This trial further supports the practice of accelerated discharge from hospital and home-based rehabilitation in selected patients recovering from hip fracture. Such a practice appears to improve physical independence and confidence in avoiding subsequent falls which may have implications for longevity and overall quality of life.

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Objective: To determine the effectiveness of exercise training (aerobic and resistance) in modifying blood lipids, and to determine the most effective training programme with regard to duration, intensity and frequency for optimizing the blood lipid pro®le. Design: Trials were identi®ed by a systematic search of Medline, Embase, Science Citation Index (SCI), published reviews and the references of relevant trials. The inclusion criteria were limited to randomized, controlled trials of aerobic and resistance exercise training which were conducted over a minimum of four weeks and involved measurement of one or more of the following: total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and triglycerides (TG). Subjects: A total of 31 trials (1833 hyperlipidemic and normolipidemic participants) were included. Results: Aerobic exercise training resulted in small but statistically signi®cant decreases of 0.10 mmolaL (95% CI: 0.02, 0.18), 0.10 (95% CI: 0.02, 0.19), 0.08 mmolaL (95% CI: 0.02, 0.14), for TC, LDL-C, and TG, respectively, with an increase in HDL-C of 0.05 mmolaL (95% CI: 0.02, 0.08). Comparisons between the intensities of the aerobic exercise programmes produced inconsistent results; but more frequent exercise did not appear to result in greater improvements to the lipid pro®le than exercise three times per week. The evidence for the effect of resistance exercise training was inconclusive. Conclusions: Caution is required when drawing ®rm conclusions from this study given the signi®cant heterogeneity with comparisons. However, the results appear to indicate that aerobic exercise training produced small but favourable modi®cations to blood lipids in previously sedentary adults.

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Problem‐based learning (PBL) in medical education uses clinical cases as the context for students to study basic and clinical sciences. Its possible advantages over traditional approaches include its greater relevance to the practice of medicine, its ability to promote retention and application of knowledge, and its encouragement of self‐directed life‐long learning. Possible disadvantages include higher costs, both in resources and staff time. Although its efficacy is difficult to evaluate, the current enthusiasm for PBL seems justified and its use is likely to increase further.