The recovery of training and education post-COVID-19: the importance of supporting the consultant workforce.

BACKGROUND/AIMS: Since the COVID-19 pandemic began, training and education have been significantly disrupted, causing an incalculable effect on trainees. However, the consultant workforce is crucial to the success of training recovery. The motivation of the consultant workforce to assist in training recovery, in a context of significant workload and increasing pressures on resources, is currently unknown. METHODS: This survey gathered the consultant workforce's views on assisting training recovery at one site of a large NHS foundation trust. RESULTS: There was reduced motivation to engage in training and education when compared to pre-pandemic levels, widespread indicators of burnout, and changes in attitude towards reducing their working hours and early retirement. CONCLUSIONS: These findings demonstrate a worrying trend that is likely to be replicated nationwide, which highlights the need to support consultants to avoid further disruption to training recovery.

Training History, Cardiac Autonomic Recovery from Submaximal Exercise and Associated Performance in Recreational Runners.

This study investigated the effect of prolonged exertion on cardiac parasympathetic (cPS) reorganization and associated aerobic performance in response to repeated short-lasting submaximal exercise bouts (SSE) performed for 7 days following prolonged exertion. In 19 recreational runners, heart rate (HR) and HR variability (HRV) indices (lnRMSSD, lnHF, and lnLF/HF) were monitored pre- and post-submaximal graded cycling performed on consecutive days following a half-marathon (HM) and compared with the baseline, pre-HM values. Additionally, HR recovery (HRR), aerobic performance, and rate of perceived exertion (RPE) were determined. HR, HRV indices, and HRR were tested for correlation with exercise performance. A significant time effect was found in HR, HRR, and HRV indices as well as in aerobic performance and RPE during the study period. Most of the measured parameters differed from their baseline values only on the same day following HM. However, HRR and HR measured in recovery after SSE were additionally affected one day following the half-marathon yet in opposite directions to those recorded on the same day as the HM. Thus, postSSE HR and HRR exhibited a bivariate time response (postSSE HR: 102 ± 14 bpm; p < 0.001; 82 ± 11 bpm; p = 0.007 vs. 88 ± 11 bpm; HRR in 30 s after SSE cessation: 14.9 ± 4.9 bpm; p < 0.001; 30.1 ± 13.3 bpm; p = 0.006 vs. 24.4 ± 10.8 bpm), potentially indicating a cPS dysfunction phase on the same day and cPS rebound phase one day following HM reflected also in consecutive changes in aerobic power. Correlations were found between the changes in measured cardiac indices with respect to baseline and the changes in aerobic performance indices throughout the study period. The effect of exercise history on cPS reorganization is more pronounced in response to SSE than at rest. Accordingly, we conclude that SSE performed repeatedly on a daily basis following prolonged exertion offers a noninvasive tool to evaluate the impact of training history on cPS recovery and associated aerobic power output in recreational athletes.

The influence of mandibular stretching on athletes subjected to high intensity workout.

The use of oral appliances is considered effective in improving sport performance. Jaw clenching or stretching, improved breathing or positioning of the jaw have been proposed to explain the improvement. In this study, we reported the effects of regularly practiced mandibular stretching at submaximal opening of the jaw in Crossfit athletes. Seventeen test subjects undergoing mandibular stretching (MS) showed significantly reduced (p0.001) performance time in a high-intensity workout measured before and after seven days of 10-minutes stretching practiced twice daily, while no improvement was observed in control subjects who did not perform the stretching. Additionally, blood lactate levels appeared to recover more quickly in MS subjects.Crossfit is a type of training regimen that pushes the limits of bodily recovery processes. Jaw stretching, eliciting the trigeminocardiac reflex (a reflex decrease in heart rate and blood pressure following trigeminal stimulation) and central oxygen-conserving mechanisms could help relieve post-training stress and improve training recovery.

