"The right thing for our patients": perspectives of physical therapists transitioning to a 7 day a week service in an urban acute care center in Canada.

BACKGROUND: True seven day a week acute care physical therapy (PT) coverage is rare. Our facility is one of a few in Canada that has increased weekend PT coverage on medicine units to seven days of full PT staffing levels. OBJECTIVE: This article investigates the perspectives of physical therapists involved in the change with the focus on the emotional experiences of those therapists. METHODS: Thematic analysis of interview and focus group transcripts with 18 physical therapist and 2 manager participants were aligned with four themes of: 1) optimism, hope and excitement; 2) frustration, guilt, and resentment; 3) fear, anxiety, uncertainty, and vulnerability; and 4) ambivalence, neutrality, and impartiality. RESULTS: Although there were several perceived benefits to quality of care and work/life balance, participants' comments also reflected: frustration, guilt, and resentment related to the rapid implementation of the change and the impact of altered work schedules. CONCLUSIONS: Participants emphasized the need to discuss large changes with staff prior to implementation in order to prevent frustration and resentment. Participants also felt that increased acute care PT coverage over seven days is valuable, but other allied health professions also need a proportional increase in staffing to improve hospital flow.

Multimodal high-intensity interval training increases muscle function and metabolic performance in females.

High-intensity interval training (HIIT) is a time-efficient method of improving aerobic and anaerobic power and capacity. In most individuals, however, HIIT using modalities such as cycling, running, and rowing does not typically result in increased muscle strength, power, or endurance. The purpose of this study is to compare the physiological outcomes of traditional HIIT using rowing (Row-HIIT) with a novel multimodal HIIT (MM-HIIT) circuit incorporating multiple modalities, including strength exercises, within an interval. Twenty-eight recreationally active women (age 24.7 ± 5.4 years) completed 6 weeks of either Row-HIIT or MM-HIIT and were tested on multiple fitness parameters. MM-HIIT and Row-HIIT resulted in similar improvements (p < 0.05 for post hoc pre- vs. post-training increases for each group) in maximal aerobic power (7% vs. 5%), anaerobic threshold (13% vs. 12%), respiratory compensation threshold (7% vs. 5%), anaerobic power (15% vs. 12%), and anaerobic capacity (18% vs. 14%). The MM-HIIT group had significant (p < 0.01 for all) increases in squat (39%), press (27%), and deadlift (18%) strength, broad jump distance (6%), and squat endurance (280%), whereas the Row-HIIT group had no increase in any muscle performance variable (p values 0.33-0.90). Post-training, 1-repetition maximum (1RM) squat (64.2 ± 13.6 vs. 45.8 ± 16.2 kg, p = 0.02), 1RM press (33.2 ± 3.8 vs. 26.0 ± 9.6 kg, p = 0.01), and squat endurance (23.9 ± 12.3 vs. 10.2 ± 5.6 reps, p < 0.01) were greater in the MM-HIIT group than in the Row-HIIT group. MM-HIIT resulted in similar aerobic and anaerobic adaptations but greater muscle performance increases than Row-HIIT in recreationally active women.

Do physiological measures predict selected CrossFit(®) benchmark performance?

PURPOSE: CrossFit(®) is a new but extremely popular method of exercise training and competition that involves constantly varied functional movements performed at high intensity. Despite the popularity of this training method, the physiological determinants of CrossFit performance have not yet been reported. The purpose of this study was to determine whether physiological and/or muscle strength measures could predict performance on three common CrossFit "Workouts of the Day" (WODs). MATERIALS AND METHODS: Fourteen CrossFit Open or Regional athletes completed, on separate days, the WODs "Grace" (30 clean and jerks for time), "Fran" (three rounds of thrusters and pull-ups for 21, 15, and nine repetitions), and "Cindy" (20 minutes of rounds of five pull-ups, ten push-ups, and 15 bodyweight squats), as well as the "CrossFit Total" (1 repetition max [1RM] back squat, overhead press, and deadlift), maximal oxygen consumption (VO2max), and Wingate anaerobic power/capacity testing. RESULTS: Performance of Grace and Fran was related to whole-body strength (CrossFit Total) (r=-0.88 and -0.65, respectively) and anaerobic threshold (r=-0.61 and -0.53, respectively); however, whole-body strength was the only variable to survive the prediction regression for both of these WODs (R (2)=0.77 and 0.42, respectively). There were no significant associations or predictors for Cindy. CONCLUSION: CrossFit benchmark WOD performance cannot be predicted by VO2max, Wingate power/capacity, or either respiratory compensation or anaerobic thresholds. Of the data measured, only whole-body strength can partially explain performance on Grace and Fran, although anaerobic threshold also exhibited association with performance. Along with their typical training, CrossFit athletes should likely ensure an adequate level of strength and aerobic endurance to optimize performance on at least some benchmark WODs.

Cardiovascular responses in older adults with total knee arthroplasty at rest and with exercise on a positive pressure treadmill.

PURPOSE: We investigated cardiovascular responses at rest and during submaximal exercise on a lower body positive pressure treadmill in older adults with total knee arthroplasty (TKA). METHODS: Twenty-four adults (mean age 64.6 ± 7.9 SD) with unilateral TKA participated (median time since surgery 8.0 weeks). Heart rate and blood pressure responses were measured at rest standing on the positive pressure treadmill with 0, 10, 20, and 30 mmHg applied. Heart rate, blood pressure, oxygen consumption, minute ventilation, knee pain and perceived exertion were measured during submaximal exercise tests (0 and 40% body weight support) conducted 1 week apart. RESULTS: At rest there were no differences in blood pressure across different treadmill pressures, but heart rate was significantly lower when 30 mmHg was applied compared to ambient pressure conditions (P < 0.05). Participants averaged 5.1 exercise test stages with 0% body weight support (maximum speed 2.5 mph, 0% incline) and 6.4 stages with 40% body weight support (maximum speed 3.0 mph, 10% incline). During exercise, heart rate, systolic blood pressure, oxygen consumption, and minute ventilation were lower when 40% body weight support was provided for a given test stage (P < 0.01). Diastolic blood pressure, knee pain and perceived exertion did not differ with body weight support but increased with increasing exercise test stages (P < 0.05). CONCLUSIONS: Provision of body weight support allowed TKA patients to walk at faster speeds and/or to tolerate greater incline with relatively lower levels of heart rate, blood pressure, and oxygen consumption.