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Predictability of psychic outcome for exercise training and exercise training including relaxation therapy after myocardial infarction.

Predictability of the psychic outcome for two cardiac rehabilitation programmes was investigated in 119 myocardial infarction patients. They were randomly assigned to either a five-week daily exercise training or to an identical training in combination with six sessions of relaxation therapy, individually. The psychic outcome was constructed as a composite measure of change on six psychological questionnaires. The aim was to determine the predictive qualities of base-line: (1) clinical data; (2) exercise testing; (3) psychosocial information derived from interview; and (4) validated psychological questionnaires and whether the kind of rehabilitation programme has any influence on the predictive qualities of the variables. The psychic outcome turned out to be highly predictable (multiple correlation of 0.72). Predictors of relatively high importance were age, work-status and job-level, followed by mild heart failure, diastolic blood pressure and heart rate, all of them dependent upon the kind of treatment. It implies that the type of rehabilitation programme modified the effect of the determinants of psychic outcome. This research strategy is promising and deserves to be stimulated in order to build rehabilitation programmes tailored to the needs and abilities of the individual patient.

Adaptation, Psychological↗

Electrocardiographic changes associated with training and discontinuation of training in an athlete with hypertrophic cardiomyopathy.

The 12-lead electrocardiogram of a 17-year-old African professional soccer player had signs of left ventricular (LV) hypertrophy and deeply inverted T waves in the inferior and precordial leads. Two-dimensional echocardiography showed mild LV hypertrophy with normal cavity size consistent with nonobstructive hypertrophic cardiomyopathy. After 5 months of complete discontinuation of training, the electrocardiogram normalized; however, the echocardiogram was unchanged. Subsequently, and contrary to our advice, the athlete resumed training and professional soccer. One year later the electrocardiogram again showed a similar and markedly abnormal pattern without cardiac dimensional changes.

Adolescent↗

Effects of ultra-marathon training and racing on hematologic parameters and serum ferritin levels in well-trained athletes.

Hematologic parameters and serum ferritin levels were measured in groups of experienced ultra-marathon runners under control conditions, 2 days after a 160-km ultra-marathon, and for up to 14 days after a 56-km ultra-marathon. Under resting conditions, 14% of the runners had subnormal serum ferritin levels compared to 2% of a control group and not one of a group of trained swimmers. Serum ferritin levels that were markedly elevated after both ultra-marathon races returned to pre-race levels only 6 days after the 56-km ultra-marathon and continued to fall in athletes who did not exercise for a further 8 days. Other hematologic changes that were present after either of the ultra-marathon races included: immediate post-race hemoconcentration (shown by increased mean red cell count, hemoglobin level, and packed cell volume) and increased mean corpuscular volume, followed by hemodilution that was greatest 48 h after the 160-km race; an increased mean corpuscular hemoglobin concentration and reticulocyte production index; transient leukocytosis, monocytosis, lymphocytopenia, eosinophilopenia, and the appearance of band cells. With the exception of the increase reticulocyte production index and the reduced packed cell volume, all other hematologic parameters had returned to control levels 6 days after the 56-km race. This study shows that serum ferritin levels may be subnormal in a proportion of distance runners and that daily training and ultra-marathon racing in particular may cause these levels to remain elevated for between 6--14 days. Thus, when hematologic parameters are measured in distance runners, it should be remembered that recent prolonged exercise may (1) produce a "dilutional anemia," (2) by increasing serum ferritin levels, mask a true iron deficiency, and (3) that these changes may require up to 6 days to return to normal.

Erythrocyte Count↗

Muscle training: physiology and practical applications of training for strength versus endurance.

An understanding of the physiology of muscle training can help the athlete, trainer, or therapist make specific improvements in athletic performance. Different metabolic pathways of muscle contraction predominate depending upon the type of work performed. Two anaerobic pathways provide energy for fast, powerful contractions while aerobic metabolism fuels sustained muscular endurance activities. Two types of human muscle fibers have been identified. Selective training of the different muscle fiber types can enhance performance in a particular sport.

Education, Nursing, Continuing↗

Pelvic floor muscle training with biofeedback and bladder training in elderly women: a feasibility study.

