Older adults' neuromuscular adaptations to resistence training and effects on challenging gait tasks

Community locomotion is threatened when older individuals are required to negotiate obstacles, which place considerable stress on the musculoskeletal system. The vulnerability of older adults during challenging locomotor tasks is further compromised by age-related strength decline and muscle atrophy. The first study in this investigation determined the relationship between the major muscle groups of the lower body and challenging locomotor tasks commonly found in the community environment of older adults. Twenty-nine females and sixteen males aged between 62 and 88 years old (68.2 ±6.5) were tested for the maximal voluntary contraction (MVC) strength of the knee extensors and 1-RM for the hip extensors, flexors, adductors, abductors, knee extensors and flexors and ankle plantar flexors. Temporal measurements of an obstacle course comprising four gait tasks set at three challenging levels were taken. The relationship between strength and the obstacle course dependent measures was explored using linear regression models. Significant associations (p≤0.05) between all the strength measures and the gait performances were found. The correlation values between strength and obstructed gait (r = 0.356-0.554) and the percentage of the variance explained by strength (R2 = 13%-31%), increased as a function of the challenging levels, especially for the stepping over and on and off conditions. While the difficulty of community older adults to negotiate obstacles cannot be attributed to a single causal pathway, the findings of the first study showed that strength is a critical requirement. That the magnitude of the association increased as a function of the challenging levels, suggests that interventions aimed at improving strength would potentially be effective in helping community older adults to negotiate environmental gait challenges. In view of the findings of the first study, a second investigation determined the effectiveness of a progressive resistance-training program on obstructed gait tasks measured under specific laboratory conditions and on an obstacle course mimicking a number of environmental challenges. The time courses of strength gains and neuromuscular mechanisms underpinning the exercise-induced strength improvements in community-dwelling older adults were also investigated. The obstructed gait conditions included stepping over an obstacle, on and off a raised surface, across an obstacle and foot targeting. Forty-three community-living adults with a mean age of 68 years (control =14 and experimental=29) completed a 24-week progressive resistance training program designed to improve strength and induce hypertrophy in the major muscles of the lower body. Specific laboratory gait kinetics and kinematics and temporal measures taken on the obstacle course were measured. Lean tissue mass and muscle activation of the lower body muscle groups were assessed. The MVC strength of the knee extensors and 1-RM of the hip extension, hip flexion, knee extension, knee flexion and ankle plantar flexion were measured. A 25% increase on the MVC of the knee extensors (p≤0.05) was reported in the training group. Gains ranging between 197% and 285% were recorded for the 1-RM exercises in the trained subjects with significant improvements found throughout the study (p≤0.05). The exercise-induced strength gains were mediated by hypertrophic and neural factors as shown by 8.7% and 27.7% increases (p≤0.05) in lean tissue mass and integrated electromyographic activity, respectively. Strength gains were accompanied by increases in crossing velocity, stride length and reductions in stride duration, stance and swing time for all gait tasks except for the foot targeting condition. Specific kinematic variables associated with safe obstacle traverse such as vertical obstacle heel clearance, limb flexion, horizontal foot placements prior to and at post obstacle crossing and landing velocities resulted in an improved crossing strategy in the experimental subjects. Significant increases in the vertical and anterior-posterior ground reaction forces accompanied the changes in the gait variables. While further long-term prospective studies of falls rates would be needed to confirm the benefits of lower limb enhanced strength, the findings of the present study provide conclusive evidence of significant improvements to gait efficiency associated with a systematic resistance-training program. It appears, however, that enhanced lower body strength has limited effects on gait tasks involving a dynamic balance component. In addition, due to the larger strength-induced increases in voluntary activation of the leg muscle compared to relatively smaller gains in lean tissue mass, neural adaptations appear to play a greater contributing role in explaining strength gains during the current resistance training protocol.

Advanced virtual engineering educational program for engineering research and teaching excellence

In this paper, an advanced virtual engineering educational program developed at University of South Australia for both on-campus and off-shore students will be studied. This extensive training program is based on a comprehensive online tutorial and comprises both face-to-face and online learning. The program provides a tailored evaluation format to ensure that all postgraduate students, including course work and research students, will have appropriate exposure to updated learning skills and research resources. Although the internet (WWW) is the primary resource being used in this educational program, other resources such as video conference, video taping, and face-to-face lecturing have also played a role in promoting engineering teaching and research excellence. The feedback from students in recent years has been very encouraging, showing increased information literacy skills and improved researching abilities. As off campus class numbers have increased, further development of the program to meet their requirement has been a priority.

An advanced virtual engineering educational program for engineering research and teaching excellence.

