The effect of exercise on gait patterns in older women: a randomized controlled trial.

BACKGROUND: This study was undertaken to determine (a) whether a program of regular exercise can improve gait patterns in older women, and (b) whether any such improvement in gait is mediated by increased lower limb muscle strength. METHOD: A 22-week randomized controlled trial of exercise was conducted as part of the Randwick Falls and Fractures Study in Sydney, Australia. Subjects were 160 women aged 60-83 years (Mean age 71.1, SD = 5.2) who were randomly recruited from the community. Exercise and control subjects were tested prior to and at the end of the trial. At initial testing, exercisers and controls performed similarly in the strength and gait parameters. They were well matched in terms of age and a number of health and life-style characteristics. RESULTS: At the end of the trial, the exercise subjects showed improved strength in five lower limb muscle groups, increased walking speed, cadence, stride length, and shorter stride times as indicated by both reduced swing and stance duration. There were no significant improvements in any of the strength or gait parameters in the controls. Within the exercise group, increased cadence was associated with improved ankle dorsiflexion strength, and increased stride length was associated with improved hip extension strength. Exercise subjects with initial slow walking speed showed greater changes in velocity, stride length, cadence, and stance duration than those with initial fast walking speed. CONCLUSION: These findings show that exercise can increase gait velocity and related parameters in older persons, and that part of this increase may be mediated by improved lower limb muscle strength.

The response of healthcare services to people at risk of suicide: a qualitative study.

OBJECTIVE: This paper describes a small qualitative research study conducted in the area of suicide. Family and close friends of 15 young people who lived in Sydney, New South Wales, prior to their suicide, between 1990 and 1995, were interviewed to elicit their perceptions of the healthcare support given to the suicidees prior to their death. METHOD: Content analysis of in-depth interview transcripts identifying common themes in the description of the participants' experiences and impressions was carried out. A recurring theme was their call for more proactive management and support programs for people at risk of suicide, as well as education and support for close family and friends. RESULT: Participants claimed that they believed there were inadequate supports in place, that information and education were uncoordinated and sparse, and that healthcare workers were not effective in preventing suicide attempts because they lacked adequate diagnostic and management skills and displayed poor attitudes towards suicidees. CONCLUSION: Experiences of care received and suggestions for improving them by people closely associated with suicide, provide healthcare staff with important information about the types of information, education and support that those at risk of suicide and their loved ones require at a time of crisis.