Prescribing or co-designing exercise in healthy adults? Effects on mental health and interoceptive awareness

Universal exercise recommendations for adults neglect individual preferences, changing constraints, and their potential impact on associated health benefits. A recent proposal suggests replacing the standardized World Health Organisation (WHO) exercise recommendations for healthy adults by co designed interventions where individuals participate actively in the decisions about the selected physical activities and the effort regulation. This study contrasts the effects on mental health and interoceptive awareness of a co designed and co-adapted exercise intervention with an exercise program based on the WHO recommendations for healthy adults. Twenty healthy adults (10 men and 10 women, 40-55 y.o.) participated voluntarily in the research. They were randomly assigned to a co-designed exercise intervention (CoD group) and a prescribed exercise program (WHO group). Supervised online by specialized personal trainers, both programs lasted 9 weeks and were equivalent in volume and intensity. The effects of the exercise intervention were tested through personal interviews, questionnaires (DASS 21 and MAIA) and a cardiorespiratory exercise test. Intragroup differences (pre post) were assessed using the Mann-Whitney Wilcoxon test and intergroup differences through Student's t-tests. Effect sizes were calculated through Cohen's d. Interviews were analyzed through thematic analysis. Eleven participants completed the intervention (CoD = 8, WHO = 5). Both groups improved, but non significantly, their cardiorespiratory testing results, and no differences were found between them post-intervention. Mental health was only enhanced in the CoD group (p < 0.001), and interoceptive awareness improved in seven of the eight scales in the CoD group (p < 0.001) and only in 3 scales in the WHO group (p < 0.01). In conclusion, the co-designed intervention was more effective for developing mental health, interoceptive awareness, autonomy, and exercise self-regulation than the WHO-based exercise program

Differences in cardiorespiratory responses in winter mountaineering according to the pathway snow conditions

Locomotion during ascent requires higher energetic consumption than in flat terrain. Efficiency in locomotion decreases in snowy terrain, presumably because of the changes in the biomechanical pattern of walking. This study aims to observe differences in cardiorespiratory responses and energetic expenditure between locomotion in a snowy terrain with an already fixed footstep pathway (FP) and in fresh virgin snow (FS) that has not been previously compacted. 15 volunteers participated in the study, all of them with experience in mountain activities at a competition level, with a regular training regime up to 10 hours a week. Estimated maximal theoretical oxygen consumption showed a mild increase (2,6% CI 95%: 0.9-4.5%, t=3.2, p=0.005) when subjects progressed in FP. Time necessary to complete FS (4 min and 15 sec ± 30 sec) itinerary was longer than for FP (3 min 45 sec ± 29 sec). Uphill walking velocity improved in 0.43 ± 0.11 Km·h-1 (t=4.2 p=0,01) when progressing in CT. Respiratory rate was higher for FS (2.3 ± 2.4 b·min-1, t=4.0 p= 0.001). For a same itinerary, locomotion in snow that has not been compacted before requires more time and represents a higher energetic cost, either at maximal or submaximal intensities. This should be considered in scheduling mountain ascents as part of the safety strategies. Climbing on virgin snow impedes developing maximal aerobic power so athletes must regard the value of strength work of lower limbs to improve performance

Contra la fractura de cadera: encender la luz y trabajar la fuerza

¡Vaya, me han operado de la cadera! A mis 91 años, es la primera vez que entro en el quirófano. Hace dos días, al levantarme e ir al baño, como siempre con la luz apagada para no despertar al nieto que había estado estudiando hasta tarde, tropecé y me golpeé. No pensé que me había hecho daño pero me di cuenta que me dolía mucho la zona de la ingle. Hoy, me han comentado que me dan el alta muy pronto. El médico me ha dado dos consejos: uno, encender la luz del pasillo y del baño al levantarme (por lo visto, es muy frecuente esta lesión y en esas circunstancias); dos, trabajar un poco la fuerza que es una solución excelente

