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PubMed1993

Ambulatory care training during core internal medicine residency training: the Canadian experience.

OBJECTIVE: To determine the status of ambulatory care training of core internal medicine residents in Canada. DESIGN: Mail survey. PARTICIPANTS: All 16 program directors of internal medicine residency training programs in Canada. OUTCOME MEASURES: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ambulatory care program and the kinds of teaching skills required of tutors. RESULTS: All of the directors responded. Fifteen stated that the ambulatory care program is mandatory, and the other stated that it is an elective. Block rotations are more common than continuity-of-care assignments. In 12 of the programs 10% or less of the overall training time is spent in ambulatory care. In 11 the faculty tutors comprise a mixture of generalists and subspecialists. The tutors simultaneously care for patients and teach residents in the ambulatory care setting in 14 of the schools. Most are paid through fee-for-service billing. The respondents felt that the ideal program should contain a mix of general and subspecialty ambulatory care training. There was no consensus on whether it should be a block or continuity-of-care experience, but the directors felt that consultation and communication skills should be emphasized regardless of which type of experience prevails. CONCLUSIONS: Although there is a widespread commitment to provide core internal medicine residents with experience in ambulatory care, there is little uniformity in how this is achieved in Canadian training programs.

Ambulatory Care↗

PubMed2026

Effects of blood flow restriction training combined with plyometric training on lower limb muscle strength and motor unit recruitment in basketball players: An experimental study.

OBJECTIVE: Previous studies have shown that plyometric training (PT) improves neuromuscular function and explosive power but not maximal strength. Blood flow restriction training (BFR) combined with low-intensity resistance training (RT) increases muscle mass and strength. This study investigated the effects of PT, and BFR combined with PT on lower-limb muscle function. METHODS: Twenty elite basketball players were randomly assigned to two groups: PT-alone group (PT, n = 10) and BFR combine with PT group (PT-BFR, n = 10). All participants underwent bodyweight-based plyometric training three times per week for eight weeks. Peak torque values for hip and knee flexion and extension, as well as root mean square (RMS) values derived from electromyography, were measured before and after the intervention. RESULTS: After the 8-week intervention, both groups showed significant improvements in knee flexion and extension peak torque at 180°/s (all p < 0.01). Between-group comparisons revealed greater gains in the PT-BFR group for hip extension and flexion at 60°/s (p = 0.036-0.002; ηp2 = 0.225-0.233). RMS of the rectus femoris increased significantly more in the PT-BFR group than in the PT group (right: p = 0.004, ηp2 = 0.385; left: p = 0.020, ηp2 = 0.266), whereas no significant changes were observed in the gastrocnemius, tibialis anterior, or biceps femoris (all p > 0.05). CMJ height also improved more in the PT-BFR group, with a significant group × time interaction (p = 0.042, ηp2 = 0.210). CONCLUSION: Both training protocols enhanced bilateral lower-limb strength, with notable gains in the non-dominant leg; however, the magnitude did not differ substantially between groups. In contrast, compared with PT alone, BFR combined with PT produced superior enhancements in lower-limb muscle strength and neuromuscular recruitment. These findings suggest that when PT is employed to improve explosive power, it may be effectively combined with BFR to further augment muscular strength.

Humans↗

PubMed1982

Square-wave endurance exercise test (SWEET) for training and assessment in trained and untrained subjects. III. Effect on VO2 max and maximal ventilation.

The effect of training on VO2 max, endurance capacity (EC) and ventilation during maximal exercise (VE max) were studied in 17 normal subjects aged 21--51 years. At the beginning of the study 11 of the subjects (eight women and three men) were untrained (U) and six others (three women and three men) trained regulatory (T). A maximal intensity exercise (on a cycle ergometer) which could be sustained for 45 min (MIE45) was performed three times per week for 6 weeks; the total mechanical work (TMW) corresponding to the MIE45 per session varied between 3.14 and 9.24 kJ . kg-1. Before training, VO2 max (a), VEmax (b), and TMW (c) were higher in T than in U subjects. Training increased these variables in most of the subjects; the increase being significantly higher (mean +/- SEM) in U (a = +29.9 +/- 3.8%; b = 49.6 +/- 6.5%; c = 47 +/- 6.9%) than in T subjects (a = 6.6 +/- 3.8%; b = 17.5 +/- 3.6+; c = 19.1 +/- 2.8%). In all but three cases the % increase of TMW was higher than that of VO2 max, suggesting a higher sensitivity of TMW in measuring EC. The significant increase in VE max, maximal voluntary ventilation, peak flows (inspiratory and expiratory) and static maximum voluntary ventilation, peak flows (inspiratory and expiratory) and static maximum pressures indicate that this training protocol improves in healthy subjects the performance of respiratory muscles as well.