Recovery of Surgical Training Through Extended Laparoscopic Simulation Training.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has adversely affected surgical training internationally. Laparoscopic surgery has a steep learning curve necessitating repetitive procedural practice. We evaluate the efficacy of short- and long-duration simulation training on participant skill acquisition to support the recovery of surgical training.  Methods A prospective, observational study involving 18 novice medical students enrolled in a five-week course. Nodal timed assessments involved three tasks: hoop placement, stacking of sugar cubes and surgical cutting. One month post-completion, we compared the ability of six novice course participants to that of six surgical trainees who completed a smaller portion of the course curriculum. Results Course participants (n=18) completed tasks 111% faster on their third and last course attempt. The surgical trainee group (n=6) took 46% longer to complete tasks compared to the six re-invited course participants, whose ability continued to advance on their fourth effort with a combined 154% earlier completion time compared to try one. Conclusions This study supports the adoption of a structured, extended, regular and spaced-out simulation course or curriculum to cultivate greater skill acquisition and retention amongst surgical trainees, and improve patient care.

Muscle fiber typology substantially influences time to recover from high-intensity exercise.

Human fast-twitch muscle fibers generate high power in a short amount of time but are easily fatigued, whereas slow-twitch fibers are more fatigue resistant. The transfer of this knowledge to coaching is hampered by the invasive nature of the current evaluation of muscle typology by biopsies. Therefore, a noninvasive method was developed to estimate muscle typology through proton magnetic resonance spectroscopy in the gastrocnemius. The aim of this study was to investigate whether male subjects with an a priori-determined fast typology (FT) are characterized by a more pronounced Wingate exercise-induced fatigue and delayed recovery compared with subjects with a slow typology (ST). Ten subjects with an estimated higher percentage of fast-twitch fibers and 10 subjects with an estimated higher percentage of slow-twitch fibers underwent the test protocol, consisting of three 30-s all-out Wingate tests. Recovery of knee extension torque was evaluated by maximal voluntary contraction combined with electrical stimulation up to 5 h after the Wingate tests. Although both groups delivered the same mean power across all Wingates, the power drop was higher in the FT group (-61%) compared with the ST group (-41%). The torque at maximal voluntary contraction had fully recovered in the ST group after 20 min, whereas the FT group had not yet recovered 5 h into recovery. This noninvasive estimation of muscle typology can predict the extent of fatigue and time to recover following repeated all-out exercise and may have applications as a tool to individualize training and recovery cycles.NEW & NOTEWORTHY A one-fits-all training regime is present in most sports, though the same training implies different stimuli in athletes with a distinct muscle typology. Individualization of training based on this muscle typology might be important to optimize performance and to lower the risk for accumulated fatigue and potentially injury. When conducting research, one should keep in mind that the muscle typology of participants influences the severity of fatigue and might therefore impact the results.

Respostas neuromusculares ao treinamento resistido de alta intensidade (HIRT) / Neuromuscular responses tohigh intensity resistance train-ing (HIRT) / Respuestas neuromusculares al entrenamiento de resistencia de alta intensidad (HIRT)

O presente estudo buscou avaliar respostas neuromusculares ao treinamento resistido de alta intensidade (HIRT). Doze universitários do sexo masculino com idade de 21 ± 3anos, realiza-ram o protocolo HIRT, que é caracterizado por pausas de 20 segundos entre as repetições. Posteriormente, foi realizado salto vertical (SV), horizontal (SH), arremesso de Medicine-Ball (MedBall) e força de pressão manual (FPM), antes, depois eapós 24h e 48h, o HIRT. Os sal-tos apresentaram significância nos períodos PRÉ e PÓS-SV (p=0,01), SH (p=0,02). Entretan-to, arremesso de MedBall e FPM não demonstraram diferenças significativas. Especula-se que o HIRT afete de modo agudo a potência de membros inferiores, mas não a de superiores. Porém, o período de 24 horas parece ser suficiente para a recuperação.

