Objectives Examine the effectiveness of a short term leg strengthening exercise program compared to attentional control on improving strength, walking abilities, and function one year after hip fracture. Design Randomized controlled pilot study. Setting Interventions occurred in patients’ homes. Participants Community-dwelling older adults (n=26) six months post hip fracture at baseline. Intervention Exercise and control participants received interventions by physical therapists twice weekly for 10 weeks. The exercise group received high intensity leg strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery. Measurements Isometric force production of lower extremity muscles; usual and fast gait speed, six minute walk (6-MW) distance, modified physical performance test (mPPT), and SF-36 physical function. Results The primary endpoint was at one year post fracture. Isometric force production (p<.01), usual and fast gait speed (p=.02 & .03, respectively), 6-MW (p<.01), and mPPT (p<.01) improved at one year post fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for mPPT scores, 0.56 for gait speed, 0.49 for 6-MW, and 0.30 for SF-36 scores. More patients in the exercise group made meaningful changes in gait speed and 6-MW distance than control patients (χ2: p=.004). Conclusion A 10-week home-based progressive resistance exercise program was sufficient to achieve moderate to large effects on physical performance and quality of life and may offer an alternative intervention mode for hip fracture patients who are unable to leave home at 6 months after the fracture. The effects were maintained at 3 months after completion of the training program.

Background and Purpose. The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate-or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. Subjects. Thirty-three elderly people (24 women, 9 men; Xϭ78.6 years of age, SDϭ6.8, rangeϭ64 -89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. Methods. Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes. Results. Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed. Discussion and Conclusion. High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained.[Mangione KK, Craik RL, Tomlinson SS, Palombaro KM. Can elderly patients who have had a hip fracture perform moderate-to high-intensity exercise at home ? Phys Ther. 2005;85:727-739.] Key Words: Exercise, aerobic performance; Exercise, force production; Hip fractures; Home care services. H ip fracture is a common medical problem that can drastically change the quality of life for the elderly person. More than 300,000 older people are expected to fracture a hip each year 1 at an estimated cost of $5 billion. 2 It has been well established that the majority of patients with hip fracture do not return to prefracture functional status at 1 year after surgery. [3][4][5][6][7] In a study of 120 people, Marottoli et al 5 showed that, 6 months after hip fracture, only 8% climbed a flight of stairs, 15% walked across a room...

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Pervasive avoidance behaviour is a core feature of anxiety disorders. However, little is known about how the availability of avoidance modulates learned threat responding. To assess this question, we recorded avoidance behaviour, electrodermal activity and expectancy ratings in 53 healthy participants during an associative learning paradigm with embedded unavoidable and avoidable trials. When avoidance was available, we observed greater avoidance behaviour for threat versus safety cues, as well as reduced differential skin conductance responses for unavoidable threat versus safety cues. When avoidance was unavailable, as during the extinction phase, we observed sustained differential skin conductance responses for threat versus safety cues. For all phases, we found greater expectancy ratings for threat versus safe cues. Furthermore, greater avoidance behaviour predicted larger differential skin conductance responses to threat versus safety cues during extinction. Overall, the results show that the conditioned response is attenuated during situations where avoidance is available, but it recovers when avoidance is unavailable, subsequently prolonging threat extinction.

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Objectives: To conduct an in-depth exploration of the selfreported long-term change in attitudes and performance after a full-day multidisciplinary simulation-based course focussed on team management of emergency events in the Critical Care Unit. To address the current lack of knowledge of factors which can lead to improved teamwork performance and their measurement through identification of measurable markers of behaviour and attitude change. Methods: A purposive sample of course participants underwent semi-structured interviews one to five months after course completion. Responses were coded using grounded theory to identify instances of learning, changes in attitudes or clinical performance, and measurable behavioural and attitudinal markers for such change. Interviews continued until data saturation was achieved. Results: Twenty nine participants (15 doctors and 14 nurses) were interviewed. Doctors became more confident in delegating and including nurses in decision making, and nurses became more confident and aware of the need for effective communication. Doctors reported that their ability to assign team roles improved over the day and that they made more frequent use of closed-loop communication. Both professional groups reported improvement in communication in the clinical setting after participation, including better vocalising of thoughts and use of colleagues' names. Attitudes to communication also improved and persisted in the clinical setting. Conclusions: Addressing gaps in current medical education knowledge, self-reported improvements in behaviour and attitudes translated to clinical performance after a simulation course. Measurable behavioural and attitudinal markers were identified that may assist with the development of evidence-based measurement tools in future team training work.

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