Adult↗

PubMed1995

Effects of unilateral isometric strength training on joint angle specificity and cross-training.

The purpose of this study was to examine the effects of unilateral isometric leg extension strength training on the strength and integrated electromyogram (IEMG) of both the trained and untrained limbs at multiple joint angles. A training (TRN) group [nine women; mean (SD) age, 20(1) years] exercised for 6 weeks with isometric leg extensions at 80% of maximal isometric torque. A control (CTL) group [eight women; 21(1) years] did not exercise. The training was performed three times per week on a Cybex II isokinetic dynamometer at a joint angle where the lever arm was 0.79 rad below the horizontal plane. The subjects were tested pre- and posttraining for maximal unilateral isometric torque in both limbs at joint angles of zero, 0.26, 0.79, 1.31, and 1.57 rad below the horizontal plane. Bipolar surface electrodes were used to record the IEMG of the vastus lateralis (VL) and vastus medialis (VM) during the isometric tests. Three univariate (torque, IEMG-VL, and IEMG-VM) four-way (group x time x limb x angle) mixed factorial ANOVAs were used to analyze the data. The results indicated joint angle specificity for isometric torque in the TRN group only, with significant increases in torque at 0.79 (P = 0.0004) and 1.31 (P = 0.0039) rad. No significant increases in torque were found in the untrained limb of the TRN group or in either limb of the CTL group. Similarly, there were no significant changes in IEMG as a result of the training for the VL or VM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Training of primary health care medical officers in mental health care. Errors in clinical judgment before and after training.

This investigation examined the nature and frequency of errors in clinical judgment that were displayed by primary health care medical officers before and after short-term training in mental health care. Thirty-nine medical officers who underwent inservice training for 2 weeks were evaluated using standardized case vignettes. Before the training, doctors displayed a sizable percentage of major and minor errors, which dropped significantly following training. Errors were not unique to psychiatric presentations alone, but occurred with respect to vignettes representing physical disorders as well. The results on the whole demonstrate a satisfactory gain in clinical skills of medical officers following the training and highlight the need for continuation of a program of this nature.

Adult↗

PubMed1991

Effects of training and training cessation on insulin action.

Physical training has been shown to improve glucose tolerance and insulin action. In the present study, insulin action was determined using the euglycemic clamp technique in six trained male athletes compared with six untrained controls matched by age, sex, and weight at 14, 38, and 86 hours and at 6 days after cessation of exercise. The rate of insulin-mediated glucose uptake (glucose disposal) was 9.40 +/- 0.46 mg.kg-1.min-1 (mean +/- SEM) for the athletes at 14 h after the last exercise bout, compared with 6.80 +/- 0.86 mg.kg-1.min-1 obtained for the untrained controls (p less than 0.01). Glucose disposal was gradually decreased to 7.78 +/- 0.87 mg.kg-1.min-1 at 38 h, 6.82 +/- 0.49 mg.kg-1.min-1 at 86 h and to 7.11 +/- 1.00 mg.kg-1.min-1 at 6 days after cessation of physical training. At 38 h, 86 h, and 6 days of detraining, glucose disposal exhibited by training athletes did not differ significantly from untrained controls. These results suggest that physical training increases insulin action, and that this effect could be reversed to the control levels within 38 h after detraining.

Adolescent↗

PubMed1987

Relationships between training volume, physical performance capacity, and serum hormone concentrations during prolonged training in elite weight lifters.