In this paper, an advanced virtual program in engineering education developed at the University of South Australia for both on-campus and offshore students is described. This extensive training program is based on a comprehensive online tutorial and comprises both face-to-face and online learning. The program provides a tailored evaluation format to ensure that all postgraduate students, including those doing coursework and research, will have appropriate exposure to updated learning skills and research resources. Although the internet is the primary resource used in this educational program, other resources, such as videoconferencing, video-taping and face-to-face lecturing, have also played a role in promoting engineering teaching and research excellence. The feedback from students in recent years has been very encouraging, and students have shown increased information literacy skills and improved researching abilities. As off-campus class numbers have increased, further development of the program to meet their requirements has been a priority.

Field fitness testing and training patterns for women in three masters sports

This study involved 33 women, aged 44-71 years involved in either masters swimming, field hockey or lawn bowls. Subjects undertook a 12-week competitive training program and participated in one fitness test session, to trial field-based tests of aerobic fitness, muscle power, body fat and flexibility. The field-based fitness testing proved practical. Athlete fitness was affected by age, competitiveness, training intensity and volume.

A preliminary evaluation of the world's largest skills enhancement program for entrepreneurs

Start and Improve Your Business (SIYB) is an entrepreneurial training program created, sponsored and disseminated by the International Labour Organization. SIYB is, arguably, the world’s largest skills enhancement program for entrepreneurs. SIYB has been in operation since the early 1970s and currently operates in almost 80 countries. During the last decade, more than 100,000 entrepreneurs, thousands of trainers and hundreds of small enterprise development organizations around the world have participated in it (Samuelsen 2003). Surprisingly for an education program of this magnitude and potential global importance, there has been relatively little program evaluation performed. What evaluation has been conducted has been unsystematic, qualitative and unsatisfactory (Harper 1985).

Meanwhile, in the nation of Botswana, since the mid seventies, there has been a huge growth in programs devoted to the training of small and medium entrepreneurs. The SIYB program has formed a significant component of this entrepreneurial training effort in Botswana (ILO 1996). SIYB training was initially supported by the United Nations and later by the Botswana government. Since its introduction into Botswana in1983, the SIYB program has been evaluated only once, in 1993 (Samuelsen 2003). The methods used (subjective questionnaire administered to an unsystematic sample of past participants) fails to provide a satisfactory evaluation of the program. So, in Botswana and worldwide, the world’s largest entrepreneurial training program continues to run in the absence of any knowledge concerning its efficacy. This paper describes the various elements of the SIYB program and places it in the context of the data-rich Botswanan environment. The descriptive work is a necessary predicate to creation of a research design capable of providing the detailed, critical program evaluation that has been so conspicuously lacking throughout the history of the SIYB initiative.

Neurophysiological responses after short-term strength training of the biceps brachii muscle

The neural adaptations that mediate the increase in strength in the early phase of a strength training program are not well understood; however, changes in neural drive and corticospinal excitability have been hypothesized. To determine the neural adaptations to strength training, we used transcranial magnetic stimulation (TMS) to compare the effect of strength training of the right elbow flexor muscles on the functional properties of the corticospinal pathway. Motorevoked potentials (MEPs) were recorded from the right biceps brachii (BB) muscle from 23 individuals (training group; n = 13 and control group; n = 10) before and after 4 weeks of progressive overload strength training at 80% of 1-repetition maximum (1 RM). The TMS was delivered at 10% of the root mean square electromyographic signal (rmsEMG) obtained from a maximal voluntary contraction (MVC) at intensities of 5% of stimulator output below active motor threshold (AMT) until saturation of the MEP (MEP maxl. Strength training resulted in a 28% (p = 0.0001) increase in 1 RM strength, and this was accompanied by a 53% increase (p = 0.05) in the amplitude of the MEP at AMT; 33% (p = 0.05) increase in MEP at 20% above AMT, and a 38% increase at MEPmax (p = 0.04). There were no significant differences in the estimated slope (p = 0.4 7) or peak slope of the stimulus-response curve for the left primary motor cortex (M1) after strength training (p = 0.61). These results demonstrate that heavy-load isotonic strength training alters neural transmission via the corticospinal pathway projecting to the motoneurons controlling BB and in part underpin the strength changes observed in this study.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

High volume versus low volume balance training on postural sway in adults with previous ankle inversion injury

