The exercises with the strongest evidence behind them are early walking, progressive resistance training, and balance work, all introduced under a physical therapist's supervision. A 2021 clinical practice guideline for postoperative rehabilitation in older hip-fracture patients gives strong recommendations for exactly this combination, paired with a multidisciplinary care team, and lists early ambulation and weight-bearing exercise as additional measures worth adding (the 2021 clinical practice guideline). Home-based programs built around simple movements — chair rises, step climbing, standing hip exercises — have measurable results months after the initial injury. The specifics of which exercise, how heavy, and how soon depend on the fracture and the surgical repair, so a therapist sets the actual plan.
Table of Contents
- Which Exercises Come First After Surgery
- Progressive Resistance and Balance Training for the Months That Follow
- What These Exercises Do Not Fix
- Home Programs With Results Behind Them
- Why a Physical Therapist Decides the Specifics
- Frequently Asked Questions
Which Exercises Come First After Surgery
Walking typically starts four to eight days after hip fracture surgery, once a patient can bear full weight on the repaired leg without pain and has enough balance to attempt it; stair practice follows once walking is reestablished (the Merck Manual's rehabilitation guide). This sequencing matters because weight-bearing status depends on the type of repair, not just the fracture itself.
Alongside walking, a UK National Health Service patient guide prescribes a set of standing exercises for post-surgical patients: partial squats, weight transfers from leg to leg, hip flexion, hip extension, hip abduction, and heel raises, usually around ten repetitions of each (the standing hip exercise guide). The same guide is explicit that these movements are done only under a physiotherapist's direction, not worked out independently from a printed sheet.
Progressive Resistance and Balance Training for the Months That Follow
Once a patient is past the immediate post-surgical phase, the evidence shifts toward structured resistance and balance work. The 2021 guideline's strong recommendations single out progressive resistance exercise and balance training as the core of longer-term rehabilitation, not optional extras (the clinical practice guideline).
A 2024 meta-analysis of 21 randomized trials covering 2,470 participants found that home-based exercise programs following hip fracture surgery produced significant improvements in balance (measured by the Berg Balance Scale), in the Timed Up and Go test, in physical function on the SF-36, and in knee extensor strength compared with usual care alone (the 2024 PLoS One meta-analysis). Knee extensor strength matters specifically because weak quadriceps make it harder to rise from a chair or climb stairs independently.
What These Exercises Do Not Fix
The same 2024 meta-analysis found no significant improvement from home-based exercise in gait speed, six-minute walk distance, the Short Physical Performance Battery score, activities-of-daily-living scores, or fear of falling, and no measurable difference in emergency visits, hospital readmissions, or fall rates compared with usual care (the 2024 meta-analysis). That gap matters for setting expectations: better balance scores and leg strength do not automatically translate into faster walking or fewer falls.
A separate 2023 systematic review of exercise-based rehabilitation after hip fracture reached a similar conclusion from a different angle. It found that exercise improved physical function and gait ability, but the included studies offered no evidence that exercise prevents a second hip fracture or a future fall (the 2023 systematic review). Exercise is a tool for regaining function, not a guaranteed shield against another injury.
Home Programs With Results Behind Them
Two trials show what a structured home program can look like in practice. In a randomized trial published in JAMA, 232 functionally limited older adults who had already finished standard rehabilitation were assigned either a six-month home exercise program — chair rises and step climbing, taught by a physical therapist and then performed independently — or a nutrition-education control. The exercise group's Short Physical Performance Battery scores rose significantly more, a 0.8-point gain that held at nine months (the Latham et al. JAMA trial).
A smaller pilot trial took a similar approach earlier in recovery. Twenty-six community-dwelling adults about six months past their hip fracture followed a ten-week home program of progressive resistance exercise, and it produced moderate-to-large improvements in physical performance that were still present three months after the program ended (the Mangione et al. pilot trial). Both programs relied on a small number of repeated, progressively harder movements rather than a long or varied routine.
Why a Physical Therapist Decides the Specifics
Exercise type, timing, and weight-bearing limits after a hip fracture have to be individualized by the treating surgeon and physiotherapist, because they depend on the fracture type and the specific surgical repair — pinning versus hemiarthroplasty, for example — and every clinical source on this topic notes that limitation (the standing exercise guide). A movement that is safe after one repair can be the wrong choice after another.
This is also why exercise is framed as part of a larger care plan rather than a stand-alone treatment. The Cochrane review on multidisciplinary rehabilitation for older people with hip fractures evaluates care delivered by a team supervised by a geriatrician or rehabilitation physician, reflecting that exercise works best as one piece of coordinated rehabilitation (the Cochrane review). For a family member helping someone through recovery, the practical takeaway is to get the specific exercises and repetitions from that care team rather than from a generic list.
Frequently Asked Questions
How soon after hip fracture surgery should walking start?
Walking typically begins four to eight days after surgery, once the patient can bear full weight on the repaired leg without pain and has adequate balance, according to the Merck Manual's rehabilitation guide.
Does exercise after a hip fracture prevent another fracture or fall?
No. A 2023 systematic review found exercise improved physical function and gait ability but found no evidence it prevents a second hip fracture or fall, and a 2024 meta-analysis found no difference in fall rates between exercise and usual-care groups.
Can hip fracture exercises be done without supervision?
The standing exercises in the NHS patient guide — partial squats, weight transfers, hip flexion, extension, and abduction, and heel raises — are explicitly meant to be done only under a physiotherapist's guidance, since the right movements depend on the type of surgical repair.