Non-Placement WIL: The Case of an Exercise Prescription Clinic

Universities globally have continued to strategically increase work-integrated learning (WIL) opportunities for students to enhance graduate employability. However, meeting the needs of the increasing number of placements in industry settings places challenges on employers and academic programme coordinators. This paper examines an innovative teaching and learning initiative demonstrating non-placement WIL practice on-campus and online through an exercise prescription clinic (EPC). The benefits provided by these opportunities have not only been for student learning, but for clients, in particular those impacted by neurological and/or muscular skeletal problems. The development of the on-campus EPC has focused on key elements of good practice in WIL highlighted by Agnew, Pill and Orrell (2017). The recent Covid-19 pandemic and the related government restrictions have resulted in the on-campus EPC being flipped online, requiring adaptability and flexibility of both students and clients. This paper reinforces the importance of developing WIL experiences that enhance the learning outcomes for both the student and the client. It also highlights the transferability of authentic industry non-placement WIL clinical experiences for future health professionals to both on-campus and online settings, which enable students the opportunity to engage with a range of clients in a safe environment, enhancing both personal and professional learning outcomes

Post-Exertional Malaise May Be Related to Central Blood Pressure, Sympathetic Activity and Mental Fatigue in Chronic Fatigue Syndrome Patients

Post-exertional malaise (PEM) is regarded as the hallmark symptom in chronic fatigue syndrome (CFS). The aim of the current study is to explore differences in CFS patients with and without PEM in indicators of aortic stiffness, autonomic nervous system function, and severity of fatigue. One-hundred and one patients met the Fukuda criteria. A Chronic Fatigue Questionnaire (CFQ) and Fatigue Impact Scale (FIS) were used to assess the level of mental and physical fatigue. Aortic systolic blood pressure (sBPaortic) and the autonomic nervous system were measured with the arteriograph and Task Force Monitor, respectively. Eighty-two patients suffered prolonged PEM according to the Fukuda criteria, while 19 did not. Patients with PEM had higher FIS scores (p = 0.02), lower central systolic blood pressure (p = 0.02) and higher mental fatigue (p = 0.03). For a one-point increase in the mental fatigue component of the CFQ scale, the risk of PEM increases by 34%. For an sBPaortic increase of 1 mmHg, the risk of PEM decreases by 5%. For a one unit increase in sympathovagal balance, the risk of PEM increases by 330%. Higher mental fatigue and sympathetic activity in rest are related to an increased risk of PEM, while higher central systolic blood pressure is related to a reduced risk of PEM. However, none of the between group differences were significant after FDR correction, and therefore conclusions should be treated with caution and replicated in further studies

Adapting a capacity-development-in-higher-education project:Doing, being and becoming virtual collaboration

In November 2019, scholars and practitioners from ten higher education institutions celebrated the launch of the iKudu project. This project, co-funded by Erasmus+[1], focuses on capacity development for curriculum transformation through internationalisation and development of Collaborative Online International Learning (COIL) virtual exchange. Detailed plans for 2020 were discussed including a series of site visits and face-to-face training. However, the realities of the COVID-19 pandemic disrupted the plans in ways that could not have been foreseen and new ways of thinking and doing came to the fore. Writing from an insider perspective as project partners, in this paper we draw from appreciative inquiry, using a metaphor of a mosaic as our identity, to first provide the background on the iKudu project before sharing the impact of the pandemic on the project’s adapted approach. We then discuss how alongside the focus of iKudu in the delivery of an internationalised and transformed curriculum using COIL, we have, by our very approach as project partners, adopted the principles of COIL exchange. A positive impact of the pandemic was that COIL offered a consciousness raising activity, which we suggest could be used more broadly in order to help academics think about international research practice partnerships, and, as in our situation, how internationalised and decolonised curriculum practices might be approached. [1] KA2 Erasmus+ Cooperation for innovation and the exchange of good practices (capacity building in the field of Higher Education

Prediction of discontinuation of structured exercise programme in chronic fatigue syndrome patients.

