Mental Health First Aid training for paramedic students: An evaluation study.

BACKGROUND: The combination of first-year placements, an increasing proportion of mental health callouts, and the high incidence of mental illness in health-professional tertiary students means standard curricula may not adequately prepare early-year paramedic students for mental health challenges. METHODS: A retrospective online survey was used to explore the experiences of paramedic students who have completed Mental Health First Aid (MHFA) training within their undergraduate studies. The content-validated survey explored the relevance, appropriateness, and novelty of MHFA training, and invited participants to reflect on the course strengths and weaknesses. RESULTS: The majority of 102 respondents, predominantly female first- and second-year paramedic students aged 18-24 years, agreed the content was relevant (86%) and appropriate (88%), with 73% agreeing they would recommend to other university students. Thematic analysis identified strengths of the course as perceived increases in mental health literacy and empowerment to act on mental health concerns. A weakness was students perceived the course did not prepare them adequately for clinical practice. CONCLUSION: The inclusion of MHFA early in paramedic curricula is appropriate and relevant, increasing mental health literacy and empowering students to recognise and act upon mental health concerns. Application of practical scenarios may further enhance student learning experiences.

Dietary Inflammatory Index and Associations with Sarcopenia Symptomology in Community-Dwelling Older Adults.

Low-grade systemic inflammation is a key driver of muscle degeneration in older adults, and diets with pro-inflammatory properties may further contribute to loss of muscle mass, strength and function. Therefore, this research aimed to explore the associations between the inflammatory potential of the diet and measures of sarcopenia symptomology in community-dwelling older adults. Upper (handgrip strength, HGS) and lower extremity (sit-to-stand) muscle strength, physical performance (timed-up-and-go, TUG) and appendicular skeletal muscle mass (ASM) was assessed according to the European Working Group on Sarcopenia in Older People version 2 (EWGSOP2) criteria. Multiple 24-hr dietary recalls were used to calculate the Dietary Inflammatory Index (DII), which was then used to group participants into anti- and pro-inflammatory dietary groups. Multiple linear regression investigated associations between DII, muscle strength, physical performance, and muscle quantity adjusted for age, gender, comorbidities, waist circumference and physical activity. Adults 65-85 years (n = 110, 72.1 ± 4.7 years, 76.4% female) were recruited. One participant was identified with sarcopenia, 35.2% were pre-frail, or frail. More participants with a pro-inflammatory DII score had low muscle quantity than those with anti-inflammatory DII (3.4% vs. 6.4%, x2 = 4.537, p = 0.043) and DII was negatively associated with HGS (ß = -0.157, p = 0.016) and ASM (ß = -0.176, p = 0.002) which remained significant after adjusting for covariates. In this population, DII was associated with less favorable muscle strength, physical performance, and muscle quantity.

Characteristics of community-based exercise programs for community-dwelling older adults in rural/regional areas: a scoping review.

Community-based exercise programs for older adults play a potentially important role in mitigating the decline in functional outcomes, body composition, psychosocial outcomes, and cardiovascular health outcomes that commonly occurs with advancing age. There is a limited understanding of the characteristics and effectiveness of community-based exercise programs, particularly when those programs are offered outside metropolitan areas. Rural/regional settings face unique challenges, such as limited access to equipment/resources, transportation, and services, as well as significant costs to run programs. The objective of this scoping review was to characterise studies in the field that have aimed to implement community-based programs in settings identified as rural / regional. A secondary aim was to establish guidance for future exercise programs in this setting and highlight future research directions. A total of 12 studies were conducted in settings identified as rural/regional areas in various countries across the world were included. Of the included studies, five were randomised controlled trials. The majority of included studies reported on functional outcomes (83%) and psychosocial outcomes (75%), yet only 42% reported body composition, 17% reported cardiovascular health and 17% reported dietary outcomes. Low male representation was observed, with women outnumbering men in 7 of 12 studies. There was also minimal investigation of qualitative outcomes in existing community-based exercise programs in rural/regional settings, presenting a key gap for future research to address. Study Protocol: https://osf.io/txpm3/ . Date of registration: 20 July 2020.

Physiological, psychological and functional changes with whole body vibration exercise in the elderly: FEVER methodology and protocols.