Balance training is commonly used in the rehabilitation process of ankle injuries; however, the exercise prescription guidelines for prescribing balance training are poorly understood. The aim of the present study was to determine if high or low volume balance training is more effective in improving postural sway after an 8 week balance training program utilising the same exercises. Seventeen subjects (14 male, 3 female) with a mean age of 24.06 ± 5.6 years were randomly allocated into a control group (CG), low volume training (LVT) or high volume training (HVT). All subjects had sustained at least two inversion ankle injuries within the last 18 months. Subjects completed 8 weeks of balance training of up to 30 mins duration, 3 times per week. LVT consisted of 40 repetitions for week 1, progressing to 90 repetitions by week 8. HVT consisted of 60 repetitions for week 1, progressing to 130 repetitions by week 8. The maximum centre of pressure (COP) excursion was obtained from the porce plate in the medial-lateral (ML) direction and subsequently used for pre-test and post-test analysis. After the 8 week training intervention, there was a significant (P<0.001) difference in postural sway between pre and post testing for both the LVT (pre = 88.69mm ± 25.08mm, post = 72.17mm ± 27.53mm) and HVT (pre = 77.47mm ±10.57mm, post = 58.54mm ± 7.01mm) groups. There was no significant (P>0.01) difference detected for improvements between the LVT and HVT, however reported effect sizes (ES) showed large effect size chances in the high volume training (ES = 1.7) whereas low volume training showed medium effect sizes changes (ES = 0.6). This preliminary study demonstrates the importance of training volume in the rehabilitation of ankle injuries, with the HVT being superior to LVT.

Anodal tDCS applied during strength training enhances motor cortical plasticity

Purpose:
The objective of this study was to assess the effect of anodal transcranial direct current stimulation (a-tDCS) on voluntary dynamic strength and cortical plasticity when applied during a 3-wk strength training program for the wrist extensors.

Methods:
Thirty right-handed participants were randomly allocated to the tDCS, sham, or control group. The tDCS and sham group underwent 3 wk of heavy-load strength training of the right wrist extensors, with 20 min of a-tDCS (2 mA) or sham tDCS applied during training (double blinded). Outcome measures included voluntary dynamic wrist extension strength, muscle thickness, corticospinal excitability, short-interval intracortical inhibition (SICI), and silent period duration.

Results:
Maximal voluntary strength increased in both the tDCS and sham groups (14.89% and 11.17%, respectively, both P < 0.001). There was no difference in strength gain between the two groups (P = 0.229) and no change in muscle thickness (P = 0.15). The tDCS group demonstrated an increase in motor-evoked potential amplitude at 15%, 20%, and 25% above active motor threshold, which was accompanied by a decrease in SICI during 50% maximal voluntary isometric contraction and 20% maximal voluntary isometric contraction (all P < 0.05). Silent period decreased for both the tDCS and sham groups (P < 0.001).

Conclusion:
The application of a-tDCS in combination with strength training of the wrist extensors in a healthy population did not provide additional benefit for voluntary dynamic strength gains when compared with standard strength training. However, strength training with a-tDCS appears to differentially modulate cortical plasticity via increases in corticospinal excitability and decreases in SICI, which did not occur following strength training alone

Disassociation of muscle triglyceride content and insulin sensitivity after exercise training in patients with Type 2 diabetes

Aim/hypothesis. We determined the effect of exercise training on insulin sensitivity and muscle lipids (triglyceride [TGm] and long-chain fatty acyl CoA [LCACoA] concentration) in patients with Type 2 diabetes. Methods. Seven patients with Type 2 diabetes and six healthy control subjects who were matched for age, BMI, % body fat and VO2peak participated in a 3 days per week training program for 8 weeks. Insulin sensitivity was determined pre- and post-training during a 120 min euglycaemic- hyperinsulinaemic clamp and muscle biopsies were obtained before and after each clamp. Oxidative enzyme activities [citrate synthase (CS), β-hydroxy-acyl- CoA (β-HAD)] and TGm were determined from basal muscle samples pre- and post training, while total LCACoA content was measured in samples obtained before and after insulin-stimulation, pre- and post training. Results. The training-induced increase in VO2peak (∼20%, p<0.01) was similar in both groups. Compared with control subjects, insulin sensitivity was lower in the diabetic patients before and after training (∼60%; p<0.05), but was increased to the same extent in both groups with training (∼30%; p<0.01). TGm was increased in patients with Type 2 diabetes (170%; p<0.05) before, but was normalized to levels observed in control subjects after training. Basal LCACoA content was similar between groups and was unaltered by training. Insulin-stimulation had no detectable effect on LCACoA content. CS and β-HAD activity were increased to the same extent in both groups in response to training (p<0.001). Conclusion/interpretation. We conclude that the enhanced insulin sensitivity observed after short-term exercise training was associated with a marked decrease in TGm content in patients with Type 2 diabetes. However, despite the normalization of TGm to levels observed in healthy individuals, insulin resistance was not completely reversed in the diabetic patients.

Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: the OzDAFNE program

AIMS: To evaluate structured type 1 diabetes education delivered in routine practice throughout Australia.

