Critical power and work-prime account for variability in endurance training adaptations not captured by V̇o2max.

Responses to exercise at a given percentage of one's maximum rate of oxygen consumption (V̇o2max), or percentage of the power associated with V̇o2max during a graded exercise test (i.e., PGXT), vary. The purpose of this study was to determine if differences in critical power (PCRIT, maximum metabolic steady state) and work-prime (W', the amount of work tolerated above steady state) are related to training-induced changes in endurance. PCRIT, W', V̇o2max, and other variables were determined before and after 22 adults completed 8 wk of either moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) performed at fixed percentages of PGXT. On average, PCRIT increased to a greater extent following HIIT (MICT: 15.7 ± 3.1% vs. HIIT: 27.5 ± 4.3%; P = 0.03), but the magnitude of change varied widely within each group (MICT: 4%-36%, HIIT: 4%-61%). The intensity of the prescribed exercise relative to pretraining PCRIT, not PGXT, accounted for most of the variance in changes to PCRIT in response to a given protocol (R2 = 0.61-0.64; P < 0.01). Although PCRIT and V̇o2max were related before training (R2 = 0.92, P < 0.01), the training-induced change in PCRIT was not significantly related to the change in V̇o2max (R2 = 0.06, P = 0.26). Before training, time-to-failure at PGXT was related to W' (R2 = 0.52; P < 0.01), but not V̇o2max (R2 = 0.13; P = 0.10). Training-induced changes in time-to-failure at the initial PGXT were better captured by the combined changes in W' and PCRIT (R2 = 0.77, P < 0.01), than by the change in V̇o2max (R2 = 0.24; P = 0.02). Differences in PCRIT and W' account for some of the variability in responses to endurance exercise.NEW & NOTEWORTHY As the highest percentage of V̇O2max at which steady state conditions can be achieved, a person's critical power (PCRIT) strongly influences the metabolic strain of a given exercise. In this study we demonstrate that training-induced changes in endurance are more strongly related to the intensity of an exercise training program, relative to PCRIT than relative to V̇o2max. Thus, exercise may be more homogenously and effectively prescribed in relation to PCRIT than traditional factors like V̇o2max.

Acute Ischemic Priapism Management: An Educational and Simulation Curriculum.

Introduction: Ischemic priapism is a urologic emergency managed by both urologic and nonurologic providers in the community. Given ischemic priapism's rare occurrence and the time-sensitive nature of treatment, effective provider education on management of this entity is imperative. We sought to develop a low-cost effective simulation model and curriculum to enhance trainee education. Methods: A comprehensive didactic curriculum based on national urologic guidelines was developed, along with a low-cost, easily reproducible priapism simulator using hot dogs and Red Vines candy. The simulators cost $1.25 each, and assembly took 10 minutes. All materials were reviewed by three urology faculty members. The curriculum was piloted with two andrology fellowship-trained urology faculty among eight urology residents (PGY2-PGY4/U1-U2) and one medical student. Participants provided feedback regarding the overall course as well as the face and content validity of the simulator. Results: Cognitive test scores significantly improved on average by 15.0% (p = .002), and confidence improved from baseline somewhat or very much among 88.9% of participants after completion of the curriculum. The task trainer was rated easy to use (average score: 4.78 out of 5), and 77.8% of participants though it was somewhat or very useful for training (average score: 4.00 out of 5). Additionally, 77.8% recommended its incorporation into resident training (average score: 4.00 out of 5). Discussion: This simulation curriculum is effective, inexpensive, and easily reproducible, making it ideal for groups with limited resources. Expanding access to simulation-based curricula on priapism management may improve education of both urologic and nonurologic trainees.

Simopoly: improving simulation center operations through a tabletop simulation exercise.

SUMMARY STATEMENT: Health care simulation is a rapidly growing, heterogeneous field requiring expertise that is not traditionally represented within health care or educational institutions. Simulation staff members often take on unique roles and have goals and career development needs that differ from more typical hospital and educational institution-based personnel. This poses both challenges and opportunities for simulation administrators. In this article, we describe a novel simulation, Simopoly, designed to provide the opportunity to think creatively about simulation center staff development, retention, and promotion in the context of daily operations and management.

Preserved muscle metaboreflex in chronic obstructive pulmonary disease.

The objective of this study was to measure the magnitude of the muscle metaboreflex in people with chronic obstructive pulmonary disease (COPD) compared with healthy controls and to assess the relationships between disease severity, exercise capacity, and the magnitude of the muscle metaboreflex. Nine people with mild-to-severe COPD and 11 age- and gender-matched healthy controls performed isometric handgrip exercise (IHG), followed by postexercise circulatory occlusion (PECO) while hemodynamic changes were measured. Continuous measures of heart rate, arterial pressure, leg blood flow, leg vascular resistance, and total peripheral resistance were obtained. Participants then performed a cycle test to exhaustion. Heart rate, blood pressure, and blood flow responses during IHG and PECO were similar between the COPD group and healthy controls (p > 0.05). There was no association between disease severity or exercise capacity and the magnitude of the muscle metaboreflex. We observed a preserved muscle metaboreflex in mild-to-severe COPD, suggesting the metaboreflex is not a contributing factor to the development of exercise intolerance in this population.

Testing the effects of an expectancy-based intervention among adolescents: Can placebos be used to enhance physical health?

It has been suggested that the well-known health benefits associated with exercise can be explained by a placebo effect, and that greater effort should be given to convince people that their current behaviors have desirable health consequences. The overall purpose of this study was to test the efficacy of this "mind-set matters" hypothesis through the use of an expectancy-based intervention with adolescents. The study involved a four week randomized controlled trial with 348 Grade 9 adolescents (M (age) = 14.07 yrs, SD = 0.30), from four high schools, taking part in either a placebo-intervention condition (n = 188) or a control condition (n = 160). Participants in the placebo-intervention condition were informed that what they are already doing in school physical education lessons fulfills current recommendations for an active lifestyle. Participants in the control condition were not given this information. Four weeks after the intervention, adolescents in the placebo-intervention condition did not demonstrate significant changes in physiological health-related measures (diet, weight, body mass index, percentage body fat, heart rate, mean arterial pressure). The findings question the external validity of the "mind-set matters" hypothesis with adolescents, and suggest that simply encouraging adolescents to believe that they are healthy may not enable them to respond with improved indicators of physical health.