BACKGROUND: The FEVER (Frail Elderly Vibration Exercise Response) study aims to address a paucity of research focusing on the use of Whole Body Vibration (WBV) by frail elderly who, with the highest levels of dependence and fall-related hospitalisation/mortality, potentially stand to benefit most from such accessible exercise. METHODS: FEVER is an open, randomised feasibility study, consisting of multiple parallel arms and a longitudinal element. Rest-home residents aged 70+years will be recruited, and assigned to a WBV-exercise group (WBV), a simulated-WBV-exercise group (SIM), or a control group (CON). WBV- and SIM-participants will undergo thrice-weekly sessions (<20-min each, including 1:1 ratio of exercise:rest) for a 16-week exercise intervention period, whilst CON-participants will receive no intervention beyond normal care. WBV-exercise will start with 5?1-minute sessions (6Hz, 2mm amplitude), progressing to 10?1-minute sessions at which time Hz/amplitude can be increased if desired. During WBV-exercise, participants will maintain an isometric knee flexion of ~20° (±5°), to dampen WBV further up the body. RESULTS: Outcomes will include assessments of functionality (primary outcome), Quality of Life, bone health and cardiovascular function. Measures will be conducted at baseline, 8-weeks and 16-weeks of the intervention, and 3-, 6- and 12-months post-intervention. As a protocol paper, there are no specific results to present; our current purpose is to share the study design with the scientific community. CONCLUSIONS: The FEVER study aims to investigate the beneficial effects of WBV-exercise in the frail elderly, ascertain an effective training regime and for the first-time identify a time-line of detraining.

Effect of whole-body microtitanium-treated garments on metabolic cost of exercise following strenuous hill running.

OBJECTIVES: To determine the effect size of wearing sports garments treated with microscopic titanium particles (AQUA TITAN) during recovery from strenuous running on the restoration of running economy during subsequent exercise. DESIGN: A double-blind crossover was used to determine the effect of AQUA TITAN on running metabolic cost in 10 healthy men. Participants performed 40 min of treadmill running comprising 2×(10 min at 5% and 10 min at -10% grade), followed by random allocation to skin-tight nylon-polyurethane AQUA TITAN treated or non-treated placebo garments covering the torso, limbs, and feet. Garments were worn continuously throughout the next 48-h, during which time participants rested (day 2) then completed a graded treadmill run to determine metabolic outcome (day 3). METHODS: Body-weight normalised running metabolic cost was evaluated by indirect calorimetry and the effect size referenced against the smallest meaningful change in economy (0.9%) for improvement in distance running performance. RESULTS: The fatigue effect while wearing control garments on metabolic cost at 48-h was small (2.2% 95%CL ±1.2%). In contrast, AQUA TITAN garments most certainly reduced running metabolic cost (-3.1% ±0.9%) vs. control. Additionally, AQUA TITAN increased the respiratory exchange ratio (0.011 ±0.005) and lowered minute ventilation at intensities below the ventilatory threshold (-4.0% ±0.9%). CONCLUSIONS: AQUA TITAN garments worn during recovery from strenuous exercise improved subsequent running economy to a magnitude likely to restore endurance performance. Future research should verify the magnitude of garment effects on performance outcomes, and on identifying the acute or passive neural, musculotendinous or metabolic mechanisms responsible.

Psychosocial determinants of fruit and vegetable consumption among students in a New Zealand university. Results of focus group interviews.

The '5+ a day' fruit and vegetable servings recommendation was introduced in New Zealand in 1994, but consumption has remained low in young adults ever since. This study aimed to identify psychosocial determinants of fruit and vegetable consumption among New Zealand university students approximately a decade after the guidelines' introduction. Twenty-nine students, aged 18-24 years, took part in focus group interviews. Important determinants included taste and health awareness/knowledge. Flatmates and partners had the greatest social influence. Cost and availability were major barriers to consumption. To improve consumption participants suggested: cooking sessions providing quick/easy recipes; more-varied nutritional information; 'made-to-measure' interventions; increasing awareness of cheap sources of fruit/vegetables; and increasing campus availability of fruit. Determinants including a negative attitude, a lack of self-efficacy and an unawareness of dietary guidelines/health consequences should be considered when developing interventions for this group, whilst a variety of different delivery channels should be used. Participants in the study were not representative of all university students, who generally have a different lifestyle to other young adults and specific determinants for fruit/vegetable consumption. Consequently, additional research is required among other young adults and university students with lower fruit and vegetable intake, so that promotional strategies can be specifically targeted.

No effect of protein coingestion on exogenous glucose oxidation during exercise.

PURPOSE: We examined the hypothesis that protein coingestion with glucose during endurance exercise increases exogenous glucose oxidation rate and gut comfort and lowers perceived exertion. METHODS: In a randomized crossover design, eight male cyclists rode 150 min at 50% of peak power on three occasions while ingesting solutions containing the following: 8% ¹³C-enriched glucose and 2% milk protein concentrate (protein-glucose), glucose only (glucose), or noncaloric placebo (water). All solutions contained sodium citrate ([⁺Na] 60 mmol·L⁻¹) and flavor and were ingested at 150 mL·15 min⁻¹. The exogenous carbohydrate oxidation rate was determined using stable isotope method and indirect calorimetry. RESULTS: Protein coingestion had no effect on the exogenous glucose oxidation rate but increased endogenous carbohydrate oxidation rate (16%; 90% confidence limits ±7%), relative to glucose. Total carbohydrate and fat oxidation rates were increased (25%; ±6%) and decreased (17%; ±4%), respectively, by protein coingestion relative to water, but the effect relative to glucose was trivial. The plasma glucose concentration relative to glucose (mean ± SD; 6.1 ± 0.8 mmol·L⁻¹) was 5.8% (±3%) lower with protein coingestion; there were no clear differences in glucose concentration for the remaining comparisons or for lactate concentration. Perceived exertion was not altered by protein coingestion; however, there was a small decrease in nausea with the protein-glucose solution relative to water (-0.14 ± 0.08 U); other protein-affected comparisons were without note. CONCLUSIONS: Adding protein to a glucose-sodium solution ingested during exercise had neutral effect on exogenous carbohydrate oxidation and perception and little effect on metabolic measures associated with endurance performance. We conclude that previously reported effects of protein coingestion on endurance capacity were unlikely due to increased exogenous carbohydrate provision.

