Long-term Training Effects Research Articles

Short- and long-term effects of different exercise programs on the gait performance of older adults with subjective cognitive decline: A randomized controlled trial.

Older adults, especially those with cognitive decline, often have poor gait performance, which results in poor clinical outcomes due to falls or decreased daily physical activity. The effects of various exercises on gait performance have been studied, whereas the short-term and long-term effects of different exercise modalities remain unknown. To compare the short- and long-term effects of aerobic training (AT), resistance training (RT), and combined training (CT) on the gait performance of community-dwelling older adults with subjective cognitive decline (SCD). A four-arm, randomized controlled trial. 388 community-dwelling older adults with SCD (mean age, 72.3years). Participants attended an exercise or education class twice a week for 26weeks. 10 gait performance parameters were examined at baseline, post-intervention (Week 26), and after 26weeks of follow-up (Week 52) using an electronic walkway system. The mean adherence of exercise sessions was 82.5 to 85.9%. All exercise intervention induced an improvement in gait speed, stride time, cadence, stride length, and double-support time at Week 26 (p<.05), without significant intergroup differences among exercise interventions. However, only RT showed a significant effect on some spatiotemporal gait parameters at Week 52. The analyses for the gait variability parameters showed mild effects of all exercise interventions. All of the exercise programs examined had a positive short-term effect on spatiotemporal gait parameters of older adults with SCD, despite no effect on gait variability parameters. RT are most recommended when long-lasting effects are the primary aim.

Working memory training in children with borderline intellectual functioning and neuropsychiatric disorders: a triple-blind randomised controlled trial.

BackgroundPoor working memory, lower IQ and maladaptive behaviour form a triple disability known to have negative effects on the academic and social development of children with borderline intellectual functioning (BIF; IQ: 70 < IQ < 85) and neuropsychiatric disorders [attention‐deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD)]. Treatment possibilities for these children are scarce and hardly evidence based. This study primarily investigated whether adaptive computerised working memory training (WMT) may lead to significantly more improvement on a non‐trained visuospatial WM task compared with a non‐adaptive control WMT (placebo) in children with BIF and neuropsychiatric disorders. As secondary outcome measures, we used the scores on several non‐trained neuropsychological near‐transfer and far‐transfer tasks as well as behavioural measures.MethodWe conducted a triple‐blind placebo‐controlled randomised clinical trial in 72 children (aged 10;0–13;11 years, 53 boys, 19 girls) with BIF and comorbid neuropsychiatric disorders (ADHD = 37, ASD = 21, both = 14) that were referred to child and adolescent psychiatry care, between May 2012 and March 2019. Children completed the Dutch version of Cogmed WMT, either the adaptive training version or the non‐adaptive placebo version, 25 sessions (30–45 min a day), for 5 weeks. The primary outcome measure was the score on a non‐trained visuospatial working memory task. The primary outcome was measured before and directly after 5 weeks of WMT and again 6 months after training.ResultsA total of 375 children were screened for eligibility and 72 were randomised. No significantly higher levels of improvement over time were found on our primary outcome measure in the experimental WMT group compared with the placebo control WMT, nor in the secondary (near‐transfer and far‐transfer tasks) or tertiary (behavioural measures) outcome measures. However, this study did show changes over time for these measurements for both the experimental and placebo conditions.ConclusionsThis study was unable to document superior training effects over time of an adaptive WMT in children with BIF and neuropsychiatric disorders, compared with a placebo (non‐adaptive) WMT. The objectively documented changes over time in the non‐adaptive WMT arm suggest that these children with persistent impairments in WM may benefit from a structured learning environment that is associated with improvement of neurocognitive functioning and coping strategies. Further research is needed to examine which elements of cognitive training may be useful for which specific patients and to study long‐term effects of training.

Long-term effects of opioid overdose prevention and response training on medical student knowledge and attitudes toward opioid overdose: A pilot study

