribed intensity. Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), General Health Questionnaire 12 (GHQ-12), heart rate (HR), Rating of Perceived Exertion Scale (RPE), Quality of Life in Depression Scale (QLDS), Multi-Dimensional Scale of Perceived Social Support (MDSPSS), SF12 Health Survey and exercise participation rates were compared between groups.ResultsIntervention participants had statistically better BDI (t = 2.638, df = 36, p = 0.006, 95% mean (SD) 26.5 (10.7), CI-20.4 to -2.7, d = 0.86), GHQ-12 (t = 3.284, df = 36, p = 0.001, mean (SD) 8.3 (3.7) 95% CI -6.5 to -1.5, d = 1.08), RSES (t = 2.045, df = 36, p = 0.024, mean (SD) 11.3 (5.8), 95% CI 0.3 -6.4, d = 0.25), QLDS (t = 1.902, df = 36, p = 0.0325, mean (SD) 15.5 (7.9), 95% CI -12.2 -0.4, d = 0.27) RPE scores (t = 1.755, df = 36, p = 0.0475, mean (SD) 9.2 (3.2), 95% CI -.5 - 5.2, d = 0.77) and attended more exercise sessions (t = 1.781, df = 36, p = 0.0415, number of sessions 8 (65%), 95% CI-0.3 -4.8, d = 0.58). SF-12, MSPSS and HR did not differ significantly between groups.ConclusionsExercise of preferred intensity improves psychological, physiological and social outcomes, and exercise participation rates in women living with depression.Trial RegistrationClinicalTrials.gov: NCT00546221

Alpe d’HuZes Cancer Rehabilitation (A-CaRe) Research: Four Randomized Controlled Exercise Trials and Economic Evaluations in Cancer Patients and Survivors

BackgroundPrevious studies showed that exercise in cancer patients is feasible and may reduce fatigue and improve physical fitness and quality of life. However, many previous studies had methodological weaknesses related to trial design, sample size, comparison group, outcome measures, short follow-up durations and programme content.PurposeThis paper aims to present the rationale and design of the clinical research subprogramme of the Alpe d’HuZes Cancer Rehabilitation (A-CaRe) programme.MethodA-CaRe Clinical Research includes four randomized controlled trials in patients: (a) after chemotherapy, (b) during chemotherapy, (c) after stem cell transplantation and (d) during childhood cancer. These trials compare high-intensity resistance and endurance exercise interventions with usual care or a waiting list control group. In two studies, a second intervention arm consisting of low-to-moderate intensity exercise is included. All four A-CaRe trials use similar methods.ResultsOutcome measures are carefully chosen based on the International Classification of Functioning Disability and Health model. Measurements will be performed prior to randomization (T0), after completion of the intervention (T1) and at follow-up (T2). The primary outcome measures are cardiorespiratory fitness, muscle strength and fatigue. Secondary outcome measures include health-related quality of life and psychosocial functioning. Furthermore, cost-effectiveness and cost-utility analyses are performed from a societal perspective.ConclusionWe hypothesize that exercise is more effective at improving physical fitness and thereby reducing fatigue and more cost-effective compared with usual care or a waiting list control group. If so, the programmes will be implemented in the Dutch clinical practice.

Physical activity and cancer prevention: a systematic review of clinical trials

Physically active individuals have lower rates of many cancers and improved cancer outcomes. Controlled exercise trials measuring putative biomarkers of cancer risk are being conducted to further understand the role of exercise in cancer etiology and progression. We aimed to systematically review the effect of exercise on various biomarkers. A comprehensive search strategy identified 353 publications from January 1980 to August 2010. We included those clinical trials of exercise measuring biomarkers following minimum 4-week intervention among cancer survivors or people with one or more cancer risk factors. Two reviewers abstracted data and assessed quality independently. Effect sizes and 95% confidence intervals were estimated. Four primary prevention and five tertiary prevention trials were included. Exercise had a small to moderate effect on improving concentrations of several blood biomarkers implicated in breast and colon cancer pathways including insulin, leptin, estrogens, and apoptosis regulation. In breast cancer survivors, exercise had a small to moderate effect on improving some biomarkers associated with prognosis including various insulin-like growth factor axis proteins, insulin, and inflammation; and a large effect on enhancing immune function. Data are few, but there is some evidence to support the role of exercise in modulating various cancer pathways.