Effect of high-protein feeding on performance and nitrogen balance in female cyclists.

PURPOSE: The effect of dietary protein ingested after exercise on recovery in women athletes is unknown. Therefore, we asked whether there is a meaningful difference between high- and low-protein recovery diets on the subsequent performance of well-trained female cyclists. METHODS: In a crossover, 12 female cyclists completed three high-intensity rides composed of 2.5-h intervals on day 1, followed by repeat-sprint performance tests on days 2 and 4, interspersed with a rest day. During the 4-h recovery on days 1 and 2, cyclists ingested 1.4/0.7/0.26 or 2.1/0.1/0.26 g·kg(-1)·h(-1) of CHO/protein/fat in high-protein or isocaloric control conditions, respectively. At other times, cyclists ingested an isoenergetic high-CHO diet. RESULTS: No effect of protein dose on the mean power during repeat sprint was evident on day 2 (high-protein vs control = -1.1%; 95% confidence limits = ±4.6%) or on day 4 (1.7%; ±4.6%); furthermore, fatigue effects (slope) were unclear (day 2 = 1.4%; ±4.9%, day 4 = 0.5%; ±4.9%). Perceptions of leg tiredness and soreness were increased, and leg strength was reduced in the high-protein condition relative to control. In the high-protein condition, plasma glucose concentrations were lower during recovery, and plasma lactate concentrations were lower during the sprints. Effects on circulating creatine kinase activity were trivial. Net nitrogen balance during the experiment was positive in the high-protein condition (mean ± SD = 177 ± 140 mg of N·kg(-1) fat-free mass) but negative in the control condition (-81 ± 73 mg of N·kg(-1) fat-free mass); the estimated protein requirement was 1.28 g·kg(-1)·d(-1) (±0.57 g·kg(-1)·d(-1)). CONCLUSIONS: In contrast with the previous findings in males, we observed no clear influence of dietary protein quantity on the subsequent performance in females. The findings on nitrogen balance suggest that female cyclists training intensely have daily protein requirements approximately 1.6 times the recommended daily allowance but 0.65 times that of males

Aquatitan garments extend joint range of motion without effect on run performance.

PURPOSE: To investigate the effects of uniquely processed titanium-permeated garments (Aquatitan) on the performance of and recovery from a high-intensity intermittent exercise. METHODS: In a crossover, 14 nationally and regionally competing male soccer/hockey players performed two 5-d trials composed of a Loughborough Intermittent Shuttle Test on day 1, followed by 4 d of recovery assessment wearing randomly allocated Aquatitan- and placebo-treated clothing that covered their torso, limbs, and feet continuously throughout the study. Repeated sprint time was measured during the shuttle test, and muscle damage, joint range of motion, isometric strength, and running performance were measured during recovery. RESULTS: The increase in sprint performance during the shuttle test (0.7%, 90% confidence interval = +/-0.9%) was likely trivial. During recovery, wearing of Aquatitan had a possible harmful effect on peak run velocity on day 3 (-1.1% +/- 1.6%) but a likely small benefit on day 5 (2.0% +/- 1.6%); combined (0.4% +/- 1.3%) and standardized outcomes suggest an overall trivial benefit. Aquatitan increased range of motion. For example, voluntary leg extension increased by 2.6% (+/-4.0%), hip flexion increased by 1.8% (+/-1.2%), plantarflexion increased by 4.8% (+/-2.8%), and shoulder extension and flexion increased by 4.2% (+/-3.0%) and 1.3% (+/-0.6%), respectively; forced voluntary differences at the hip and shoulder were trivial. Running efficiency was possibly increased on days 3 and 5. The effects on isometric strength were largely trivial, but a slight enhancement of the psychological state was observed. In a separate perception experiment, participants perceived tactile differences that were influenced by the knowledge of treatment. CONCLUSIONS: For competitive subelite male soccer/hockey players, performance gains in response to wearing Aquatitan-treated garments are likely of trivial consequence. However, improved joint range of motion during recovery indicates that the garments reduced muscle­tendon stiffness, suggesting enhanced compliance, which warrants further investigation. Garment feel may also explain the outcomes.