BackgroundMedical settings provide ideal opportunities to identify patients with substance use disorders and provide harm reduction and treatment resources. Medical students often volunteer in the community and can spend substantial time with patients, serving as touchpoints. Accordingly, medical schools have begun training in harm reduction. Initial studies show such training acutely improves knowledge, but sustained effects remain unclear. This pilot study explored longer-term impacts of Opioid Overdose Prevention and Response Training (OOPRT) on medical student knowledge about opioids, overdose, and naloxone. MethodsStudents completed a survey about knowledge of opioid use disorder, overdoses, and attitudes towards patients. This included Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales. A subset of students was invited to attend OOPRT and complete a post-training survey. All who completed the baseline survey were invited to complete a 6-month follow-up. We analyzed long-term training effects on OOKS and OOAS scores. Results89 students completed baseline and 6-month follow-up surveys; of these, 22 received training. OOPRT yielded significant improvements in knowledge of signs of opioid overdose (F(2,38) = 18.04, P < .001), actions to take during overdose (F(2,38) = 8.32, P = .001), and naloxone use (F(2,38) = 35.46, P < .001), along with attitudes regarding overdose competencies (F(2,38) = 99.40, P < .001) and concerns (F(2,38) = 8.86, P < .001). When comparing over time, students who attended OOPRT retained significantly higher competency scores than those who did not attend F(1,87) = 40.82, P < .001). No other significant differences were observed. ConclusionsThis study demonstrates immediate efficacy of OOPRT in improving opioid overdose knowledge and attitudes and sustained changes at 6 months, compared to standard undergraduate medical curricula alone. Future research with larger sample sizes is underway to validate these preliminary findings and examine the difference in attitudes and knowledge retention over time. Given that students report interest in receiving OOPRT and consider it worthwhile, systematic study is warranted.

A randomized EPIREMED protocol study on the long-term visuo spatial effects of very preterm children with a working memory deficit

BackgroundVery preterm children generally perform poorly in executive functions and particularly in working memory. Adaptive training tasks encouraging these children to work continuously on their personal working memory capacity can be very useful. Above all in preschool-age children, several cognitive training programs focused on improving working memory capacity. Cogmed is a computerized visuospatial cognitive training program that improves working memory in children and adolescents with attention-deficit/hyperactivity disorder. The main objective is to assess the long-term effects (18 months) of cognitive training (Cogmed) on visuospatial processing in preschool-age very preterm children with working memory impairment.MethodsThe EPIREMED study is a prospective, randomized, controlled, multicentric trial nested in a population based epidemiological survey. An intervention group (Cogmed cognitive training) and a control group (standard care management) will compare children aged 5½ to 6 years, born between 24- and 34-weeks’ gestational age, with a global intelligence quotient > 70 and a working memory index < 85. The study will include 166 children from national study EPIPAGE-2 (Epidemiological Study on Small Gestational Ages). The intervention consists of 25 sessions administered over a 5- to 8-week period. The primary endpoint will be the visuospatial processing, assessed by the score of the visuospatial index: score of the WPPSI-IV (Wechsler Preschool and Primary Scale of Intelligence). The secondary endpoints will allow to assess the executive functions, language and abilities, infant behavior, quality of life assessment, school performance and parental anxiety.DiscussionThis project’s primary goal is to demonstrate the necessity of early visuospatial memory assessment within the vulnerable population of very preterm children, and to prove the feasibility and efficacy of computerized cognitive training using online software programs. A better global neuropsychological development improvement (visuospatial processing and other far transfer) can be expected with an improvement in learning and decreased behavioral problems. In the long term, these improvements might also reduce those global costs linked to the consequences of extreme prematurity.Trial registrationNCT02757794 (registered on 2nd May 2016 at ClinicalTrial.gov).

Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis

ObjectivesMultiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. Design and methodsSynthesis of published works within the field of exercise training in MS. ResultsExercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. ConclusionsResistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.

Hematology, Hormones, Inflammation, and Muscle Damage in Elite and Professional Soccer Players: A Systematic Review with Implications for Exercise