A follow-up study of 1 year was performed on 11 male elite weight lifters. Several parameters including training volume, weight lifting performance, and serum hormone concentrations were measured during seven test occasions. In addition, the same measurements were repeated three times during a 6-week period preceding the primary competition, which took place about 5 months after beginning of the follow-up. The primary findings were observed during the 6-week period from which the first 2 weeks of stressful training was associated with significant decreases (P less than 0.01-0.001) in serum testosterone concentration, in testosterone/cortisol and in testosterone/SHBG ratios, and with a significant (P less than 0.001) increase in serum LH concentration. The individual changes during the stressful training in serum testosterone/SHBG ratio were related (r = .63; P less than 0.05) to the individual changes in the weight lifting result in the clean and jerk lift. During the following "normal" 2-week and reduced 2-week training periods, the concentration of serum testosterone remained unaltered, but serum cortisol and serum LH decreased significantly (P less than 0.05-0.01). During these periods, the serum testosterone/SHBG ratio increased (P less than 0.01). The individual changes during this preparatory 4-week training before the primary competition in serum testosterone/SHBG ratio and the individual changes in the weight lifting result in the clean and jerk lift correlated significantly with each other (r = .68; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

Cross training: indices of training stress and performance.

Twenty well-trained runners (VO2max 4.6+/-0.5 L x min[-1]) were age and ability matched and assigned to either a cross training (CT) or run only group (RT). All subjects maintained normal running distance and intensity for 6 wk and reported for three additional training sessions per week. These workouts were performed outdoors on a 400-m track or measured road course (RT) or on a bicycle ergometer (CT). The sessions were as follows: (work x rest(-1) ratio = 1): 5 x 5 min at >95% VO2max/peak (Monday), 50-60 min at 70% VO2max/peak (Wednesday), and 3 x 2.5 min at >105% VO2max/peak, plus 6 x 1.25 min at >115% VO2max/peak (Friday). Subjects were tested before (PRE), after 3 wk (MID), and after 6 wk (POST) of intensified training. Blood samples were obtained from RT, CT, and ten controls (CON) at each time point (0600 h). Runners also completed a 10-min submaximal run at the same absolute intensity (velocity to elicit 75% of initial V02max) during which heart rate, RPE, and VO2 were measured. Each runner then completed a simulated 5-km race (time trial) on a treadmill. Total testosterone (TT), free testosterone (FT), cortisol (C), and creatine kinase activity (CK) were determined. Running economy was similar between RT and CT; however, RPE decreased significantly at MID and POST compared with that at PRE (P < 0.05; time effect). There were no significant differences among groups for TT, FT, or CK, but C was significantly lower in CON than in RT and CT. Performance was significantly faster (P < 0.05; time effect) in the 5-km race at MID (1076.1+/-81.4 s) and POST (1068.6+/-83.9) compared with PRE (1096.6+/-79.5) but was not different between CT and RT. In conclusion, RT and CT responded similarly to 6 wk of increased training, and both groups improved 5-km performance to a similar extent.

Adult↗

PubMed2001

Beta-hydroxy-beta-methylbutyrate (HMB) supplementation does not affect changes in strength or body composition during resistance training in trained men.

This investigation evaluated the effects of oral beta-hydroxy-beta-methylbutyrate (HMB) supplementation on training responses in resistance-trained male athletes who were randomly administered HMB in standard encapsulation (SH), HMB in time release capsule (TRH), or placebo (P) in a double-blind fashion. Subjects ingested 3 g x day(-1) of HMB or placebo for 6 weeks. Tests were conducted pre-supplementation and following 3 and 6 weeks of supplementation. The testing battery assessed body mass, body composition (using dual energy x-ray absorptiometry), and 3-repetition maximum isoinertial strength, plus biochemical parameters, including markers of muscle damage and muscle protein turnover. While the training and dietary intervention of the investigation resulted in significant strength gains (p < .001) and an increase in total lean mass (p = .01), HMB administration had no influence on these variables. Likewise, biochemical markers of muscle protein turnover and muscle damage were also unaffected by HMB supplementation. The data indicate that 6 weeks of HMB supplementation in either SH or TRH form does not influence changes in strength and body composition in response to resistance training in strength-trained athletes.

Adult↗

PubMed2004

Home training with and without additional group training in physically frail old people living at home: effect on health-related quality of life and ambulation.

