Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

Comment on “Whole-genome analyses resolve early branches in the tree of life of modern birds”

Jarvis et al. (Research Articles, 12 December 2014, p. 1320) presented molecular clock analyses that suggested that most modern bird orders diverged just after the mass extinction event at the Cretaceous-Paleogene boundary (about 66 million years ago). We demonstrate that this conclusion results from the use of a single inappropriate maximum bound, which effectively precludes the Cretaceous diversification overwhelmingly supported by previous molecular studies.

The hard work of leisure: Healthy life, activewear and Lorna Jane

Since the 2000s activewear has grown as a fashion category, and the tropes of gym wear – leggings, leotards and block colours – have become fashionable attire for both men and women outside the gym. This article examines the rise of activewear in the context of an on-going dialogue between fashion and sport since the beginning of the twentieth century. Through an analysis of the Australian activewear label, Lorna Jane, we consider the fashionable female body as both the object and subject of a consumer culture that increasingly overlays leisure with fashion. Activewear can be seen as the embodiment of an active and fashionable lifestyle that is achieved through a regime of self-discipline, and that symbolizes the pleasure in attaining and displaying the healthy and fit body.

Futility and the law: Knowledge, practice and attitudes of doctors in end of life care

Despite the potential harm to patients (and others) and the financial cost of providing futile treatment at the end of life, this practice occurs. This article reports on empirical research undertaken in Queensland that explores doctors’ perceptions about the law that governs futile treatment at the end of life, and the role it plays in medical practice. The findings reveal that doctors have poor knowledge of their legal obligations and powers when making decisions about withholding or withdrawing futile treatment at the end of life; their attitudes towards the law were largely negative; and the law affected their clinical practice and had or would cause them to provide futile treatment.

Older Australians: Structural barriers to learning in later life

Learning in older age is associated with a wide range of benefits including increases in skills, social interactions, self-satisfaction, coping ability, enjoyment, and resilience to age-related changes in the brain. It is also recognized as being a fundamental component of active ageing and if active ageing objectives are to be met for the growing ageing population, barriers to learning for this group need to be fully understood so that they can be properly addressed. This paper reports on findings from a study aimed at determining the degree that structural factors deter older people aged 55 years and older from engaging in learning activities relative to other factors, based on survey (n=421) and interview (n=40) data. Quantitative and qualitative analyses revealed that factors related to educational institutions as well as infrastructure were commonly cited as barriers to participation in learning. The implications of these and other findings are discussed.