Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes

OBJECTIVE—To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training.

RESEARCH DESIGN AND METHODS—We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60–80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA_1c), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months.

RESULTS—Compared with the WL group, HbA_1c decreased significantly more in the RT&WL group (–0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P < 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P = 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P < 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months.

CONCLUSIONS—In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control.

Can Australain general practitioners tackle chidhood overweight/obesity? Methods and processes from the LEAP (live, eat, and play) randomized controlled trial

Background: General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

Objectives: To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children.

Methods: A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks.

Results: General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

Conclusions: Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Effect of 2 weeks of endurance training on uncoupling protein3 content in untrained human subjects

Aim: The mitochondrial uncoupling protein-3 (UCP3) is able to lower the proton gradient across the inner mitochondrial membrane, thereby uncoupling substrate oxidation from ATP production and dissipating energy as heat. What the effect of endurance training on UCP3 is, is still  controversial. Endurance-trained athletes are characterized by lower levels of UCP3, but longitudinal studies in rodents reported no effect of endurance training on muscular UCP3 levels. Here, we examined the effect of a 2-week training programme on skeletal muscle UCP3 protein content in untrained human subjects, and hypothesized that UCP3 will be reduced after the training programme. Methods: Nine untrained men [age: 23.3±3.2 years; BMI: 22.6±2.6 kg m^-2; maximal power output (^Wmax): 3.8±0.6 W kg^-1 body weight] trained for 2 weeks. Before and at least 72 h after the training period, muscle biopsies were taken for determination of UCP3 protein content. Results: UCP3 protein content tended to be lower after the training programme [95±10 vs. 109±12 arbitrary units (AU), P= 0.08]. Cytochrome c content tended to increase with 33% in response to endurance training (52± 6 vs. 39± 6 AU, P = 0.08). The ratio UCP3 relative to cytochrome c tended to decrease significantly upon endurance training (2.0±0.4 vs. 3.2±0.6 AU, P = 0.01). Conclusion: A short-term (2-week) endurance training programme decreased UCP3 protein levels and significantly reduced the ratio of UCP3 to cytochrome c.

No effect of eccentric training on jumper's knee in volleyball plays. During the competitive season : a randomized clinical trial

Background: The effect of surgery on patellar tendinopathy (jumper's knee) is questionable, and conservative treatment protocols have not been properly documented.

Purpose: The aim of this study was to investigate the effect of a newly developed eccentric training program for patellar tendinopathy in volleyball players during the competitive season.

Study Design: Randomized clinical trial.

Methods: Patients were recruited from male and female elite volleyball teams in Norway, and the diagnosis was based on clinical examination alone. Of 51 players diagnosed with patellar tendinopathy, 29 could be included in the study. The training group (n = 13) performed squats on a 25° decline board as a home exercise program (3 × 15 repetitions twice daily) for a 12-week intervention period during the final half of the competitive season. The eccentric (downward) component was done on the affected leg. The control group (n = 16) trained as usual. The primary outcome was a symptom-based questionnaire developed specifically for patellar tendinopathy (Victorian Institute of Sport Assessment score), and patients were followed up before and after the intervention period, as well as after 6 and 30 weeks. All subjects self-recorded training to document their activity level (eccentric training, volleyball training, matches, other training).

Results: There was no change in Victorian Institute of Sport Assessment score during the intervention period in the training (pre, 71.1 ± 11.3; post, 70.2 ± 15.4) or control group (pre, 76.4 ± 12.1; post, 75.4 ± 16.7), nor was there any change during the follow-up period at 6 weeks or 6 months. The training group completed 8.2 ± 4.6 weekly sessions of eccentric training during the intervention period (59% of the recommended volume), and there was no difference between groups in training or competition load.

Conclusion: There was no effect on knee function from a 12-week program with eccentric training among a group of volleyball players with patellar tendinopathy who continued to train and compete during the treatment period. Whether the training would be effective if the patients did not participate in sports activity is not known.