Exercise and Osteoporosis-Related Fractures: Perspectives and Recommendations of the Sports and Exercise Scientist

Osteoporosis-related fractures represent a major health concern, particularly in elderly populations. Direct and indirect costs (amounting to nearly $17 billion in 2005), increased morbidity, and loss of independence place substantial burden on the health care system. Observational studies have shown that a physically active lifestyle is associated with a 30% to 50% decrease in vertebral or hip fractures, and a recent meta-analysis that determined the effects of exercise on fracture incidence further confirmed these results. However, because no randomized controlled exercise trials have selected fractures as a primary endpoint, causality between a sedentary lifestyle and fractures may be potentially confounded by participants' poor health status. With regard to fall reduction and bone strength as the main surrogates for fracture risk, many randomized controlled trials and corresponding meta-analyses have reported significant positive outcomes. Interestingly, no study that has assessed fall-related injuries has focused specifically on interventions that aimed to reduce fall impact. There is ongoing debate as to which factor, osteoporosis or falls, is more important for fracture prevention. This may be dependent on the region prone to fracture and the subjects' health status. In randomized controlled trials on exercise, the type, mode, and composition of exercise parameters are predictors of study outcome. Unfortunately, many exercise trials on fall prevention have not adequately described the exercise protocol used, which makes it difficult to determine which fall prevention protocol was most effective. A recent meta-analysis recommended Tai Chi and/or a mix of balance and resistance exercises for fall prevention. More sophisticated protocols are required to impact bone strength. Corresponding state-of-the-art protocols have focused on periodized high-impact/high-intensity resistance protocols performed at least twice per week. In the frail elderly, high-frequency/high-cycle number exercise programs with low-to-moderate strain intensity may also positively affect bone strength.

Exercise and Osteoporosis-Related Fractures: Perspectives and Recommendations of the Sports and Exercise Scientist

Osteoporosis-related fractures represent a major health concern, particularly in elderly populations. Direct and indirect costs (amounting to nearly $17 billion in 2005), increased morbidity, and loss of independence place substantial burden on the health care system. Observational studies have shown that a physically active lifestyle is associated with a 30% to 50% decrease in vertebral or hip fractures, and a recent meta-analysis that determined the effects of exercise on fracture incidence further confirmed these results. However, because no randomized controlled exercise trials have selected fractures as a primary endpoint, causality between a sedentary lifestyle and fractures may be potentially confounded by participants' poor health status. With regard to fall reduction and bone strength as the main surrogates for fracture risk, many randomized controlled trials and corresponding meta-analyses have reported significant positive outcomes. Interestingly, no study that has assessed fall-related injuries has focused specifically on interventions that aimed to reduce fall impact. There is ongoing debate as to which factor, osteoporosis or falls, is more important for fracture prevention. This may be dependent on the region prone to fracture and the subjects' health status. In randomized controlled trials on exercise, the type, mode, and composition of exercise parameters are predictors of study outcome. Unfortunately, many exercise trials on fall prevention have not adequately described the exercise protocol used, which makes it difficult to determine which fall prevention protocol was most effective. A recent meta-analysis recommended Tai Chi and/or a mix of balance and resistance exercises for fall prevention. More sophisticated protocols are required to impact bone strength. Corresponding state-of-the-art protocols have focused on periodized high-impact/high-intensity resistance protocols performed at least twice per week. In the frail elderly, high-frequency/high-cycle number exercise programs with low-to-moderate strain intensity may also positively affect bone strength.

Trajectories of change in self-esteem in older adults: exercise intervention effects.

