In the literature the odds of a new fracture are six to 20 times higher than the initial fracture figure 1 within the first year of recovery. 9 Knowing this, the goal of physical therapy in the postoperative treatment of patients with a proximal femoral fracture is to increase muscle strength, and to improve walking safety and efficiency, thus enabling the elderly patient to become more independent. 10 To ensure a safe start for physical therapy it is extremely important for the professional to know the type of fracture, as well as the material used for surgical fixation. These data will interfere in the conduct, which includes walking time, weight bearing on the limb, and restrictions in some movements.

It is of crucial importance, regardless of the type of fracture and material used for fixation, for this patient to remain orthostatic and to walk as early as possible to avoid respiratory complications and other complications inherent to immobility, yet sometimes this is not possible due to the patient’s general state of health. In a study, conducted in the hospital ward, where the patients were divided into 2 groups, one for early walking and the other for late walking, the professionals found evidence that cardiovascular stability is one of the main determinants of success of early walking after hip fracture surgery and this early gait was determinant for an increase of the subjects’ functionality, when compared with the late gait group. 11 Aerobic fitness is something the physiotherapist should think about when developing a treatment plan, as it can increase the patient’s physical function, because cardiorespiratory fitness can result in an increase in walking capacity.

This is what was reported in a pilot study that performed aerobic exercise with arm ergometer over a 4-week period. 8 It is estimated that in 12 months after a hip fracture, the patient presents a loss of 6% of the lean body mass. A study conducted with 90 elderly individuals tested a 6-month intensive rehabilitation program compared with a control group that performed exercises of lower intensity and besides increasing the muscle strength of the patients from the intervention group, also increased gait speed, balance and ADL performance. 9 Another similar study resulted in an increase in gait speed in the group of higher exercise intensity, yet only in patients with cognitive deficit.

This shows that besides the physical benefits, strength exercises can also produce advantages in the psychosocial area, which is often altered in the elderly individual who has sustained a fracture and that can be one of the causes of low physical function in the post-trauma period. 12 This gain of muscle strength has proven effective Carfilzomib both through weight training and through neuromuscular stimulation using an apparatus; the latter technique has gained prominence for the increase of strength in inhibited muscles.