Using knowledge management processes to develop and implement organisational training strategies for virtual teams : an action learning approach

This paper develops a conceptual model of a knowledge management system that could be used to develop and implement organizational training strategies for virtual teams. An action research-based case is presented to support and illustrate the contention that action-learning methods can be effectively used to enable and tap into the knowledge generated by virtual teams. Virtual teams are an increasingly common response to changing organizational needs. However, the use of virtual teams has outpaced our understanding of their dynamics and unique characteristics. Practitioners are now offering virtual team training, but few organizations are making the effort to offer in-house training. Moreover, they are missing out on the opportunity to systematically capture the knowledge produced by virtual teams and cycle it back into virtual team training and support systems.

Working and learning in vocational education and training in the knowledge era : final report of the professional development for the future project

This Report summarises the outcomes of the phases of the Professional
Development for the Future Project and presents the implications of this research for professional development of staff in Vocational Education and Training (VET), as they become knowledge workers.

These shifts are occurring within the knowledge era. Distinguishing features of this era are summarised into four broad areas:
- the importance and value placed on knowledge in organisations
- the time span of discretion
- the complexity of relationships, and
- the ubiquitous nature of information and communication technology.

It is within this context that work is currently performed, and understanding this context provides the foundation for considering new capabilities required in the knowledge era.
Key capabilities required of knowledge workers to work effectively in the
knowledge era were drawn together from an analysis of the theoretical literature and the results of interviews with knowledge workers. The core capabilities identified include:
- adaptive problem solving – becoming designers as well as problem -
solvers
- rapid knowledge gathering and sharing with others
- discriminating between relevant and irrelevant information, and
- understanding and working effectively with the organisation’s culture.

Knowledge era characteristics and knowledge worker capabilities have been mapped to each other illustrating conceptual linkages between these two areas.

Professional development themes drawn from interviews with knowledge
workers are presented. While global trends in knowledge work have been well documented, the impact of these trends on the capabilities of workers, and the ways in which knowledge workers develop these capabilities is less well understood. Their learning methods challenge our current thinking in relation to the ways in which workers acquire skills and knowledge. Some of the professional development methods include seeking exposure to new ideas from a wide variety of sources, embracing intense learning opportunities, and using relationships to increase knowledge.

‘Thought pieces’ (see p17 ff) commissioned for this Project, as well as
subsequent interviews with the authors, provided further insights into the
professional development of knowledge workers. The implications of these insights are an extension of earlier themes and emphasise:
- the emergent nature of knowledge work
- the importance of relationships that facilitate knowledge sharing
- coherent conversations and dialogue
- collaborative work and generosity.

A key insight is the shift from thinking about knowledge work in terms of
borrowed knowledge to an emphasis on generated knowledge within a context.

Data from focus groups of the Project provide further insights for knowledge worker professional development. These augment the perspectives of the earlier data analysis but also add greater emphasis to:
- the clear and direct relationship between professional development and
work and career aspirations of knowledge workers,
- the relationship of professional development to the organisational
mission, and
- the issues of managing and leading knowledge workers and their
development.

As part of this analysis the defining features of organisational life in VET were reviewed in relation to effective professional development of knowledge workers.

The final section of the Report revisits the core dimensions of the Project.
Concise commentaries on working and learning in the knowledge era,
professional development in the knowledge era, and leadership and
management in the knowledge era are presented.

The Report concludes with a discussion of the enablers of professional
development for knowledge workers in VET. This discussion is introduced by a re-statement of the VET sector’s positioning in the knowledge era and the consequences of this for VET managers an d staff in terms of complexity, uncertainty and diminished prospects for accurate predictiveness. The enablers comprised:
- integration of information technology into socio -technical systems
- greater understanding of the organisation from within
- connecting staff to the organisation’s fundamental identity
- connecting to the work and career trajectories of workers
- establishing work structures which integrate the use of professional
development resources with knowledge work
- providing workers with the autonomy to design their own professional
development activities
- building professional development into the iterative nature of knowledge
work, and
- creating organisational contexts that value intuitive thinking and working.