Knowledge of the long-term effects of soccer training on hematological, hormonal, inflammatory, and muscle damage markers and physical performance may help to better design strength and conditioning programs for performance development and injury prevention for the individual player and the team. The aim of this systematic review was to summarize and discuss evidence on the long-term effects of soccer training on selected hematological, hormonal, inflammatory, and muscle damage markers and physical performance in elite and professional soccer players. A second goal was to investigate associations between selected physiological markers and measures of performance. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature search was conducted in four electronic databases (PubMed, ISI Web of Knowledge, Web of Science, and SPORTDiscus) from inception until August 2020 to identify articles related to soccer training effects. To be included in this systematic review, studies had to examine male elite (national level) and/or professional (international level) soccer players aged > 17years and a soccer training period > 4weeks, and report outcomes related to hematological, hormonal, inflammatory, muscle damage, and performance markers. The search syntax initially identified 2420 records. After screening titles, abstracts, and full texts, 20 eligible studies were included in this systematic review, with training durations lasting between 4 and 18weeks in 15 studies, around 6months in four studies, and around 1year in one study. Effects of long-term soccer training revealed parameter-specific increases or decreases in hematological, hormonal, inflammatory, and muscle damage markers and physical performance. Two studies showed a moderate increase in hematological markers such as hemoglobin (effect size [ES] = 0.67-0.93). Parameter-specific changes were noted for hormonal markers in the form of increases for total testosterone (ES = 0.20-0.67) and free testosterone (FT) (ES = 0.20-0.65) and decreases for cortisol (ES = - 0.28 to - 1.31). Finally, moderate to very large increases were found for muscle damage markers such as creatine kinase (ES = 0.94-6.80) and physical performance such as countermovement jump (CMJ) height (ES = 0.50-1.11) and squat jump (SJ) height (ES = 0.65-1.28). After long-term periods of soccer training, significant positive correlations were found between percentage change (Δ%) in FT and Δ% in CMJ height (r = 0.94; p = 0.04) and between Δ% in total testosterone/cortisol (TT/C) ratio and Δ% in SJ (r = 0.89; p = 0.03). Findings suggest that long-term soccer training induces increases/decreases in hematological, hormonal, inflammatory, and muscle damage markers and physical performance in male elite and professional soccer players. These fluctuations can be explained by different contextual factors (e.g., training load, duration of training, psychological factors, mood state). Interestingly, the observed changes in hormonal parameters (FT and TT/C) were related to vertical jump performance changes (e.g., CMJ and SJ). Anabolic hormones and TT/C can possibly be used as a tool to identify physical performance alteration after long-term soccer training.

Effects of periodic robot rehabilitation using the Hybrid Assistive Limb for a year on gait function in chronic stroke patients

Using a robot for gait training in stroke patients has attracted attention for the last several decades. Previous studies reported positive effects of robot rehabilitation on gait function in the short term. However, the long-term effects of robot rehabilitation for stroke patients are still unclear. The purpose of the present study was to investigate the long-term effects of periodic gait training using the Hybrid Assistive Limb (HAL) on gait function in chronic stroke patients. Seven chronic stroke patients performed 8 gait training sessions using the HAL 3 times every few months. The maximal 10-m walk test and the 2-minute walking distance (2MWD) were measured before the first intervention and after the first, second, and third interventions. Gait speed, stride length, and cadence were calculated from the 10-m walk test. Repeated one-way analysis of variance showed a significant main effect on evaluation time of gait speed (F = 7.69, p < 0.01), 2MWD (F = 7.52, p < 0.01), stride length (F = 5.24, p < 0.01), and cadence (F = 8.43, p < 0.01). The effect sizes after the first, second, and third interventions compared to pre-intervention in gait speed (d = 0.39, 0.52, and 0.59) and 2MWD (d = 0.35, 0.46, and 0.57) showed a gradual improvement of gait function at every intervention. The results of the present study showed that gait function of chronic stroke patients improved over a year with periodic gait training using the HAL every few months.

Low-Load Blood-Flow Restriction Exercise to Failure and Nonfailure and Myoelectric Activity: A Meta-Analysis.

To compare the short- and long-term effects of low-load resistance training with blood-flow restriction (LL-BFR) versus low- (LL-RT) or high- (HL-RT) load resistance training with free blood flow on myoelectric activity and investigate the differences between failure (exercise performed to volitional failure) and nonfailure (exercise not performed to volitional failure) protocols. We identified sources by searching the MEDLINE, PubMed, CINAHL, Web of Science, CENTRAL, Scopus, SPORTDiscus, and PEDro electronic databases. We screened the titles and abstracts of 1048 articles using our inclusion criteria. A total of 39 articles were selected for further analysis. Two reviewers independently assessed the methodologic quality of each study and extracted the data. A meta-analytic approach was used to compute standardized mean differences (SMDs) ± 95% CIs. Subgroup analyses were conducted for both failure and nonfailure protocols. The search identified 39 articles that met the inclusion criteria. Regarding the short-term effects, LL-BFR increased muscle excitability compared with LL-RT during nonfailure protocols (SMD = 0.61; 95% CI = 0.34, 0.88), whereas HL-RT increased muscle excitability compared with LL-BFR during failure (SMD = -0.61; 95% CI = -1.01, -0.21) and nonfailure (SMD = -1.13; 95% CI = -1.94, -0.33) protocols. Concerning the long-term effects, LL-BFR increased muscle excitability compared with LL-RT during exercises performed to failure (SMD = 1.09; 95% CI = 0.39, 1.79). Greater short-term muscle excitability levels were observed in LL-BFR than in LL-RT during nonfailure protocols. Conversely, greater muscle excitability was present during HL-RT than LL-BFR, regardless of volitional failure. Furthermore, LL-BFR performed to failure increased muscle excitability in the long term compared with LL-RT.

The Role of Military Training in Improving Psychological Resilience and Reducing Depression Among College Freshmen.