Amputation risk factors in severely frostbitten patients

In recent years, the incidence of frostbite has increased among healthy young adults who practice winter sports (skiing, mountaineering, ice climbing and technical climbing/alpinism) at both the professional and amateur levels. Moreover, given that the population most frequently affected is healthy and active, frostbite supposes a substantial interruption of their normal activity and in most cases is associated with long-term sequelae. It particularly has a higher impact when the affected person's daily activities require exposure to cold environments, as either sports practices or work activities in which low temperatures are a constant (ski patrols, mountain guides, avalanche forecasters, workers in the cold chain, etc.). Clinical experience with humans shows a limited reversibility of injuries via potential tissue regeneration, which can be fostered with optimal medical management. Data were collected from 92 frostbitten patients in order to evaluate factors that represent a risk of amputation after severe frostbite. Mountain range, years of expertise in winter mountaineering, time elapsed before rewarming and especially altitude were the most important factors for a poor prognosis

Severe hypoxic exercise does not impair lung diffusion in elite swimmers

Background: Exercise performed at high-altitude may cause a sub-clinical pulmonary interstitial edema which can worsen gas exchange function. This study aimed to evaluate whether there are changes in alveolar-capillary diffusion after exercise during a short-term exposure to hypobaric hypoxia in elite swimmers. Materials & Methods: Seven elite swimmers [age: 20.4 ± 1.4 years, height: 1.78 ± 10.8 m, body mass (BM): 69.7 ± 11.1 kg] participated in the study. Diffusing capacity of the lungs for carbon monoxide (DLCO), transfer coefficient of carbon monoxide (KCO), pulse oximeter oxygen saturation (SpO2) and heart rate (HR) were measured at sea level at rest (SL-R), and after a short-term hypobaric hypoxia exposure (4,000 m), both at rest (HA-R) and at the end of moderate interval exercise (HA-E). Results: The combined exposure to high-altitude and exercise did not change DLCO from SL-R to HA-R, or HA-E (43.8 ± 9.8 to 41.3 ± 10.5 to 42.4 ± 8.6 ml·min-1·mmHg-1, P = 0.391). As expected, elite swimmers showed large decrease in SpO2 (72 ± 5; P < 0.001) and increase in HR (139 ± 9 beats·min-1; P < 0.003) after HA-E. Conclusions: An acute high-altitude exposure combined with submaximal exercise does not change alveolar-capillary diffusion in elite swimmers

És apropiada l'activitat física que fan els nostres escolars? Existeix correlació entre l'índex de massa corporal i les característiques de l'activitat física desenvolupada?

Fonament. Un dels objectius de la salut pública és la promoció d'un estil de vida actiu. La població infantil és clau, ja que l'activitat física (AF) és necessària per a un creixement saludable; és molt difícil canviar hàbits a partir de l'adolescència i el sedentarisme és factor causal de patologia i d'obesitat infantil. Objectiu. Conèixer les característiques de l'AF realitzada pels nostres escolars, estimar el temps destinat a conductes sedentàries (screen-time) i analitzar la relació entre índex de massa corporal (IMC), AF i screen-time. Mètode. Participants: 329 escolars (medi rural) prèvia obtenció del consentiment informat. Variables estudiades: IMC; AF i screen-time (enquesta de 7 dies i test K13 Plus d'AF). Resultats. Descriptius (mitjana ± DE): edat 7,2 ± 2,6 anys. IMC 17,3 ± 3,2 kg/m2 , Z-score IMC 0,12 ± 1,1. Screentime 59,4 ± 43,4 minuts/dia. Tipus AF (minuts/dia): intensitat lleu 34,7 ± 29,9, moderada 59,07 ± 52, elevada 26,2 ± 27,5. Puntuació test K13 Plus d'AF 5,5 ± 1,9 (puntuació equivalent a regular). Anàlisi correlació: significativa inversa entre IMC i AF de moderada intensitat (coeficient de Pearson -0,130; p = 0,018). Conclusions. En general, els valors mitjans dels infants avaluats corresponen amb els considerats aconsellables actualment, tot i que possiblement cal optimitzar les recomanacions vigents. En la prevenció del sobrepès/obesitat infantil cal considerar la correlació IMC/AF de moderada intensitat. S'han de promoure intervencions adreçades a augmentar el temps d'AF d'intensitat lleu i moderada, i a evitar un augment de l'screen-time. La piràmide d'AF pot ser una bona eina per al consell i ensenyament a les famílies

Severity of post-cardiac surgery acute kidney injury and long-term mortality: is chronic kidney disease the missing link?