Professional development needs to be thou ght of in a much broader context in the knowledge era. What each VET staff member knows and shares will become increasingly central to their work, and in that sense all VET workers require capabilities for knowledge work. This report accurately describes t he VET context, the capabilities required, and the organisational enablers that will promote ‘knowing’ and thus embed a new style of professional development within VET.

Effects of high-intensity progressive resistance training on self-reported health status in older persons with type 2 diabetes

Purpose: To evaluate the influence of high-intensity progressive resistance training (PRT) on self-reported physical and mental health in older persons with type 2 diabetes.

Methods: We performed a 12-month RCT with 36 overweight men and women with type 2 diabetes (aged 60-80 years) who were randomly assigned to a moderate weight-loss diet plus PRT (PRT&WL) or a moderate weight-loss diet plus a control (stretching) program (WL). Gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. The SF-36 (v1) questionnaire was used to obtain physical (PCS) and mental (MCS) health component summary scores at baseline, 6 and 12 months.

Results: Subject retention was 81% and 72% after 6 and 12 months respectively. Exercise adherence during gymnasium- and home-based training was 88% and 73% for the PRT&WL group, and 85% and 78.1% for the WL group respectively. In a regression model adjusted for age and sex, PCS improved in the PRT&WL group compared to the WL group after 6 months of gymnasium-based training (2.3 versus -2.0, p = 0.05), which persisted after 12 months training (0.7 versus -4.1, p = 0.03). There were no between-group differences at 6 or 12 months for the MCS.

Conclusion: High-intensity PRT was effective in improving self-reported physical health, but not mental health. PRT provides an effective exercise alternative in lifestyle management for older adults with type 2 diabetes.

Identifying the barriers to implementing the Victorian Department of Education and Training guidelines regarding the provisions of nutrient dense food options in school canteens

Aims & rationale/Objectives : To identify barriers to the full implementation of new guidelines regarding school canteen menus launched by The Victorian Education Department in May 2004.
Methods : A self-administered questionnaire was sent to principals, business mangers and canteen managers of 13 secondary schools in South West Victoria covered by The Greater Green Triangle area (response rate 59%). The questions explored the canteen's role, operation, staffing and profits; existence and content of canteen policy; enablers and barriers to the sale of healthier foods; introduction and promotion of healthier foods; and perceived implications of banning less healthy foods.
Principal findings : The study identified several barriers to implementing healthy menus in school canteens, these being largely consistent with those found in other studies. The majority of schools reported they were making attempts to follow the guidelines for school food services, but were experiencing difficulty in proceeding to full implementation. The barriers identified through the study were student preference for less healthy options, concerns about profitability, lack of policy or its active communication and promotion at the school level and competition from other food outlets.
Discussion : There was evidence that healthy foods had not been actively promoted, suggesting that identification of student preferences as a barrier was based on perception rather than observation. The Victorian guidelines are effectively voluntary, with no accountability measures in place.
Implications : Research needs to be conducted to provide reliable and tested information about factors which impact on student choice. Schools would benefit from specialised assistance to formulate business plans for contemporary canteens selling healthy food and a clarification of government policy.
Presentation type : Poster

The effect of training in reduced energy density eating and food self-monitoring accuracy on weight loss maintenance

Background:
Failure to maintain weight losses in lifestyle change programs continues to be a major problem and warrants investigation of innovative approaches to weight control.
Objective:
The goal of this study was to compare two novel group interventions, both aimed at improving weight loss maintenance, with a control group.
Methods and Procedures:
A total of 103 women lost weight on a meal replacement–supplemented diet and were then randomized to one of three conditions for the 14-week maintenance phase: cognitive-behavioral treatment (CBT); CBT with an enhanced food monitoring accuracy (EFMA) program; or these two interventions plus a reduced energy density eating (REDE) program. Assessments were conducted periodically through an 18-month postintervention. Outcome measures included weight and self-reported dietary intake. Data were analyzed using completers only as well as baseline-carried-forward imputation.
Results:
Participants lost an average of 7.6 plusminus 2.6 kg during the weight loss phase and 1.8 plusminus 2.3 kg during the maintenance phase. Results do not suggest that the EFMA intervention was successful in improving food monitoring accuracy. The REDE group decreased the energy density (ED) of their diets more so than the other two groups. However, neither the REDE nor the EFMA condition showed any advantage in weight loss maintenance. All groups regained weight between 6- and 18-month follow-ups.
Discussion:
Although no incremental weight maintenance benefit was observed in the EFMA or EFMA + REDE groups, the improvement in the ED of the REDE group's diet, if shown to be sustainable in future studies, could have weight maintenance benefits.