Background: Military training plays an important protective role in enhancing mental health. However, the effects of military training on psychological resilience and depression among college freshmen in China remain unclear. The present study aimed to evaluate changes in psychological resilience and depression through military training among college freshmen, and to investigate associated psychosocial factors including childhood trauma that may influence its effects on psychological resilience.Methods: A prospective and self-comparison study design was employed. College freshmen who received 3 weeks of military training were recruited. Socio-demographic variables were collected and childhood trauma exposure was estimated by the Childhood Trauma Questionnaire (CTQ). The Connor-Davidson Resilience Scale (CD-RISC) and Patient Health Questionnaire (PHQ-9) were used to assess psychological resilience and depression before and after the military-style training.Results: The military training significantly increased the total and subscale scores of CD-RISC (p < 0.001), and decreased the PHQ-9 score (p < 0.001). The proportion of students with clinical depression reduced from 10.5% at baseline to 7.2% after the training (p < 0.001). Improvement of CD-RISC scores was positively affected by male gender and urban area, while negatively affected by older age, and higher baseline scores of PHQ-9 and CTQ. A significant correlation was found between changes in scores of CD-RISC and PHQ-9 through the training (r = −0.238, p < 0.001).Conclusions: Military training may have a positive effect on increasing psychological resilience and reducing depressive symptoms among college freshmen, especially in male students and those from an urban area, while older age, childhood trauma, higher depression levels, and resilience at baseline may weaken, or even mask its positive effect. Follow-up research should be considered for the long-term effects of military-style training.

Preventing Recurrence of Depression: Long-Term Effects of a Randomized Controlled Trial on Cognitive Control Training for Remitted Depressed Patients

Previous studies suggest that cognitive control training (CCT) shows potential as a preventive intervention for depression. In this study, the first to examine long-term preventive effects of CCT, we examined effects on (a) task-specific cognitive transfer at 1-year follow-up, (b) recurrence of depression, and (c) functioning over the course of a year. Each of 92 remitted depressed patients were randomly assigned to a CCT condition or an active control condition (ACT). Effects of training were monitored using weekly assessments of emotion regulation, cognitive complaints, depressive symptoms, and resilience (brief weekly questionnaire). At 1-year follow-up, participants completed a structured clinical interview, cognitive transfer task, and questionnaires. We observed task-specific cognitive transfer ( p &lt; .001, d = 1.23) and lower recurrence rates in the CCT condition ( p = .04; odds ratio = 0.38). However, no long-term beneficial effects of training were observed on the weekly ratings of functioning, and groups did not differ in performance on the self-report questionnaires at 1-year follow-up.

The role of pre-pubertal training history on hippocampal neurotrophic factors and glucocorticoid receptor protein levels in adult male rats

Neurotrophic factors play an integral role in hippocampal plasticity, and interaction with HPA axis components, especially glucocorticoid receptors (GR), can mediate the structural and functional changes. In the present work, we investigated the long-term effects of combined exercise training (CET) and voluntary physical activity in an enriched environment (EE) in the pre-pubertal period on hippocampal neurotrophic factors and GR. For this purpose, a longitudinal study was designed. After three weeks, all rats were kept in the standard cages without any interventions until adulthood. Western blot analysis revealed a significant increase in hippocampal BDNF and VEGF protein levels in both EE and CET groups (P < 0.001), along with an increase in GR protein levels. In addition, EE decreased serum corticosterone levels compared to CET (P < 0.05). Serum insulin-like growth factor-1 (IGF-1) levels did not demonstrate remarkable changes between groups. Training interventions during sensitive developmental periods may produce profound and long-lasting effects on the hippocampus, at least in part by interactive effects of neurotrophic factors cascades and GR.

Ten-year resistance training background modulates somatosensory P3 cognitive brain resonse in older men: A magnetoencephalograpy study.