This 12-month, 2 arm, single blind randomized controlled exercise trial examined relationships among changes in multidimensional self-esteem as a function of intervention mode (i.e., walking vs. flexibility-toning-balance). Data were collected on three equidistant occasions (baseline, 6 and 12 months). One-hundred seventy-nine older adults (M(age) = 66.38) began the study and 145 completed assessments at all time points. Participants completed measures of physical and global self-esteem as well as demographic information. There were no significant group differences at baseline on these demographic indicators or esteem variables. Data were analyzed using linear and parallel process growth modeling procedures. Results supported the position that across both groups, domain-level (i.e., physical self-worth) was dependent upon sub-domain-level (i.e., perceived attractiveness, strength, and condition) esteem change. Furthermore, greater improvements were observed in the flexibility-toning-balance group, in terms of perceived strength and attractiveness esteem, compared to the walking group. Our findings support theoretically-based predictions and extend the literature showing unique psychological responses conditional on specific types of physical activities.

Economic evaluation within a factorial-design randomised controlled trial of exercise, manual therapy, or both interventions for osteoarthritis of the hip or knee: study protocol

IntroductionClinical guidelines for the treatment of hip and knee osteoarthritis recommend non-pharmacological and non-surgical treatments. Exercise treatments are recommended as primary strategies, but specific exercise programme components have not been...

Exercise and Pharmacotherapy in Patients With Major Depression: One-Year Follow-Up of the SMILE Study

To examine a 1-year follow-up of a 4-month, controlled clinical trial of exercise and antidepressant medication in patients with major depressive disorder (MDD). In the original study, 202 sedentary adults with MDD were randomized to: a) supervised exercise; b) home-based exercise; c) sertraline; or d) placebo pill. We examined two outcomes measured at 1-year follow-up (i.e., 16 months post randomization): 1) continuous Hamilton Depression Rating Scale score; and 2) MDD status (depressed; partial remission; full remission) in 172 available participants (85% of the original cohort). Regression analyses were performed to examine the effects of treatment group assignment, as well as follow-up antidepressant medication use and self-reported exercise (Godin Leisure-Time Exercise Questionnaire), on the two outcomes. In the original study, patients receiving exercise achieved similar benefits compared with those receiving sertraline. At the time of the 1-year follow-up, rates of MDD remission increased from 46% at post treatment to 66% for participants available for follow-up. Neither initial treatment group assignment nor antidepressant medication use during the follow-up period were significant predictors of MDD remission at 1 year. However, regular exercise during the follow-up period predicted both Hamilton Depression Rating Scale scores and MDD diagnosis at 1 year. This relationship was curvilinear, with the association concentrated between 0 minute and 180 minutes of weekly exercise. The effects of aerobic exercise on MDD remission seem to be similar to sertraline after 4 months of treatment; exercise during the follow-up period seems to extend the short-term benefits of exercise and may augment the benefits of antidepressant use. clinicaltrials.gov Identifier: NCT00331305.

Are Changes in Leg Power Responsible for Clinically Meaningful Improvements in Mobility in Older Adults?

From among physiological attributes commonly targeted in rehabilitation, to identify those in which changes led to clinically meaningful differences (CMDs) in mobility outcomes. Secondary analysis of data collected for a randomized controlled trial of exercise using binary outcomes defined by recording a large CMD (Short Physical Performance Battery (SPPB)=1 unit; gait speed (GS)=0.1 m/s). Iterative models were performed to evaluate possible confounding between physiological variables and relevant covariates. Outpatient rehabilitation centers. Community-dwelling mobility-limited older adults (n=116) participating in a 16-week randomized controlled trial of two modes of exercise. Physiological measures included leg power, leg strength, balance as measured according to the Performance-Oriented Mobility Assessment (POMA), and rate pressure product at the maximal stage of an exercise tolerance test. Outcomes included GS and SPPB. Leg power and leg strength were measured using computerized pneumatic strength training equipment and recorded in Watts and Newtons, respectively. Participants were 68% female, had a mean age of 75.2, a mean of 5.5 chronic conditions, and a baseline mean SPPB score of 8.7. After controlling for age, site, group assignment, and baseline outcome values, leg power was the only attribute in which changes were significantly associated with a large CMD in SPPB (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.09-2.02) and GS (OR=1.31, 95% CI=1.01-1.70). Improvements in leg power, independent of strength, appear to make an important contribution to clinically meaningful improvements in SPPB and GS.