The present study aimed to evaluate neuromuscular responses to high intensity resistance training (HIRT). Twelve male university students aged 21 ± 3 years, in which they performed the HIRT protocol, which is characterized by pauses of 20sec between repetitions. Subse-quently, horizontal (SH) vertical jumps (SV), Medicine Ball (MedBall) and manual pressure force (FPM) were performed before, after and after 24h and 48h the HIRT. The jumps showed significance in the periods PRÉ and POS SV (p = 0.01), SH (p = 0.02). However, MedBall and FPM throw did not show significant difference. HIRT acutely affects the poten-cy of lower limbs, but not of upper limbs. However, the 24-hour period seems to be sufficient for recovery.

El presente estudio buscó evaluar respuestas neuromusculares al entrenamiento resistido de alta intensidad (HIRT). Doce universitarios varones con edad de 21 ± 3 años, en el que reali-zaron el protocolo HIRT, que se caracteriza por pausas de 20seg entre repeticiones. Se reali-zaron saltos verticales (SV) horizontales (SH), lanzamiento de Medicina-Ball (MedBall) y fuerza de presión manual (FPM), antes, después y después de 24h y 48h el HIRT. Los saltos presentaron significancia en los períodos PRÉ y PÓS SV (p = 0,01), SH (p = 0,02). Sin em-bargo, el lanzamiento de MedBall y FPM no mostró diferencia significativa. El HCA afecta de forma aguda a la potencia de miembros inferiores, pero no de superiores. Sin embargo, el período de 24h parece suficiente para la recuperación.

Effects of Recovery Mode during High Intensity Interval Training on Glucoregulatory Hormones and Glucose Metabolism in Response to Maximal Exercise.

Catecholamines [adrenaline (A) and noradrenaline (NA)] are known to stimulate glucose metabolism at rest and in response to maximal exercise. However, training and recovery mode can alter theses hormones. Thus our study aims to examine the effects of recovery mode during High-intensity Interval Training (HIIT) on glucoregulatory hormone responses to maximal exercise in young adults. Twenty-four male enrolled in this randomized study, assigned to: control group (eg, n=6), and two HIIT groups: intermittent exercise (30 s run/30 s recovery) with active (arg, n=9) or passive (prg, n=9) recovery, arg and prg performed HIIT 3 times weekly for 7 weeks. Before and after HIIT, participants undergo a Maximal Graded Test (MGT). Plasma catecholamines, glucose, insulin, growth hormone (Gh) and cortisol were determined at rest, at the end of MGT, after 10 and 30 min of recovery. After training V02max and Maximal Aerobic Velocity (MAV) increased significantly (p<0.05) in arg. After HIIT and in response to MGT plasma glucose increase significantly (p=0.008) lesser in arg compared to prg whereas insulin concentrations were similar. The glucose/insulin ratio was significantly lower at MGT end (p=0.033) only in arg after training. After HIIT, in response to MGT, plasma A, NA, cortisol and Gh concentrations were significantly higher only in arg (p<0.05). HIIT using active recovery is beneficial for aerobic fitness, plasma glucose and glucoregulatory hormones better than HIIT with passive recovery. These findings suggest that HIIT with active recovery may improve some metabolic and hormonal parameters in young adults.

Enhanced External Counterpulsation and Short-Term Recovery From High-Intensity Interval Training.

PURPOSE: Enhanced external counterpulsation (EECP) is a recovery strategy whose use has increased in recent years owing to the benefits observed in the clinical setting in some cardiovascular diseases (ie, improvement of cardiovascular function). However, its claimed effectiveness for the enhancement of exercise recovery has not been analyzed in athletes. The aim of this study was to determine the effectiveness of EECP on short-term recovery after a fatiguing exercise bout. METHODS: Twelve elite junior triathletes (16 [2] y) participated in this crossover counterbalanced study. After a high-intensity interval training session (6 bouts of 3-min duration at maximal intensity interspersed with 3-min rest periods), participants were assigned to recover during 30 min with EECP (80 mm Hg) or sham (0 mm Hg). Measures of recovery included performance (jump height and mean power during an 8-min time trial), metabolic (blood lactate concentration at several time points), autonomic (heart-rate variability at several time points), and subjective (rating of perceived exertion [RPE] and readiness to compete) outcomes. RESULTS: There were no differences between EECP and sham in mean RPE or power output during the high-intensity interval training session, which elicited a significant performance impairment, vagal withdrawal, and increased blood lactate and RPE in both EECP and sham conditions (all P < .05). No significant differences were found in performance, metabolic, or subjective outcomes between conditions at any time point. A significantly lower high-frequency power (P < .05, effect size = 1.06), a marker of parasympathetic activity, was observed with EECP at the end of the recovery phase. CONCLUSION: EECP did not enhance short-term recovery after a high-intensity interval training session in healthy, highly trained individuals.