OBJECTIVE: It is generally assumed that interventions used to treat urinary incontinence (UI) in young women could simply be applied to older competent and motivated women, but these assumptions have not been formally tested. The purpose of this study was to determine the feasibility of using physical therapies to treat UI in older women. DESIGN: Twelve-week time series. SETTINGS AND SUBJECTS: We recruited women older than 75 years with UI from an outpatient urology clinic and a waiting list for incontinence surgery. METHODS: After a baseline evaluation, the women collected data on their incontinence symptoms and bladder habits for 3 weeks using the 72-hour voiding diary and the 24-hour pad test. They then received 6 physical therapy treatments consisting of a combination of bladder training and pelvic floor muscle training assisted with biofeedback for 6 weeks. This was followed by another 3-week period of data collection and a final evaluation. RESULTS: Ten women participated in the study; 7 completed it. They were all comfortable with the treatment. They complied with the study demands in terms of attendance at treatment session (100%), data collection (96%), and completion of exercises at home (82%). The authors observed a decrease in the number of incontinent and urgency episodes. CONCLUSION: This preliminary study demonstrates that some women older than 75 years are good candidates to undertake physical therapies for UI and follow study demands. Random controlled studies that include this population will provide evidence regarding the effectiveness of these therapies.

Age Factors↗

Living high-training low increases hypoxic ventilatory response of well-trained endurance athletes.

This study determined whether "living high-training low" (LHTL)-simulated altitude exposure increased the hypoxic ventilatory response (HVR) in well-trained endurance athletes. Thirty-three cyclists/triathletes were divided into three groups: 20 consecutive nights of hypoxic exposure (LHTLc, n = 12), 20 nights of intermittent hypoxic exposure (four 5-night blocks of hypoxia, each interspersed with 2 nights of normoxia, LHTLi, n = 10), or control (Con, n = 11). LHTLc and LHTLi slept 8-10 h/day overnight in normobaric hypoxia (approximately 2,650 m); Con slept under ambient conditions (600 m). Resting, isocapnic HVR (DeltaVE/DeltaSp(O(2)), where VE is minute ventilation and Sp(O(2)) is blood O(2) saturation) was measured in normoxia before hypoxia (Pre), after 1, 3, 10, and 15 nights of exposure (N1, N3, N10, and N15, respectively), and 2 nights after the exposure night 20 (Post). Before each HVR test, end-tidal PCO(2) (PET(CO(2))) and VE were measured during room air breathing at rest. HVR (l. min(-1). %(-1)) was higher (P < 0.05) in LHTLc than in Con at N1 (0.56 +/- 0.32 vs. 0.28 +/- 0.16), N3 (0.69 +/- 0.30 vs. 0.36 +/- 0.24), N10 (0.79 +/- 0.36 vs. 0.34 +/- 0.14), N15 (1.00 +/- 0.38 vs. 0.36 +/- 0.23), and Post (0.79 +/- 0.37 vs. 0.36 +/- 0.26). HVR at N15 was higher (P < 0.05) in LHTLi (0.67 +/- 0.33) than in Con and in LHTLc than in LHTLi. PET(CO(2)) was depressed in LHTLc and LHTLi compared with Con at all points after hypoxia (P < 0.05). No significant differences were observed for VE at any point. We conclude that LHTL increases HVR in endurance athletes in a time-dependent manner and decreases PET(CO(2)) in normoxia, without change in VE. Thus endurance athletes sleeping in mild hypoxia may experience changes to the respiratory control system.

Acclimatization↗

Training in environmental health research for action: the Shanghai-California Environmental Health Training Program.

The Shanghai Center for Disease Control and Prevention (SCDC) was created in 1998; in 2001, with support from Fogarty International Center, the intergovernmental Shanghai-California Environmental Health Training Program was formed. Providing U.S.-based training to SCDC managers allows them to return to Shanghai and share their knowledge. Indexing Chinese journals will enable more exchange of information and will support improvements in Chinese scholarship. Increased international contact will result in greater trust and more rapid warnings to international colleagues, with resultant faster responses to emerging public health threats. Building research capacity in SCDC will allow for more rapid translation of results to policy. The progress of the Program toward establishing a regional (Shanghai) biological specimen bank is an example of building institutional capacity to enhance research that can serve as a lasting foundation for public health research and policy decisions in both Shanghai and China.

California↗

Neuromuscular differences between endurance-trained, power-trained, and sedentary subjects.

