Introduction : Hospital-acquired pneumonia may affect hospitalized patients and results in increased morbidity and mortality. Preventive actions to reduce the incidence are required, especially in patients at a higher risk of postoperative complications, such as the elderly. Purpose : To explore whether an intensified physiotherapy regimen can prevent hospital-acquired pneumonia and reduce hospital length of stay in patients aged 80 and older who have undergone hip fracture surgery. Method : Inclusion criteria were patients aged 80 or older who had undergone hip fracture surgery at a University Hospital in Sweden (n=69). The study has a quasi-experimental design with a historical comparison group (n=64) receiving routine physiotherapy treatment. The intervention group received intensified physiotherapy which included breathing exercises with positive expiratory pressure (PEP) valve. The patients were instructed to take a deep breath, hold their breath for two seconds and then exhale through the valve three sessions of 10 deep breaths, with 30–60 seconds of rest, at least four times daily. Early mobilization to a seated position and walking was advised as soon as possible after surgery. Results : There was a significant difference in number of hospital-acquired pneumonia between the intervention group; 2 patients (3%) and the comparison group; 13 patients (20%) (p=0.002). Patients in the intervention group had a significantly shorter length of stay than those in the comparison group (10.6 ± 4 vs 13.4 ± 9 days, p=0.022). Conclusion : Intensified physiotherapy treatment after hip fracture surgery may be of benefit to reduce the number of hospital-acquired pneumonia in patients over 80 years.