New regimen for eccentric calf-muscle training in patients with chronic insertional achilles tendinopathy : results of a pilot study

Background: Chronic painful insertional Achilles tendinopathy is seen in both physically active and non-active individuals. Painful eccentric training, where the patients load the Achilles tendon into full dorsiflexion, has shown good results in patients with mid-portion Achilles tendinosis. However, only 32% of patients with insertional Achilles tendinopathy had good clinical results with that type of eccentric training regimen.

Aim: To investigate whether a new model of painful eccentric training had an effect on chronic painful insertional Achilles tendinopathy.

Patients and methods: 27 patients (12 men, 15 women, mean age 53 years) with a total of 34 painful Achilles tendons with a long duration of pain (mean 26 months), diagnosed as insertional Achilles tendinopathy, were included. The patients performed a new model of painful eccentric training regimen without loading into dorsiflexion. This was done as 3x15 reps, twice a day, 7 days/week, for 12 weeks. Pain during Achilles-tendon-loading activity (VAS) and patient’s satisfaction (back to previous activity) were evaluated.

Results: At follow-up (mean 4 months) 18 patients (67%, 23/34 tendons) were satisfied and back to their previous tendon-loading activity. Their mean VAS had decreased from 69.9 (SD 18.9) to 21 (SD 20.6) (p<0.001). Nine patients (11 tendons) were not satisfied with the treatment, although their VAS was significantly reduced from 77.5 (8.6) to 58.1 (14.8) (p<0.01).

Conclusion: In this short-term pilot study this new model of painful eccentric calf-muscle training showed promising clinical results in 67% of the patients.

Tennis playing initiated before puberty leads to greater skeletal benefits in peri-pubertal boys than girls when training is maintained

Introduction: The purpose of the study was to compare the exercise-induced changes in bone mass and geometry between boys and girls.

Methods: Eighty competitive tennis players (43 boys, 37 girls) aged 7–19 years participated. Pubertal status was self-assessed using Tanner stages (TS 1–5). The dominant and nondominant humeri were compared for DXA-derived bone mass (BMC) and MRI-derived bone geometry [total bone area (TA), medullary area (MA) and cortical bone area (CA)].

Results/Discussion: Exercise-induced side-to-side differences in BMC, TA and CA were significant from TS1 to 5 in boys and girls (p < 0.06). Pre-pubertal (TS1) girls and boys show similar side-to-side difference in BMC after adjustment for training volume (19% vs. 15%, ns). Similar findings were found forTA and CA. In contrast, during puberty (TS2-4) boys displayed greater side-to-side differences than girls for BMC (27% vs. 18%, p < 0.05), TA (13–15% vs. 8%, p < 0.05) and CA (32% vs. 20%, p < 0.01), even after adjustment for tennis history. Girls partly compensated for the lack of an exercise-induced increase in bone size by a reduction of the medullary cavity on the dominant side (−5.5 to −13%, p < 0.05). In post-puberty (TS 5 or postmenarche), the size of the medullary cavity remained smaller on the dominant side in girls (−5% to −9%, p = 0.1–0.05??) whereas no such reduction was observed in boys.

Conclusion: Regular exercise initiated before puberty and maintained throughout puberty leads to greater skeletal benefits in peri-pubertal boys than girls for bone mass and bone size, two of the major determinants of bone strength.