This study tested the hypothesis that neuromuscular characteristics of plantar flexor (PF) and knee extensor (KE) muscles explain differences of both performance in vertical jump and maximal voluntary isometric contraction (MVC) between endurance-trained (END, n = 9), power-trained (POW, n = 8), and sedentary subjects (SED, n = 8). Evoked twitch characteristics of PF and KE were measured. MVC, maximal voluntary activation (%VA) of KE, and performance in vertical jump were also measured. POW have higher maximal rate of twitch force development (MRFD) than SED and END for both PF (p < 0.05) and KE (p < 0.01); %VA and MVC were higher for POW and END than SED (p < 0.01). Higher performances were measured in vertical jump for POW compared with END and SED. Significant relationships were found between the squat jump performance and MRFD for both KE and PF (R = 0.71, p < 0.0001 and R = 0.55, p < 0.01, respectively). These findings show that low MRFD on lower limbs extensors does not limit expression of MVC on subjects with high levels of activation, whereas intrinsic muscular qualities have a direct influence on performance during the vertical jump.

Adult↗

Training community members for action: Washington's Action Training Network.

The Children's Alliance in Washington State has established an ambitious goal of building the "Children's Action Network" (Network), a statewide network of children's advocates who regularly take action to inform public policy related to children and families. There are currently about 3,000 members in the Network. Policy advocacy training is an integral component of the Network providing advocates with necessary tips and tools for communicating with policy-makers. In order to meet key objectives and overcome significant challenges and barriers, the training program evolved greatly over the last five years. This article describes some of the challenges faced, particularly in reaching specific target populations, key strategies undertaken, and how the curriculum developed over time.

Child↗

The Asian American Network for Cancer Awareness, Research and Training's role in cancer awareness, research and training.

PURPOSE: The purpose of this paper is to describe the content for the Asian American Network for Cancer Awareness Research and Training (AANCART) with respect to Asian American demographic characteristics and their cancer burden, highlights of accomplishments in various AANCART regions, aspirations for AANCART, and an interim assessment of AANCART's activities to date. METHODS: The author compiled literature and other data references to describe the context for Asian American demographic characteristics and their cancer burden. As the AANCART Principal Investigator, he collected data from internal AANCART reports to depict highlights of accomplishments in various AANCART regions and offer evidence that AANCART's first two specific aims have been attained. PRINCIPAL FINDINGS: With respect to our first specific aim, we have built an infrastructure for cancer awareness, research and training operationally at a Network-wide basis through program directors for biostatistics, community, clinical, and research and in our four original AANCART regions: New York, Seattle, San Francisco, and Los Angeles. With respect to our second specific aim, we have established partnerships as exemplified by working collaboratively with New York's Charles B. Wang Community Health Center in securing external funding with them for a tobacco control initiative and nationally with the American Cancer Society. With respect to our third specific aim, we have been fortunate to assist at least eight junior investigators in receiving NCI-funded pilot studies. The most notable change was the transfer of AANCART's national headquarters from Columbus, Ohio to Sacramento, California along with potentially an increased diversification of Asian American ethnic groups as well as an expansion to Hawaii and Houston. CONCLUSION: As of the end of year 2 of AANCART, AANCART's two specific aims have been achieved. We are focusing on our third specific aim.

Asian↗

Trust in training: the Oil, Chemical, and Atomic Workers International Union Worker-to-Worker Training Program.

The OCAW's Worker-to-Worker Training Program was established with one of the first grants awarded under the Superfund Amendments and Reauthorization Act of 1986. The union intended the program to serve as a model to industry and to raise the standard of safety and health training throughout the industry. The program, which requires trainees to actively participate in learning activities, has garnered praise from its participants.

Chemical Industry↗

Assertion training outcome and generalization effects under didactic vs. facilitative training conditions.

One hundred and eleven college undergraduates (25% male) participated in one of two cognitive behavioral training programs, which included behavior rehearsal, modelling, coaching, cognitive-restructuring, and emphasis on the transferability of skills. Neither self-report nor behavioral outcome differences between the facilitative vs. the didactic approaches were noted. Both programs produced impressive self-report and behavioral gains in comparison to pretest scores; these gains were maintained 1 to 2 years after the program. There was also evidence of verbal and nonverbal bilateral transfer between request behavior and refusal behavior in the short term. The generalization results were interpreted on the basis that the distinctive components of request behavior (such as enunicating a statement of a problem and a specific request) are more difficult than those of refusal behavior, such than there is transfer of request training to refusal behavior, but not vice versa. Request behavior involves the mobilization and personal initiation of a complex interaction with another person rather than the more reactive non-compliance with the initiative of another, as is the case in refusal behavior.