Longitudinal Examination of the Exercise and Self-Esteem Model in Middle-Aged Women

This 2-year prospective study examined the exercise and self-esteem model in middle-aged women (N = 143) previously enrolled in a randomized controlled exercise trial. Across the 2-year period, increases in physical activity (PA) and self-efficacy and reductions in body mass index (BMI) were associated with improved subdomain self-perceptions relative to physical condition, and reductions in BMI were associated with improved subdomain self-perceptions relative to physical condition and body attractiveness. The effects of PA, self-efficacy, and BMI on changes in physical self-worth and global self-esteem were mediated by changes in self-perceptions relative to physical condition and body attractiveness. The results of this longitudinal analysis support the hierarchical and multidimensional structure of self-esteem and indicate that middle-aged women can enhance how they perceive their condition and body attractiveness by continued participation in physical activity, increasing their self-efficacy, and maintaining healthy BMI levels.

Charting the progression of disability in Parkinson disease: study protocol for a prospective longitudinal cohort study.

BackgroundPeople with Parkinson disease (PD), even in the presence of symptomatic relief from medical, surgical, and rehabilitative interventions, face a persistent worsening of disability. This disability is characterized by diminished quality of life, reduced functional mobility, declining performance in activities of daily living and worsening neurological impairments. While evidence has emerged supporting the clinically meaningful benefits of short-term exercise programs on these underlying factors, assertions regarding the effects of sustained programs of exercise and physical activity on the trajectory of disablement in PD are made in the absence of direct evidence. Indeed, the natural decline in quality of life and functional mobility in people diagnosed with PD is poorly understood. Moreover, outcome measures commonly used in clinical exercise trials typically do not capture the full spectrum of disability as defined by the World Health Organization (WHO).Methods/DesignThe objective of this multicenter prospective study will be to examine the 2-year trajectory of disablement in a cohort of persons with PD. Two hundred sixty participants will be recruited to produce an expected final sample size of 150 individuals. Participants will be included if they are greater than 40 years of age, have a neurologist confirmed diagnosis of idiopathic PD, and are at Hoehn and Yahr stages 1 through 4. Data will be collected every 6 months during the study period. Primary outcome measures reflecting a broad spectrum of disablement will include, but will not be limited to, MDS-UPDRS, Timed Up and Go, Berg Balance Test, Nine Hole Peg Test, PDQ-39, and directly monitored ambulatory activity. Self-reported exercise and physical activity data also will be recorded. Statistical analyses will be used to characterize the trajectory of disablement and examine the influence of its underlying contributing factors.DiscussionTertiary prevention is an important component of contemporary healthcare for individuals living with degenerative disease. For individuals with PD, there is growing recognition that exercise and/or physical activity efforts to slow the rate of functional mobility decline, in particular, may be critical for optimizing quality of life. By describing the natural trajectory of disablement, exercise habits, and physical activity in a cohort of persons with PD, this investigation will establish an important foundation for future intervention research. Specifically, through the evaluation of the influence of sustained exercise and physical activity on disablement, the study will serve as a preliminary step toward developing a randomized controlled trial of long-term exercise in persons with PD.

Recruitment issues in a randomized controlled exercise trial targeting wheelchair users

This paper describes recruitment challenges and lessons learned in conducting a randomized controlled exercise trial in the absence of direct access to a clinical population. One-hundred thirty-five wheelchair users were enrolled in a home and community-based intervention to promote exercise adoption and maintenance. Over 44 months of recruitment, 355 individuals inquired about the study and 323 completed the screening process. Nearly half were determined ineligible (150/323, 46.4%), typically due to having restricted arm movement, cognitive impairment, or medical conditions that are contraindicated for unsupervised exercise. Respondents cited paid media advertisements and recruitment materials placed in health care providers' offices most frequently as being how they learned about the study. RCT participant recruitment, particularly in the absence of direct access to a clinical population, required far more time and resources than anticipated to achieve sufficient enrollment. Nurturing relations with key gatekeepers, creating a visible public profile, and maintaining ongoing recruitment activities were essential to success.