OBJECTIVE: To test the effect of two exercise regimes on health-related quality of life (HRQoL) and ambulatory capacity. DESIGN: Randomized controlled trial. SUBJECTS: Seventy-seven community-dwelling physically frail people over 75 years of age (mean = 81, SD = 4.5). INTERVENTIONS: Home training (HT, N= 38) comprised twice daily functional balance and strength exercises and three group meetings. Combined training (CT, N= 39) included group training twice weekly and the same home exercises. Interventions lasted 12 weeks. Physiotherapists ran both programmes. Home exercises were recorded daily. MAIN MEASURES: HRQoL was assessed by SF-36, and ambulatory capacity by walking speed and frequency and duration of outdoor walks. RESULTS: Following intervention, CT improved the SF-36 mental health index significantly more than HT (p = 0.01). The SF-36 physical health index (p = 0.002) and walking speed (p = 0.02) demonstrated improvements, but no group differences. Six months after cessation of intervention there was still overall improvements on the mental health index (p = 0.032), borderline overall improvements on the physical health index (p = 0.057), higher weekly number of outdoor walks for the CT group than for the HT group (p = 0.027) and an improved habitual walking speed in the CT group only (p = 0.022). CONCLUSIONS: HT improved HRQoL and walking speed, but additional group training gave larger benefits on mental health. Group training away from home may be beneficial for mental health and ambulatory capacity.

Activities of Daily Living↗

PubMed1999

[Alternating training approach: comparative study of faculty education at the faculty training college and nurses' education].

The hypothesis of this essay asserts that sandwich courses which are the object of this study in the framework of vocational training in the I.S.F.I. (nurses' school) and I.U.F.M (teacher training), will pertain to an educational logic if it facilitates the construction of the link between theory and practice, the emergence of practice knowledge, the construction of professional skills and if it enables the student to have access to a form of professional socialization. Today, the device lacks coherence and efficiency, there is not much time devoted to analysis and concentration. The presence of more performing trainers, involved in a real partnership would be necessary as well as the reorientation of these training on the professional skills. However, the sandwich courses help the students to distance themselves from practice and enable them to live through their own experiences. The study of the characteristics of these two training enables to make proposals aiming at improving the existing situation: they concern the development of new pedagogical methods, the creation of adapted tools, the improvement of the existing partnership and the training of the trainers.

Curriculum↗

PubMed2001

The effect of concentric isokinetic strength training of the quadriceps femoris on electromyography and muscle strength in the trained and untrained limb.

The purpose of the present investigation was to examine the effects of unilateral concentric isokinetic leg extension training on peak torque (PT) and electromyographic (EMG) responses in the trained and untrained limbs. Twenty adult men were randomly assigned to a training (TRN, n = 11) or control (CTL, n = 9) group. The TRN group performed 6 sets of 10 leg extensions 3 days per week for 12 weeks at a velocity of 90 degrees.s(-1). All subjects were tested every 4 weeks for PT and EMG responses of both legs at a velocity of 90 degrees.s(-1). The 3-way mixed factorial analysis of variance (ANOVA) indicated a significant (p < 0.05) increase in PT over the 12 weeks in both the trained and untrained limb for the TRN group but no significant change in PT in either limb for the CTL group. The results of the 3-way ANOVA for the EMG data indicated no significant change in EMG amplitude in the trained or untrained limb for the TRN or CTL group. The increase in PT in the absence of a change in EMG may result from hypertrophic factors and/or changes in the other muscles or muscle groups involved in leg extension.

Adaptation, Physiological↗

PubMed2003

Training GPs in parent consultation skills. An evaluation of training for the Triple P-Positive Parenting Program.

BACKGROUND: The Triple P-Positive Parenting Program is a behavioural family intervention program that aims to prevent severe behavioral, emotional and developmental problems in children by enhancing the knowledge, skills, and confidence of parents. OBJECTIVE: This study evaluated the effect of training general practitioners in the use of the primary care version of the TPP on their consultation skills, satisfaction and confidence in conducting consultations with parents. STUDY DESIGN: Participants were assigned to an experimental condition that involved a brief behaviorally oriented parent consultation skills training program or to a wait-list comparison group. Thirty-two GPs participated in the training. Fifteen participants attended the first workshop (intervention group) and 17 attended the second (wait-list comparison group). RESULTS: GPs who participated in the training reported greater satisfaction with the outcomes of their parent consultations and showed significantly greater use of targeted parent consultation skills than GPs in the wait-list comparison group. Observations of GP consultation skills during simulated patient interviews with parents showed there was a significant overall improvement in their interactional skills during parent consultations. There was a high level of satisfaction with the quality of training received by the GPs. CONCLUSION: This was a brief, cost effective program that had significant effects on participating GPs' skills, confidence and satisfaction with child consultations involving behavioral problems. Implications for public health approaches to the prevention of child psychopathology are discussed.