Purpose: The purpose of this study was to assess differences in the physiological profiles of completers vs. non-completers following a structured exercise programme (SEP) and the ability to predict non-completers, which is currently unknown in this group. Methods: Sixty-nine patients met the Fukuda criteria. Patients completed baseline measures assessing fatigue, autonomic nervous system (ANS), cognitive, and cardiovascular function. Thirty-four patients completed a home-based SEP consisting of 10–40 min per day at between 30 and 80% actual HR max. Exercise intensity and time was increased gradually across the 16 weeks and baseline measures were repeated following the SEP. Results: Thirty-five patients discontinued, while 34 completed SEP. For every increase in sympathetic drive for blood pressure control as measured by the taskforce, completion of SEP decreased by a multiple of 0.1. For a 1 millisecond increase in reaction time for the simple reaction time (SRT), the probability for completion of SEP also decreases by a multiple of 0.01. For a one beat HRmax increase, there is a 4% increase in the odds of completing SEP. Conclusion: The more sympathetic drive in the control of blood vessels, the longer the reaction time on simple visual stimuli and the lower the HRmax during physical exercise, then the lower the chance of SEP completion in ME/CFS

Relationship between Cardiopulmonary, Mitochondrial and Autonomic Nervous System Function Improvement after an Individualised Activity Programme upon Chronic Fatigue Syndrome Patients

Background: The therapeutic effects of exercise from structured activity programmes have recently been questioned; as a result, this study examines the impact of an Individualised Activity Program (IAP) on the relationship with cardiovascular, mitochondrial and fatigue parameters. Methods: Chronic fatigue syndrome (CFS) patients were assessed using Chalder Fatigue Questionnaire (CFQ), Fatigue Severity Score (FSS) and the Fatigue Impact Scale (FIS). VO(2)peak, VO(2)submax and heart rate (HR) were assessed using cardiopulmonary exercise testing. Mfn1 and Mfn2 levels in plasma were assessed. A Task Force Monitor was used to assess ANS functioning in supine rest and in response to the Head-Up Tilt Test (HUTT). Results: Thirty-four patients completed 16 weeks of the IAP. The CFQ, FSS and FIS scores decreased significantly along with a significant increase in Mfn1 and Mfn2 levels (p = 0.002 and p = 0.00005, respectively). The relationships between VO2 peak and Mfn1 increase in response to IAP (p = 0.03) and between VO2 at anaerobic threshold and ANS response to the HUTT (p = 0.03) were noted. Conclusions: It is concluded that IAP reduces fatigue and improves functional performance along with changes in autonomic and mitochondrial function. However, caution must be applied as exercise was not well tolerated by 51% of patients

Cardiac power output in healthy adults and patients with peripheral vascular disease

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Effects of Post-Exertional Malaise on Markers of Arterial Stiffness in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Background: Evidence is emerging that individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may suffer from chronic vascular dysfunction as a result of illness-related oxidative stress and vascular inflammation. The study aimed to examine the impact of maximal-intensity aerobic exercise on vascular function 48 and 72 h into recovery. Methods: ME/CFS (n = 11) with gender and age-matched controls (n = 11) were randomly assigned to either a 48 h or 72 h protocol. Each participant had measures of brachial blood pressure, augmentation index (AIx75, standardized to 75 bpm) and carotid-radial pulse wave velocity (crPWV) taken. This was followed by a maximal incremental cycle exercise test. Resting measures were repeated 48 or 72 h later (depending on group allocation). Results: No significant differences were found when ME/CFS were directly compared to controls at baseline. During recovery, the 48 h control group experienced a significant 7.2% reduction in AIx75 from baseline measures (p < 0.05), while the matched ME/CFS experienced no change in AIx75. The 72 h ME/CFS group experienced a non-significant increase of 1.4% from baseline measures. The 48 h and 72 h ME/CFS groups both experienced non-significant improvements in crPWV (0.56 ms−1 and 1.55 ms−1, respectively). Conclusions: The findings suggest that those with ME/CFS may not experience exercise-induced vasodilation due to chronic vascular damage, which may be a contributor to the onset of post-exertional malaise (PEM)

THE IMPACT OF SHORT TERM SUPERVISED AND HOME-BASED WALKING PROGRAMMES ON HEART RATE VARIABILITY IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASET

