The role of key workers in improving physical health in first episode psychosis: A scoping review.

AIM: Studies have demonstrated that a majority of the decline in health status and functioning emerges during the first few years following the onset of psychosis. This knowledge led to the development of specialized early intervention services (EIS) targeting patients experiencing their first episode of psychosis (FEP). The central component of EIS is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. The aim of this scoping review was to examine how key workers can enhance the physical health outcomes in people with FEP by addressing the factors associated with increased mortality in this population. METHODS: The scoping review framework comprised a five-stage process developed by Arksey and O'Malley. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: A total of 27 studies conducted across 10 countries were analysed. These studies discussed the various ways in which key workers can mediate enhancements in the various factors contributing to the increased mortality rates in FEP patients. CONCLUSIONS: A broad range of key worker-mediated outcomes was identified, which were broadly classified into three themes: influences on lifestyle, influences on effects of psychosis and influences on organizational barriers. Our findings suggest that key workers primarily mediated the amelioration of psychosis-induced effects and the reduction of organizational barriers. Further trials of key worker interventions to enhance physical health outcomes in this cohort are warranted.

Effects of segment masses and cut-off frequencies on the estimation of vertical ground reaction forces in running.

The purpose of this study is to examine the effect of the body's mass distribution to segments and the filtering of kinematic data on the estimation of vertical ground reaction forces from positional data. A public dataset of raw running biomechanics was used for the purposes of the analysis, containing recordings of twenty-eight competitive or elite athletes running on an instrumented treadmill at three different speeds. A grid-search on half of the trials was employed to seek the values of the parameters that optimise the approximation of biomechanical loads. Two-way ANOVAs were then conducted to examine the significance of the parameterised factors in the modelled waveforms. The reserved recordings were used to validate the predictive accuracy of the model. The cut-off filtering frequencies of the pelvis and thigh markers were correlated to running speed and heel-strike patterns, respectively. Optimal segment masses were in agreement with standardised literature reported values. Root mean square errors for slow running (2.5 m/s) were on average equal to 0.1 (body weight normalized). Errors increased with running speeds to 0.13 and 0.18 for 3.5 m/s and 4.5 m/s, respectively. This study accurately estimated vertical ground reaction forces for slow-paced running by only considering the kinematics of the pelvis and thighs. Future studies should consider configuring the filtering of kinematic inputs based on the location of markers and type of running.

Key Worker-Mediated Enhancement of Physical Health in First Episode Psychosis: Protocol For a Feasibility Study in Primary Care.

BACKGROUND: Studies have demonstrated that, for patients with psychosis, a majority of the decline in health status and functioning emerges during the first few years after the onset of illness. This knowledge led to the development of specialized early intervention services (EISs) targeting patients experiencing their first episode of psychosis. The central component of EISs is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. OBJECTIVE: This paper outlines the protocol for a feasibility study examining how key workers may enhance physical health by supporting integration between primary and secondary care. METHODS: Semistructured interviews were conducted with key stakeholder groups (General Practitioners and health care professionals working in mental health services). The interviews informed the development of the complex intervention involving a longitudinal pre-post intervention in 8 general practices in 2 regions in Ireland (one urban and one rural). Patients with first episode psychosis (FEP) will be identified from clinical records at general practices and mental health services. RESULTS: Baseline and follow-up data (at 6 months) will be collected, examining measures of feasibility, acceptability, and intervention effect size. CONCLUSIONS: Study findings will inform future practice by examining feasibility of key workers enhancing physical health through improved interaction between primary and secondary care. By identifying issues involved in enhancing recruitment and retention, as well as the likely effect size, the study will inform a future definitive intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13115.

Managing player load in professional rugby union: a review of current knowledge and practices.

BACKGROUND: The loads to which professional rugby players are subjected has been identified as a concern by coaches, players and administrators. In November 2014, World Rugby commissioned an expert group to identify the physical demands and non-physical load issues associated with participation in professional rugby. OBJECTIVE: To describe the current state of knowledge about the loads encountered by professional rugby players and the implications for their physical and mental health. FINDINGS: The group defined 'load' as it relates to professional rugby players as the total stressors and demands applied to the players. In the 2013-2014 seasons, 40% of professional players appeared in 20 matches or more, and 5% of players appeared in 30 matches or more. Matches account for ∼5-11% of exposure to rugby-related activities (matches, team and individual training sessions) during professional competitions. The match injury rate is about 27 times higher than that in training. The working group surmised that players entering a new level of play, players with unresolved previous injuries, players who are relatively older and players who are subjected to rapid increases in load are probably at increased risk of injury. A mix of 'objective' and 'subjective' measures in conjunction with effective communication among team staff and between staff and players was held to be the best approach to monitoring and managing player loads. While comprehensive monitoring holds promise for individually addressing player loads, it brings with it ethical and legal responsibilities that rugby organisations need to address to ensure that players' personal information is adequately protected. CONCLUSIONS: Administrators, broadcasters, team owners, team staff and the players themselves have important roles in balancing the desire to have the 'best players' on the field with the ongoing health of players. In contrast, the coaching, fitness and medical staff exert significant control over the activities, duration and intensity of training sessions. If load is a major risk factor for injury, then managing training loads should be an important element in enabling players to perform in a fit state as often as possible.