The short-term effect of high versus moderate protein intake on recovery after strength training in resistance-trained individuals.

BACKGROUND: Dietary protein intakes up to 2.9 g.kg-1.d-1 and protein consumption before and after resistance training may enhance recovery, resulting in hypertrophy and strength gains. However, it remains unclear whether protein quantity or nutrient timing is central to positive adaptations. This study investigated the effect of total dietary protein content, whilst controlling for protein timing, on recovery in resistance trainees. METHODS: Fourteen resistance-trained individuals underwent two 10-day isocaloric dietary regimes with a protein content of 1.8 g.kg-1.d-1 (PROMOD) or 2.9 g.kg-1.d-1 (PROHIGH) in a randomised, counterbalanced, crossover design. On days 8-10 (T1-T3), participants undertook resistance exercise under controlled conditions, performing 3 sets of squat, bench press and bent-over rows at 80% 1 repetition maximum until volitional exhaustion. Additionally, participants consumed a 0.4 g.kg-1 whey protein concentrate/isolate mix 30 min before and after exercise sessions to standardise protein timing specific to training. Recovery was assessed via daily repetition performance, muscle soreness, bioelectrical impedance phase angle, plasma creatine kinase (CK) and tumor necrosis factor-α (TNF-α). RESULTS: No significant differences were reported between conditions for any of the performance repetition count variables (p > 0.05). However, within PROMOD only, squat performance total repetition count was significantly lower at T3 (19.7 ± 6.8) compared to T1 (23.0 ± 7.5; p = 0.006). Pre and post-exercise CK concentrations significantly increased across test days (p ≤ 0.003), although no differences were reported between conditions. No differences for TNF-α or muscle soreness were reported between dietary conditions. Phase angle was significantly greater at T3 for PROHIGH (8.26 ± 0.82°) compared with PROMOD (8.08 ± 0.80°; p = 0.012). CONCLUSIONS: When energy intake and peri-exercise protein intake was controlled for, a short term PROHIGH diet did not improve markers of muscle damage or soreness in comparison to a PROMOD approach following repeated days of intensive training. Whilst it is therefore likely that moderate protein intakes (1.8 g.kg-1.d-1) may be sufficient for resistance-trained individuals, it is noteworthy that both lower body exercise performance and bioelectrical phase angle were maintained with PROHIGH. Longer term interventions are warranted to determine whether PROMOD intakes are sufficient during prolonged training periods or when extensive exercise (e.g. training twice daily) is undertaken.

Recovery in Level 7-10 Women's USA Artistic Gymnastics.

This study assessed physical performance in women's artistic gymnastics following three variable recovery periods. Participants included fifteen female gymnasts (mean age = 13.5 ± 1.1) who had competed at USA Gymnastics (USAG) levels 7 - 10 within at least one year prior to the study. Each testing session consisted of a warm-up followed by four muscular endurance tests and one explosive maximal test. Assessments included pull-ups, leg lifts, handstand push-ups, vertical jump, and push-ups. After the performance assessments, the participants completed a typical practice session. The performance measures were reassessed at the beginning of each of the recovery periods of 24, 48, and 72 hours in a counterbalanced design. Performance assessments were converted into Z-scores and then averaged for a composite session Z-score. The composite session Z-scores were compared to evaluate the recovery duration. Composite Z's were significantly lower (p=0.000), after the 24 (z=-1.10) and the 48 hour (z=-0.71) recovery periods compared to baseline (z=0.00). However, there was no difference in scores (p=1.00) between the baseline and 72 hours (z=0.004) recovery. Full recovery required 72 hours under the conditions of this study.