The aims of the study were to determine whether heart rate variability (HRV) measured at rest and during exercise could be altered by an exercise training programme designed to increase walking performance in patients with peripheral arterial disease. Forty-four volunteers were randomised into 12 weeks of either: supervised walking training twice weekly for 30 min at 75% VO2peak (SU), home-based walking training sessions: twice weekly, 30 min per week (HB) or no exercise (CT). HRV measures were calculated from a 5-min resting ECG. Each patient then underwent maximal, graded exercise treadmill testing. All measures were repeated after 12 weeks. The SU group showed significantly (p < 0.001) increased maximal walking time (MWT) but no change in VO2peak. There were no statistically significant changes in any of the measures of HRV in any group. Effect sizes for change in HRV measures were all very small and in some cases negative. Improved walking performance was not accompanied by central cardiorespiratory or neuroregulatory adaptations in the present study. The lack of any change in HRV was possibly due to either the low intensity or discontinuous nature of exercise undertake

Comparison of cardiac output determined by different rebreathing methods at rest and at peak exercise

Several rebreathing methods are available for cardiac output (QT) measurement. The aims of this study were threefold: first, to compare values for resting QT produced by the equilibrium-CO2, exponential-CO2 and inert gas-N2O rebreathing methods and, second, to evaluate the reproducibility of these three methods at rest. The third aim was to assess the agreement between estimates of peak exercise QT derived from the exponential and inert gas rebreathing methods. A total of 18 healthy subjects visited the exercise laboratory on different days. Repeated measures of QT, measured in a seated position, were separated by a 5 min rest period. Twelve participants performed an incremental exercise test to determine peak oxygen consumption. Two more exercise tests were used to measure QT at peak exercise using the exponential and inert gas rebreathing methods. The exponential method produced significantly higher estimates at rest (averaging 10.9 l min-1) compared with the equilibrium method (averaging 6.6 l min-1) and the inert gas rebreathing method (averaging 5.1 l min-1; P < 0.01). All methods were highly reproducible with the exponential method having the largest coefficient of variation (5.3%). At peak exercise, there were non-significant differences between the exponential and inert gas rebreathing methods (P = 0.14). The limits of agreement were -0.49 to 0.79 l min-1. Due to the ability to evaluate the degree of gas mixing and to estimate intra-pulmonary shunt, we believe that the inert gas rebreathing method has the potential to measure QT more precisely than either of the CO2 rebreathing methods used in this study. At peak exercise, the exponential and inert gas rebreathing methods both showed acceptable limits of agreement. © Springer-Verlag 2007

LACK OF AGREEMENT BETWEEN GAS EXCHANGE VARIABLES MEASURED BY TWO METABOLIC SYSTEMS

The purpose of this study was to assess the agreement and consistency between gas exchange variables measured by two online metabolic systems during an incremental exercise test. After obtaining local ethics approval and informed consent, 15 healthy subjects performed an incremental exercise test to volitional fatigue using the Bruce protocol. The Innocor (Innovision, Denmark) and CardiO2 (Medical Graphics, USA) systems were placed in series, with the Innocor mouthpiece attached to the pneumotach of the CardiO2. Metabolic data were analysed during the last 30 seconds of each stage and at peak exercise. There were non- significant differences (p > 0.05) between the two systems in estimation of oxygen consumption (VO2) and in minute ventilation (VE). Mean Cronbach's alpha for VO2 and VE were 0.88 and 0.92. The Bland-Altman analysis revealed that limits of agreement were -0.52 to 0.55 l.min-1 for VO2, and -8.74 to 10.66 l.min-1 for VE. Carbon dioxide production (VCO2) and consequently respiratory exchange ratio (RER) measured by the Innocor were significantly lower (p < 0.05) through all stages. The CardiO2 measured fraction of expired carbon dioxide (FeCO2) significantly higher (p < 0.05). The limits of agreement for VO2 and VE are wide and unacceptable in cardio-pulmonary exercise testing. The Innocor reported VCO2 systematically lower. Therefore the Innocor and CardiO2 metabolic systems cannot be used interchangeably without affecting the diagnosis of an individual patient. Results from the present study support previous suggestion that considerable care is needed when comparing metabolic data obtained from different automated metabolic systems