IMPORTANCE: For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE: To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS: The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES: Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0 to 12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range 23 to 85 and 9 to 101, higher score indicates better function). RESULTS: Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n = 100) showed significant improvement relative to the control group (n = 95) in functional mobility (mean SPPB scores for intervention group: 6.2 (SD 2.7) at baseline, 7.2 (SD 3) at 6 months; control group: 6.0 (SD 2.8) at baseline, 6.2 (SD 3) at 6 months; and between-group differences 0.8 (95% CI 0.4 to 1.2), p < 0.001; mean AM-PAC mobility scores for intervention group: 56.2 (SD 7.3) at baseline, 58.1 (SD 7.9) at 6 months; control group: 56 (SD 7.1) at baseline, 56.6 (SD 8.1) at 6 months; and between-group difference 1.3 (95% CI 0.2 to 2.4), p = 0.03; and mean AM-PAC daily activity scores for intervention group: 57.4 (SD 13.7) at baseline, 61.3 (SD 15.7) at 6 months; control group: 58.2 (SD 15.2) at baseline, 58.6 (SD 15.3) at 6 months; and between-group difference 3.5 (95% CI 0.9 to 6.0), p = 0.03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. CONCLUSIONS AND RELEVANCE: Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00592813.

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