Adult↗

PubMed1986

Career development of residents in university and independent training programs: the influence of special training fellowships, type of practice, specialization, and research.

General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.

Adult↗

PubMed1985

[Chronobiologic aspects of autogenic training. Thermometric findings of autogenic training in relation to diurnal periodicity in autonomic dystonia patients].

In a cohort of patients suffering from neuro-dystonia a group of test subjects well acquainted with the techniques of autogenous training and another consisting of patients unfamiliar with these techniques were compared with regard to the rise in the skin temperature in their fingers at various times of the day. Furthermore, the connection between the personal perception of warmth of the test subjects during autogenous training and the actually measured increase the temperature was observed: 1. In the test group as well as among the controls two different patterns of reaction with regard to diurnal fluctuations of the skin temperature occurred which were interpreted as so-called "morning types" and "evening types" respectively. 2. The increase in temperature induced by autogenous training in the test group was always higher than the one in the group of controls. 3. Subject to the circadian reaction pattern of the skin temperature there were fluctuations related to the actual time of day with regard to the increases in temperature induced by autogenous training. 4. There was merely a "slight" correlation between the personal experience or warmth and the measured temperature increase, and the intensity of the temperature experience seems to be influenced more by the relative initial value of the skin temperature than by the objectifyable temperature increase. These results are discussed with regard to practical consequences for the acquisition of autogenous training and its therapeutic application with neuro-dystonic patients.

Adult↗

PubMed1982

A comparison of combined running and weight training with circuit weight training.

The purpose of this study was to compare the physiologic effects of a program of combined running and weight training (RUN-CWT) with a program of circuit weight training (CWT). Thirty-six females (X age = 35.7 yr) and 41 males (X age = 36.1 yr) were randomly assigned to RUN-CWT, CWT, and control groups. The training groups participated in 12-wk programs, 3 d . wk-1. Three circuits of 10 weight-training exercises were completed with 12-15 repetitions performed in 30 s at 40% of one-repetition maximum at each station. The 30-min RUN-CWT program included 30 s of running on an indoor track following each CWT station, whereas the 22.5 min CWT program included a 15-s rest period between stations. The RUN-CWT groups had a significant (+ 17%) increase in VO2max (females 30.5-35.7 ml . kg-1 . min-1 and males 39.7-46.3 ml . kg-1 . min-1) and strength (females + 24% and males +21%), and a significant decrease in body fat percentage (females -3.2% and males -4.1%). The CWT groups also increased significantly in VO2max (+12%) and strength (+17%) and decreased in body fat (-3.0%). The controls did not change significantly in any variable. Statistically, one training program was not shown to be superior to the other; thus, both programs of RUN-CWT and CWT were effective in improving measures of physical fitness.

Body Composition↗

PubMedDate not supplied

The training ethic and the ethics of training.

To practice a training ethic, one must view giving or obtaining training regarding workplace health hazards as an ethical responsibility. Furthermore, the training itself must be carried out ethically. Here, the authors discuss the training ethic as an extension of workers' right to know and address ethical issues that arise during training.

Confidentiality↗

PubMed1997

Effects of a pre-training conditioning programme on basic military training attrition rates.

The medical attrition rates of 4 cohorts of recruits undergoing basic military training (BMT) were studied. They were grouped as follows: Group A (n = 3475), a mixture of fit and unfit recruits; Group B (n = 2081), consisting only of fit recruits; Group C (n = 940) comprising only unfit recruits who underwent a 4 to 6 weeks conditioning programme prior to being subjected to a similar 3-month BMT for all 3 groups and Group D (n = 2613) comprising unfit recruits who underwent an extended 4-month BMT. It was found that Group B [Relative risk (RR) = 0.26 95% confidence interval (CI) = 0.21, 0.33] and Group C (RR = 0.45 95% CI = 0.38, 0.62) had significantly lower medical attrition rates compared with Group A (RR = 1). Group D, however, did not show significantly lower attrition rates in spite of a more gradual training pace. When the unfit cohorts were compared, Group C (RR = 0.52 95% CI = 0.40, 0.67) had significantly lower attrition rates than Group D (RR = 1). The major cause of medical attrition in all groups was musculo-skeletal injuries sustained during training. Our results showed that a formal pre-training conditioning programme resulted in lower attrition during BMT and this reduction was more effective than training the recruits at a slower pace by extending the BMT by one month.

Adult↗