Adult↗

Perspectives on the training experiences and the training needs of community psychologists.

The present study examined the attitudes and perspectives of Division 27 (Community Psychology) members toward training roles and issues. Surveys sent to Division members focused upon: (a) background and demographic data; (b) past and present academic and employment characteristics; (c) relevance of community psychology to present employment; (d) community psychology relevance as an area of training; and (e) roles and functions which are perceived as essential to community psychology. Results indicate that the membership perceives human service topics (social planning and community change) as more important than traditional direct service aspects. The significance of the emphasis on broader social system activities is discussed in relationship to the predominantly clinical academic background of Division members.

Attitude of Health Personnel↗

Dermatology residency training in 1932 versus dermatology residency training in 1990.

Dermatologic training programs and patient care in 1932 are compared with patient care, research, and residency training programs in 1990. The changes are due to development of newer diagnostic procedures and therapeutic agents, emergence of dermatopharmacology programs, research conducted by and supported by the pharmaceutical industry, and support of cutaneous research by the government. The excellence of teaching and patient care in 1932 was due to the "giants" who created interest in dermatology and by their dedication and ingenuity managed recalcitrant dermatoses without presently available drugs, chemotherapeutic agents, diagnostic techniques, basic information, and advances in cutaneous surgery.

Dermatology↗

Audiology training in Nigeria--I: A training model.

The purpose of this paper was to develop a model for preparing professional audiology personnel in a developing country (Nigeria). Professional audiologists in Nigeria are expected to provide basic and advanced audiologic services in hospitals, special schools for the hearing-impaired and to develop, conduct or supervise hearing conservation programs in regular school settings, industries as well as local government health centers. The competencies expected of students upon completing their professional programs are presented in the form of 'training modules' vis-a-vis basic science, medical educational, hearing conservation, aural rehabilitation and clinical practicum. Training implications of the modules are discussed with regards to the promise they hold for the preparation of audiology personnel particularly in developing countries.

Audiology↗

Simulators in training: defining the optimal role for various simulation models in the training environment.

Clearly, the potential applications for simulation training in endoscopy are vast. Endoscopy models may serve as a platform to introduce new skills, to maintain proficiency, or even to assess competency. As these applications are explored fully, the strengths and weaknesses of specific devices will dictate their roles. Educators must ensure that these roles are founded on reliable research but remain mindful that simulators are only tools to augment clinical training, with the goal of benefiting both student and patient, and are not a replacement for patient-based experience.

Animals↗

Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder.

OBJECTIVES: To compare the efficacy of pelvic floor muscle training (PFMT), biofeedback-assisted PFMT (BAPFMT), and electrical stimulation (ES) in the management of overactive bladder (OAB). METHODS: The interventions for the 12-week treatment period, conducted by the physiotherapist who was unaware of the progress and outcome, included (a) a PFMT program tailored to the subject's PERFECT (power, endurance, repetitions, and fast [1-second] contractions, with every contraction timed) scheme, used for training at home; (b) an electromyography BAPFMT program and home program tailored to the subject's PERFECT scheme; and (c) an ES program using biphasic symmetric probe current with 10-Hz frequency, 400-micros pulse width, 10/5 duty cycle, and varying intensity. Identical preintervention and postintervention assessment included King's Health Questionnaire, as well as outcomes of urge incontinence and other urinary symptoms. RESULTS: Of the 103 women who completed this study, 34 were in the PFMT group, 34 in the BAPFMT group, and 35 in the ES group. The changes in the three parameters of King's Health Questionnaire revealed statistically significant differences, except for the total score, between ES and BAPFMT (domain 7, P = 0.003; domain 9, P = 0.029; and total score, P = 0.952). These same parameters were significantly different between ES and PFMT (domain 7, P = 0.007; domain 9, P = 0.001; and total score P = 0.004). The change in total score was significantly different between BAPFMT and PFMT (P = 0.003). The subjective improvement/cure rate of OAB was 51.4% for ES, 50.0% for BAPFMT, and 38.2% for PFMT (P = 0.567). CONCLUSIONS: ES had the greatest subjective reduction rate of OAB and was the most effective of the three treatments. BAPFMT was more effective than PFMT.

Adult↗