An investigation into the recovery process of a maximum stretch-shortening cycle fatigue protocol on drop and rebound jumps.

The aim of this study was to investigate the recovery process of a maximal stretch-shortening cycle (SSC) fatigue workout on the biomechanical performance of drop jump (DJ) and rebound jump (RBJ) on a force sledge apparatus. Thirteen elite level rugby players performed sledge DJs and RBJs before and 15, 45, 120, and 300 seconds after a maximum SSC fatigue workout. Flight time, ground contact time (CT), peak force, reactive strength index (RSI), and leg-spring stiffness were the dependent variables. The DJ results showed that after 15 seconds recovery, there was a significant reduction in flight time (FT) (p < 0.01), RSI (p < 0.001), peak force (p < 0.01), and leg stiffness (p < 0.001). Similarly, the results for the RBJ indicated that the fatigue workout significantly reduced FT (p < 0.001), peak force (p < 0.01), RSI (p < 0.01), and significantly increased CT (p < 0.05) at the 15-second interval. The results also indicated a potentiation effect at the 300-second interval because of significant increases in RSI, peak force, and leg stiffness (p < 0.05) for the RBJ and significant increases in RSI (p < 0.05), peak force, and leg stiffness (p < 0.01) and a significant decrease in ground CT (p < 0.05) for the DJ. A maximal SSC fatigue workout had both an inhibiting and potentiating effect on DJ and RBJ performance depending on the recovery interval. The efficiency of the SSC function was reduced immediately after the cessation of the fatigue workout. A potentiation effect was evident for both jumps 300 seconds postfatigue.

Effect of squatting on sprinting performance and repeated exposure to complex training in male rugby players.

This study was undertaken to examine the effect of a heavy weight training exercise on sprinting performance and on the effect of repeated exposure to a complex training protocol. Eleven male rugby union players (age 20.9 +/- 3.1 years) participated in the study, which involved 5 separate testing sessions. Back squat 3 repetition maximum (3RM) was established in session 1. Sessions 2-5 were identical and involved the subjects completing a 30-m sprint before and after a 3RM back squat protocol. Four minutes of rest was given between the back squatting and the posttest 30-m sprint. All sprint trials were measured with a laser measurement device (LAVEG, Jenoptik, Jena, Germany). Sprint time and instantaneous, average, and maximum velocity were the dependent variables. The criterion for significance was set at an alpha level of p > or = 0.05. No significant improvement was evident for any of the testing sessions (p > or = 0.05). In session 1, there was a significant increase in 30-m time and a significant reduction in average 30-m velocity and maximum velocity (p < 0.05). The expected benefits in sprinting may not have been realized because of intra and intersubject variations in sprint technique. The session x phase interaction revealed a significant improvement in the pre to posttest changes in instantaneous velocity at 20 m (p = 0.035) and 30 m (p = 0.036) from session 1 to session 4. This indicates that the rugby players may be able to learn to apply the potentiation effects of complex training. From a practical perspective, players may need repeated exposure to this training modality to gain benefit from it, and this should be reflected in program planning.

Identifying the optimal resistive load for complex training in male rugby players.

Alternating a resistance exercise with a plyometric exercise is referred to as "complex training". In this study, we examined the effect of various resistive loads on the biomechanics of performance of a fast stretch-shortening cycle activity to determine if an optimal resistive load exists for complex training. Twelve elite rugby players performed three drop jumps before and after three back squat resistive loads of 65%, 80%, and 93% of a single repetition maximum (1-RM) load. All drop jumps were performed on a specially constructed sledge and force platform apparatus. Flight time, ground contact time, peak ground reaction force, reactive strength index, and leg stiffness were the dependent variables. Repeated-measures analysis of variance found that all resistive loads reduced (P < 0.01) flight time, and that lifting at the 93% load resulted in an improvement (P < 0.05) in ground contact time and leg stiffness. From a training perspective, the results indicate that the heavy lifting will encourage the fast stretch-shortening cycle activity to be performed with a stiffer leg spring action, which in turn may benefit performance. However, it is unknown if these acute changes will produce any long-term adaptations to muscle function.

The optimal complex training rest interval for athletes from anaerobic sports.

Complex training research has indicated that 3-4 minutes may be an optimum intracomplex rest interval. The purpose of this study was to determine if a heavy resistive exercise causes performance enhancement of a slow stretch-shortening cycle exercise and if there is an optimal rest interval. Eighteen subjects performed countermovement jumps (CMJs) before and after a 5 repetition maximum back squat lifting protocol. This procedure was repeated 4 times over 2 days using rest intervals of 30 seconds and 2, 4, and 6 minutes. Flight time and peak ground reaction force (GRF) were the dependent variables. All jumps were performed on a specially constructed sledge and force platform apparatus. Repeated measures analysis of variance found a significant reduction in flight time at the 30-second and 6-minute interval (p < 0.05). No significant difference was found between men and women. Only the men showed an enhancement in jump performance after the 4-minute interval. The improvement window was different for each subject, and an analysis of the greatest increase and decrease in flight time and peak GRF was conducted, showing a significant decrease for men and women and a significant increase in flight time for men and peak ground reaction force for women. The results suggest that complex training can benefit or inhibit CMJ performance depending on the rest interval. The individual determination of the intracomplex rest interval may be necessary in the practical setting.