Prospective evaluation of a colorectal cancer nurse follow-up clinic

AIM

Colorectal Nurse Specialist (CNS) clinics for postoperative follow up of colorectal cancer aim to maintain clinical efficacy while reducing costs. We prospectively studied the efficacy and financial implications of such a clinic.

METHOD

This was a prospective study of all patients attending CNS clinics over 3 years. A lower-risk protocol for patients with Dukes A was used over 3 years and a higher-risk protocol for patients with Dukes B, C or D was used over 5 years. Department of Health Pricing Charts were used to cost the follow-up protocols, and adjustment was performed to calculate the cost of each quality adjusted life year (QALY) gained.

RESULTS

One hundred and ninety-three patients entered into this nurse-led follow-up protocol implemented by the CNS clinic between 2005 and 2007. The Dukes stages and proportions of patients in each stage were as follows: stage A, 13%; stage B, 8%; stage C, 36.3%; and stage D, 9.3%. Ninety-seven per cent underwent curative treatment and 2.6% had palliative treatment. Twenty-one per cent of patients developed recurrent disease. Overall actuarial 5-year survival was 80% and recurrences had a 30% 5-year actuarial survival. The total cost per patient for 3 years of follow up was £1506 and £1179 for lower-risk rectal and nonrectal cancers, respectively. The adjusted cost for each QALY gained for lower-risk tumours was £1914. The total cost per patient with higher-risk tumours was £1814 and £1487 for rectal and nonrectal tumours, respectively. The adjusted cost for each QALY gained was £2180 for higher-risk tumours.

CONCLUSIONS

This clinic demonstrated cost-effective detection of recurrent disease. Computed tomography (CT) was the most sensitive alert test. As all recurrences were detected within 4 years, we suggest that this is the indicated time to follow up.

Effect of functional isometric squats on vertical jump in trained and untrained men

Functional isometrics (FIs) combine dynamic and isometric muscle actions and may hyperstimulate the nervous system leading to an enhanced postactivation potentiation (PAP) and improved subsequent performance. The purpose of this study was to investigate the impact of an FI squat on the countermovement vertical jump (CMVJ) in resistance trained and untrained men. Thirteen trained men (age: 22.8 +/- 3.2 years, mass: 90.0 +/- 16.3 kg, and height: 178.9 +/- 7.1 cm) and 8 untrained men (age: 28.5 +/- 5.9 years, mass: 101.5 +/- 23.0 kg, and height: 177.0 +/- 4.8 cm) participated. On separate days, subjects performed CMVJs after 2 different warm-up conditions. The warm-up conditions consisted of either 5 minutes of low-intensity cycling or 5 minutes of low-intensity cycling plus a 3-second FI squat with 150% of their 1 repetition maximum (1RM). A 2 x 3 repeated-measures analysis of variance with Bonferroni post hoc revealed that when comparing the 2 warm-up conditions in the trained subjects, a significant increase (p < 0.05) in CMVJ occurred at 4 minutes (2.4 cm, +5.1%) post-FI squat. This increase was maintained when subjects were retested at 5 minutes post (2.6 cm, + 5.5%). No significant difference in CMVJ was detected in the untrained group (p = 0.49). Results support the addition of an FI squat performed at 150% of 1RM to a low-intensity cycling warm-up to enhance PAP in resistance trained but not in untrained men as measured by CMVJ. Practically, adding functional isometrics to a warm-up scheme may significantly enhance acute, short-term power output in resistance trained men.

Physiological and psychophysical comparison between a lifting task with identical weight but different coupling factors

The objective of the revised NIOSH (National Institute for Occupational Safety and Health) lifting equation is to prevent or reduce lifting-related injuries. The coupling component of the equation relates to quality of the grip (i.e., hand-to-object interface) and can be rated good, fair, or poor. Good coupling is theorized to reduce lifting stress, whereas poor coupling is theorized to increase lifting stress. This study compared the physiological and psychophysical stress between a lifting task with identical weight but different coupling factors. Subjects (n = 21; 26 +/- 6 years; 177.8 +/- 7.8 cm; 73.9 +/- 10.7 kg) transferred a milk crate or bag of dog food each weighing 12.5 kg back and forth from the floor to a table for 2, paced, 5-minute work bouts. Steady-state metabolic data were used to compare the lifting tasks. Results showed significantly higher oxygen consumption, caloric cost, heart rate, and rating of perceived exertion during the lifting task using the milk crate vs. the bag of dog food (p < 0.05). No difference in respiratory exchange ratio was observed (p > 0.05). In conclusion, a significantly higher metabolic cost and perceived exertion was observed when subjects performed a paced two-handed lifting task with good coupling factors than when using an object with poor coupling factors. When lifting stress is measured by metabolic cost and perceived exertion, these results are in contrast to expectations that a poor quality grip (i.e., poor coupling) would increase stress of a lifting task. Results of this study may help the work-place practitioner make decisions related to the use of the revised NIOSH lifting equation in the design and pacing of lifting-related tasks. Improved decision making may benefit productivity and enhance injury prevention in the workplace.