While the retrospective cohort study by Lopez-Delgado and colleagues suggests a strong association of the RIFLE classification and long-term mortality of acute kidney injury (AKI) after post-cardiac surgery, it has a number of limitations. The numbers of patients with pre-existing chronic kidney disease (CKD) or with non-recovery of renal function, de novo CKD or progression of CKD to stage V are not given. The authors used an obsolete definition of CKD and a modified RIFLE classification system for definition and grading of AKI. Taken together, numerous studies underscore the strong association between AKI and de novo CKD. Severity, duration and frequency of AKI as well as age, comorbidities and pre-existing CKD are known risk factors for the development and/or progression of CKD. Careful analyses of the cumulative mortality curves reported by Lopez-Delgado and colleagues or by our group revealed a triphasic pattern. In the early phase, survival rates drop steeply due to critical illness, followed by a phase of smaller decline (caused by patient characteristics and development of CKD) and later on by a flatter survival curve attributable to the high cardiovascular mortality of progressive CKD. Physicians need to consider the long-term sequels of severe AKI. Lopez Delgado and colleagues's study provides further arguments for an early follow-up of survivors of AKI by nephrologists

Acute mountain sickness susceptibility and basic cognitive function after a brief simulated altitude of 4800 m.

Twelve climbers with not been exposed in the last 12 months at high altitude were evaluated using verbal, spatial, reasoning and numerical tasks from Thurstone's (1969) Primary Mental Abilities (PMA) test. These tasks were undertaken before and immediately after completing the Richalet et al. (1988) Normobaric Hypoxic (NH) test, which evaluates the acute mountain sickness (AMS) risk using a FiO2 of 11.5% during rest and exercise. A control group of eight climbers did not perform the NH test, so as to rule out the possible learning effect of the PMA test. Four participants (33%) from the experimental group were classified as having high susceptibility to AMS. However, the PMA test performed after the NH test did not significantly differ from the one carried out before the NH test or from the cognitive abilities measured in the control group (p> .05)

Impact of non-neurological complications in severe traumatic brain injury outcome

Introduction: Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the ICU, the impact of these complications on mortality, and their possible correlation with TBI severity. Methods: An observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded. Results: Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO(2)) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to 5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05). Conclusions: Low initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5)

Laboratori d'habilitats: aprenentatge i avaluació dels continguts pràctics de Fisiologia Humana

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524Un dels reptes en els ensenyaments amb docència pràctica és avaluar els coneixements i les habilitats que els estudiants adquireixen al laboratori. En aquest sentit, els estudiants de Ciències Mèdiques Bàsiques, actualment Ciències Biomèdiques, durant els cursos 11-12 i 13-14 van participar en el laboratori d’habilitats de l’assignatura Fisiologia Humana I i II. El laboratori d’habilitats consisteix en un laboratori que disposa dels equips i materials que es fan servir a les pràctiques de l’assignatura i que està a lliure disposició dels estudiants en un horari concret. Un cop realitzades les pràctiques, els estudiants poden participar lliurement en el laboratori d’habilitats per consultar dubtes i practicar les habilitats que han adquirit durant el normal desenvolupament de les pràctiques i que seran objecte d’avaluació. L’avaluació es realitza en el mateix laboratori d’habilitats i consisteix en un examen escrit i oral sobre els continguts de pràctiques, a més d’una demostració de les habilitats adquirides. Les habilitats ponderen un 10% en l’avaluació continuada i són avaluades mitjançant una rúbrica que permet al professorat puntuar objectivament l’estudiant. Un cop realitzat l’examen pràctic els estudiants van ser enquestats per tal de conèixer la seva opinió respecte al “laboratori d’habilitats” i al nou sistema d’avaluació de la docència pràctica. La majoria d’estudiants creuen que el laboratori d’habilitats els ha fet treballar i comprendre millor els continguts de les pràctiques (obtenint una puntuació de 4.2 de mitjana dels dos cursos, sobre 5), prefereixen aquest mètode d’avaluació enfront al tradicional, basat en preguntes a l'examen teòric (4.6 sobre 5), els ha resultat interessant (4.4 sobre 5) i globalment l’experiència els ha resultat satisfactòria (4.5 sobre 5). Les puntuacions obtingudes en l’examen d’habilitats han estat de 8,5 sobre 10 (de mitjana en els darrers 2 cursos). Així, es pot concloure que aquesta metodologia docent, àmpliament acceptada pels estudiants, permet reforçar i avaluar les habilitats treballades al laboratori