Long-term Outcomes of Exercise

Long-term evidence from randomized trials of the effectiveness of exercise in preventing disability and fall-related fractures in elderly people has been lacking. We performed extended follow-up of 160 women (aged 70-73 years at baseline) with osteopenia in a population-based, randomized, controlled exercise trial. The trial was conducted from April 1 through April 30, 2001. Follow-up was conducted from May 1, 2001, through December 31, 2005. Mean total time in observation was 7.1 years. Primary outcome measures were femoral neck bone mineral density, postural sway, and leg strength. Secondary outcome measures were hospital-treated fractures and functional ability measures. Outcomes were measured annually using masked assessors. There was a significant difference between groups in favor of exercise in terms of postural sway (group × time interaction, P = .005), walking speed (group × time interaction, P < .001), and Frenchay Activities Index score (group x time interaction, P = .001). The bone mineral density decreased similarly across time in both groups. The incidence rate of fractures during the total follow-up among women in the exercise group vs women in the control group was 0.05 vs 0.08 per 1000 person-years (Poisson incidence rate ratio, 0.68; 95% confidence interval, 0.34-1.32). There were no hip fractures in the exercise group, whereas 5 hip fractures occurred in the control group. One woman in the exercise group and 8 women in the control group died (Poisson incidence rate ratio, 0.11; 95% confidence interval, 0.01-0.85). Mainly home-based exercises followed by voluntary home training seem to have a long-term effect on balance and gait and may even protect high-risk elderly women from hip fractures. clinicaltrials.gov Identifier: NCT00655577.

Managing hip and knee osteoarthritis with exercise: what is the best prescription?

Hip and knee osteoarthritis are common, chronic, and disabling. Therapeutic exercise is a component of all major rheumatologic society guidelines, yet the frequency, dose, duration, and therapeutic threshold for exercise are not clearly delineated. This review summarizes current studies of exercise for hip and knee osteoarthritis, discusses issues that influence the design, interpretation, and aggregation of results and how these factors impact the translation of data into clinical practice. A review of databases to identify current randomized controlled trials (2000 to present) of exercise to manage the symptoms of hip and knee osteoarthritis is discussed here. One study enrolling only hip patients was identified. Six studies of outcomes for individuals with hip or knee osteoarthritis and 11 studies of persons with knee osteoarthritis were found. Limited studies focus specifically on exercise for persons with hip osteoarthritis. Exercise is provided as a complex intervention combining multiple modes and provided in various settings under a range of conditions. Regardless of the variability in results and inherent biases in trials, exercise appears to reduce pain and improve function for persons with knee osteoarthritis and provide pain relief for persons with hip osteoarthritis. Given the complexity of exercise interventions and the specific issues related to study design, novel approaches to the evaluation of exercise are warranted.

Impaired weight transfer persists at least four months after hip fracture and rehabilitation

Objective: To determine whether choice stepping reaction time performance is impaired in people after hip fracture and whether different aspects of choice stepping performance improve with rehabilitation. Design: This study includes a secondary analysis of data obtained from participants in a randomized controlled trial of exercise after hip fracture. Setting: Data were either collected in a hospital rehabilitation unit, research institute or participant homes. Subjects: The hip fracture group (n = 91) were recruited from three rehabilitation hospitals in metropolitan Sydney. The control group (n = 77) were healthy age-, gender- and dwelling-matched controls, participating in unrelated studies of fall risk factors. Main measures: Response time, movement time and total time components of the choice stepping reaction time test. Results: Improvements in choice stepping reaction time were seen in people after hip fracture, during a 16-week rehabilitation period, however performance remained impaired (1808 ± 663 ms), compared with matched controls (1029 ± 255 ms, P<0.001). Further, choice stepping performance was significantly slower when transferring weight onto the affected leg (1271 ± 615 ms), compared with the unaffected leg (1119 ± 499 ms, P<0.001). Conclusions: Movement deficits are evident for an extended time frame following rehabilitation for hip fracture. The slower response time following the rehabilitation period highlights ongoing difficulties with weight transfer onto the affected leg.