Anabolic androgenic steroids: use and perceived use in nonathlete college students

OBJECTIVE

The authors investigated the use and perceived use of anabolic androgenic steroids (AAS) among nonathlete college students.

PARTICIPANTS

The authors surveyed a sample of 485 nonathlete college students at a major metropolitan university.

METHODS

They administered a survey on use and perceived use of AAS to the students.

RESULTS

Forty-two participants (9%) reported using AAS (37 men, 5 women). Seniors were the most likely to use AAS (36%), and freshman the least likely (7%). Thirty-four percent of nonusers and 41% of users indicated they knew between 1 and 5 AAS users. Of the total sample, 36% perceived that 5% to 10% of nonathlete college students used AAS. Reasons for AAS use were because friends were using (7%), a desire to enhance physical appearance (45%), and a desire to increase physical performance (48%).

CONCLUSIONS

These findings may have significant implications in planning strategic preventive educational programs, and health educators should target incoming college freshmen with the intent of dissuading AAS use.

Detraining in the older adult: effects of prior training intensity on strength retention

In this study, we assessed the influence of training intensity on strength retention and loss incurred during detraining in older adults. In a previous study, untrained seniors (age = 71.0 +/- 5.0; n = 61) were randomly divided into 3 exercise groups and 1 control group. Exercise groups trained 2 days per week for 18 weeks with equivalent volumes and acute program variables but intensities of 2 x 15 repetitions maximum (RM), 3 x 9RM, or 4 x 6RM. Thirty of the original training subjects (age 71.5 +/- 5.2 years) participated in a 20-week detraining period. A 1RM for 8 exercises was obtained pre- and posttraining and at 6 and 20 weeks of detraining. The total of 1RM for the 8 exercises served as the dependent variable. Analysis of variance procedures demonstrated significant increases in strength with training (44-51%; p < 0.05), but no group effect. All training groups demonstrated significant strength decreases at both 6 and 20 weeks of detraining independent of prior training intensity (all group average 4.5% at 6 weeks and 13.5% at 20 weeks; p < 0.04). However, total-body strength was significantly greater than pretraining values after the detraining period (all group average 82% at 6 weeks and 49% at 20 weeks; p < 0.001). The results suggest that when older adults participate in progressive resistance exercise for 18 weeks, then stop resistance training (i.e., detrain), strength losses occur at both 6 and 20 weeks of detraining independent of prior resistance training intensity. However, despite the strength losses, significant levels of strength are retained even after 20 weeks of detraining. The results have important implications for resistance-trained older adults who could undergo planned or unplanned training interruptions of up to 5 months.

Metabolic demands of "junkyard" training: pushing and pulling a motor vehicle

Junkyard training involves heavy, cumbersome implements and nontraditional movement patterns for unique training of athletes. This study assessed the metabolic demands of pushing and pulling a 1,960-kg motor vehicle (MV) 400 m in an all-out maximal effort. Six male, strength-trained athletes (29 +/- 5 years; 89 +/- 12 kg) completed 3 sessions. Sessions 1 and 2 were randomly assigned and entailed either pushing or pulling the MV. Oxygen consumption (VO(2)) and heart rate (HR) were measured continuously. Blood lactate was sampled immediately prior to and 5 minutes after sessions 1 and 2. Vertical jump was assessed immediately prior to and after sessions 1 and 2. During session 3 a treadmill VO(2)max test was conducted. No significant differences (p < 0.05) in VO(2), HR, or blood lactate occurred between pushing and pulling efforts. VO(2) and HR peaked in the first 100 m, and from 100 m on, VO(2) and HR averaged 65% and 96% of treadmill maximum values (VO(2)max = 50.3 ml x kg(-1) x min(-1); HRmax = 194 b x min(-1)). Blood lactate response from the push and pull averaged 15.6 mmol.L(-1), representing 131% of the maximal treadmill running value. Vertical jump decreased significantly pre to post in both conditions (mean = -10.1 cm, 17%). All subjects experienced dizziness and nausea. In conclusion, a 400-m MV push or pull is an exhausting training technique that requires a very high anaerobic energy output and should be considered an advanced form of training. Strength coaches must be aware of the ultra-high metabolic and neuromuscular stresses that can be imposed by this type of training and take these factors into consideration when plotting individualized training and recovery strategies.

Cold exposure and exercise metabolism

Research regarding the effect of cold exposure on metabolism and substrate utilisation during exercise has produced inconsistent results. Intensity of exercise and training status of subjects are known to impact metabolism and substrate utilisation regardless of environmental conditions. Duration and intensity of cold exposure during exercise also may exert impact. Thus, systematic manipulation of these variables (fitness, intensity of exercise, cold conditions) should provide a means to determine metabolic and substrate utilisation patterns when exercising in the cold. However, a number of variables have been introduced into research methodologies that may confound results. Duration and intensity of cold exposure prior to exercise, and acclimation and clothing status of subjects may confound or override the influence of other variables. Future research addressing the impact of cold exposure on metabolism and substrate utilisation during exercise must attempt to isolate and control each influential factor (prior to and during exercise), and must be alert to the interactive effects that can occur.