Building research capacity in General Practice : Incorporating research as a component of GP vocational training

Aims & rationale/Objectives : Australian research shows that most GP registrar supervisors lack confidence to support registrar research projects and themselves have little or no research experience. Assisting registrars to develop critical thinking skills and an understanding of research methods sufficient to enable active use of these tools in general practice is one of the curriculum statements in the RACGP Training Program Curriculum. A University Department of Rural Health (UDRH) and a General Practice Education and Training (GPET) organisation formed a partnership to: Engage basic term registrars in group research and concurrent research skills training program; Improve research skills, confidence, and knowledge; and Contribute research findings relevant to general practice.

Methods : Registrars' initial research knowledge and confidence was measured by a questionnaire. In addition to a final focus group, feedback via evaluation forms was sought from the 11 registrars and two GPET supervisors at the conclusion of each research training session.

Principal findings : Approaches

Implications : Research skills development training and involvement in research can be successfully integrated into a GP vocational training program.

Computer-simulated environment for training : challenge of efficacy evaluation

Computer-assisted instruction has been around for decades. There has been much speculation about the benefits of computer-mediated learning. Numerous applications have been developed in different domains incorporated with emerging technologies. In recently years, advanced technologies, such as Augmented Reality (AR) and Virtual Reality (VR), have received much attention in their potential of creating interactive learning experience for the users. However, related literature and empirical studies indicated that learning effects in computer-simulated environments or Virtual Environments (VEs) are not systematically tested. Furthermore, the performance and learning in computer-simulated learning environment need to be evaluated through more rigorous methods. This paper suggests that 1) the efficacy of VEs is subject to a close examination, not only in terms of how VE-based training systems are easy of use, but also in terms of how effective learning is; 2) evaluation of learning in computer simulated learning environments is required to be reconsidered in terms of theoretical basis and evaluation methodologies that are relevant to the measurement of training effectiveness in computer-simulated virtual learning environment. This paper explains on how learning can be assessed in VEs through the lens of training evaluation.

A comparison of methods to calculate the optimal load for maximal power output in the power clean

The aim of this study was to compare three calculation methods to determine the load that maximises power output in the power clean. Five male athletes (height=179.8 10.5cms, weight 91 .8 8.8kg, power dean 1RM = 117.0 20.5kg) performed two per cleans at 10% increments from 50% to 100% of 1RM. Bar displacement data was collected using a Ballistic Measurement System (BMS) and vertical ground reaction force (VGRF) data was measured by a Kistler 9287B Force Plate. Power output was calculated for BMS (system mass), BMS (bar mass) and VGRF/BMS system mass. Optimal load was determined to be 70% for the BMS (system mass) and VGRF BMS (system mass) methods and 90% for the BMS (bar mass) method. Sports scientists should be aware of the technical issues underlying these findings due to the practical ramifications for athlete testing and training.

Responding to rural skills shortages : innovations using vocational education and training

Aims & Rationale/Objectives
To locate, analyse and make accessible innovative models of health training and service delivery that have been developed in response to a shortage of skills.

Methods
Drawing on a synthesis of Australian and international literature on innovative and effective models for addressing health skill shortages, 50 models were selected for further study. Models were also identified from nominations by key health sector stakeholders. Selected models represent diversity in terms of the nature of skill shortage addressed, barriers overcome in developing the model, health care specialisations, and customer groups.

Principal Findings
Rural and remote areas have become home to a set of innovative service delivery models. Models identified encompass local, regional and state/national responses. Local responses are usually single health service-training provider partnerships. Regional responses, the most numerous, tend to have a specific focus, such as training young people. A small number of holistic state or national responses, eg the skills ecosystem approach, address multiple barriers to health service provision. Typical barriers include unwillingness to risk-take, stakeholder differences, and entrenched workplace cultures. Enhancers include stakeholder commitment, community acceptance, and cultural fit.

Discussion
Of particular interest is increasing numbers of therapy assistants to help address shortages of allied health professionals, and work to formalise their training, and develop standards of practice and policy. Other models likely to help address skill shortage amongst VET health workers focus on recruiting, supporting and training employees from a range of disadvantaged target groups, and on providing career paths with opportunities for staff to expand their skills. Such models are underpinned by nationally recognised qualifications, but each solution is targeted to a particular context in terms of the potential workforce and local need.