METHODS: Participants attended a five-day training program in insulin dose adjustment and carbohydrate counting between April 2007 and February 2012. Using an uncontrolled before-and-after study design, we investigated: HbA1c (% and mmol/mol); severe hypoglycaemia; diabetes ketoacidosis (DKA) requiring hospitalisation, and diabetes-related distress (Problem Areas in Diabetes scale; PAID), weight (kg); body mass index. Data were collected pre-training and 6-18 months post-training. Change in outcome scores were examined overall as well as between groups stratified by baseline HbA1c quartiles. Data are mean±SD or % (n).

RESULTS: 506 participants had data eligible for analysis. From baseline to follow-up, significant reductions were observed in the proportion of participants reporting at least one severe hypoglycaemic event (24.7% (n=123) vs 12.1% (n=59), p<0.001); and severe diabetes-related distress (29.3% (n=145) vs 12.6% (n=60), p<0.001). DKA requiring hospitalisation in the past year reduced from 4.1% (n=20) to 1.2% (n=6). For those with above target baseline HbA1c there was a small, statistically significant improvement (n=418, 8.4±1.1% (69±12mmol/mol) to 8.2±1.1% (66±12mmol/mol). HbA1c improvement was clinically significant among those in the highest baseline quartile (n=122, 9.7±1.1% (82±11mmol/mol) to 9.0±1.2% (75±13mmol/mol), p<0.001).

CONCLUSIONS: The proportion of participants reporting severe hypoglycaemia, DKA and severe diabetes-related distress was at least halved, and HbA1c reduced by 0.7% (7mmol/mol) among those with highest baseline levels. Structured type 1 diabetes education delivered in routine practice offers clinically important benefits for those with greatest clinical need.

Study protocol: the registrar clinical encounters in training (ReCEnT) study

Background
Patient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.
Methods/design
This is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.
Conclusions
The study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

Improvement of heart rate variability after exercise training and its predictors in COPD

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Orange juice improved lipid profile and blood lactate of overweight middle-aged women subjected to aerobic training

Objective This study investigated how consumption of orange juice associated with aerobic training affected serum lipids and physical characteristics of overweight middle-aged womenMethods The experimental group consisted of 13 women who consumed 500 mL/d of orange juice and did 1 h aerobic training 3 times a week for 3 months The control group consisted of another 13 women who did the same aerobic training program but did not consume orange juiceResults At the end of the experiment the control group lost an average of 15% of fat mass (P < 0 05) and 25% of weight (P < 0 05) whereas the experimental group lost 11% of fat mass and 1 2% of weight (P < 0 05) Consumption of orange juice by the experimental group was associated with Increased dietary intake of vitamin C and folate by 126% and 61% respectively Serum LDL-C decreased 15% (P < 0 05) and HDL-C increased 18% (P < 0 05) in the experimental group but no significant change was observed in the control group Both groups improved the anaerobic threshold by 20% (P < 0 05) but blood lactate concentration decreased 27% in the experimental group compared to the 17% control group suggesting that experimental group has less muscle fatigue and better response to trainingConclusions The consumption of 500 mL/d of orange juice associated with aerobic training in overweight women decreased cardiovascular disease risk by reducing LDL-C levels and increasing HDL-C levels This association also decreased blood lactate concentration and increased anaerobic threshold showing some improvement in the physical performance (C) 2010 Elsevier B.V. All rights reserved

Effect of respiratory muscle training on pulmonary function in preoperative preparation of tobacco smokers

OBJETIVO: Avaliar o efeito da utilização de um programa de treinamento específico dos músculos respiratórios sobre a função pulmonar em indivíduos tabagistas. MÉTODOS: Foram estudados 50 indivíduos tabagistas assintomáticos com idade superior a 30 anos, nos seguintes momentos: A0 - avaliação inicial seguida do protocolo de exercícios respiratórios; A1 - reavaliação após 10 minutos da aplicação do protocolo; e A2 -reavaliação final após duas semanas de treinamento utilizando o mesmo protocolo três vezes por semana. A avaliação foi realizada através das medidas de pressões respiratórias máximas (PImax. e PEmax.), picos de fluxo respiratórios (PFI e PFE), ventilação voluntária máxima (VVM), capacidade vital Forçada (CVF) e Volume expiratório forçado no primeiro segundo (VEF1). RESULTADOS: Não houve melhora na CVF e VEF1 da avaliação inicial para a final. Houve aumento significativo das variáveis PFI, PFE, VVM e PImax nas avaliações A1 e A2. A variável PEmax. aumentou somente na avaliação A2. CONCLUSÃO: A aplicação de protocolo de exercícios respiratórios com e sem carga adicional em indivíduos tabagistas produziu melhora imediata na performance dos músculos respiratórios, mas esta melhora foi mais acentuada após duas semanas de exercício.