The brain electrophysiological component P3, associated with good cognitive abilities, deteriorates during healthy aging. Both cognitive functions and P3 component amplitude respond positively to exercise, but the effects of resistance training on P3 are much less studied. Short-term resistance training interventions in older adults indicate modulation towards larger P3 amplitude, but this association has not been studied with a longitudinal study design. We investigated magnetoencephalographically recorded P3 (P3m) in a unique study design of nine aged men (mean age 77.7 y) with quasi-supervised resistance training background over a 10-year period and eight controls of similar age (mean age 77.5 y) with no training background. We elicited P3m utilizing lower limb electrical stimulation, as the resistance training program was mostly directed to lower limbs. Somatosensory oddball paradigm was performed with the right foot's fourth toe as standard (90%) and hallux as deviant (10%). Participants were asked to respond to deviants with a button press using their left index finger. Topographic maps showed bilateral temporoparietal activation for P3m in both groups. No amplitude differences were found in active P3m regions between groups. However, the groups differed in hemispheric activity of P3m. The exercise group showed stronger activation in the right frontotemporal and parietal sensor-groups compared to the left sensor-groups, and the control group showed stronger activation in right frontotemporal sensor-group compared to left. The control group showed shorter P3m latency in the right temporal sensor-group than the exercise group, but the latencies in other sensor-groups were similar. In aging, the brain utilizes compensatory areas to perform cognitive tasks. Our results suggest modulation in topographic distribution of P3m activity in aging men with long-term resistance training background compared to their controls. This might arise from a difference in age-related compensatory mechanisms in P3m generation.

Long-Term Mutual Training for the CYBATHLON BCI Race With a Tetraplegic Pilot: A Case Study on Inter-Session Transfer and Intra-Session Adaptation.

CYBATHLON is an international championship where people with severe physical disabilities compete with the aid of state-of-the-art assistive technology. In one of the disciplines, the BCI Race, tetraplegic pilots compete in a computer game race by controlling an avatar with a brain-computer interface (BCI). This competition offers a perfect opportunity for BCI researchers to study long-term training effects in potential end-users, and to evaluate BCI performance in a realistic environment. In this work, we describe the BCI system designed by the team Mirage91 for participation in the CYBATHLON BCI Series 2019, as well as in the CYBATHLON 2020 Global Edition. Furthermore, we present the BCI’s interface with the game and the main methodological strategies, along with a detailed evaluation of its performance over the course of the training period, which lasted 14 months. The developed system was a 4-class BCI relying on task-specific modulations of brain rhythms. We implemented inter-session transfer learning to reduce calibration time, and to reinforce the stability of the brain patterns. Additionally, in order to compensate for potential intra-session shifts in the features’ distribution, normalization parameters were continuously adapted in an unsupervised fashion. Across the aforementioned 14 months, we recorded 26 game-based training sessions. Between the first eight sessions, and the final eight sessions leading up to the CYBATHLON 2020 Global Edition, the runtimes significantly improved from 255 ± 23 s (mean ± std) to 225 ± 22 s, respectively. Moreover, we observed a significant increase in the classifier’s accuracy from 46 to 53%, driven by more distinguishable brain patterns. Compared to conventional single session, non-adaptive BCIs, the inter-session transfer learning and unsupervised intra-session adaptation techniques significantly improved the performance. This long-term study demonstrates that regular training helped the pilot to significantly increase the distance between task-specific patterns, which resulted in an improvement of performance, both with respect to class separability in the calibration data, and with respect to the game. Furthermore, it shows that our methodological approaches were beneficial in transferring the performance across sessions, and most importantly to the CYBATHLON competitions.

Parent- and teacher-reported long-term effects of parent training on child conduct problems in families with child protection and other support services: a randomized controlled trial

BackgroundThis randomized controlled trial (RCT) evaluated the long-term effectiveness of the Incredible Years® (IY) Parenting Program in modifying children’s externalizing problems among families in Child Protection Services (CPS) and using other special support services. We also examined whether parent-reported effects of the IY® generalize to the daycare/school setting as reported by teachers.MethodsParticipants in the study were 3–7-year-old children with behavioural problems (N = 102 at baseline, N = 89 at one-year follow-up). Participants were randomized to intervention (N = 50) and control groups (N = 52) after the baseline assessment. The intervention group received 19-week IY® Parenting Program. The effectiveness of the intervention was analyzed using linear mixed model.ResultsOur previously reported pre-post intervention effects on CBCL (Child Behavior Checklist) and ECBI (Eyberg Child Behavior Inventory) were not sustained to the one-year follow-up. Child conduct problems decreased from baseline to follow-up in both intervention and control groups. The positive changes were not observed at daycare/school from baseline to post-intervention or to the one-year follow-up, and there were no significant differences in changes between the groups.ConclusionsEvidence-based parenting program IY® seems to be an effective intervention for child conduct problems in the short term in families in the CPS context, but sustaining the positive effects and generalizing them to the daycare/school context are challenging.Trial registration: The trial is registered in the ClinicalTrials.gov registry (NCT03239990), Registered August 4th, 2017; https://clinicaltrials.gov/ct2/results?cond=&term=NCT03239990&cntry=&state=&city=&dist=

Computerized inhibitory control training reduces anxiety in preadolescent students

The study examined the relationship between anxiety, inhibitory control (IC), and resting-state electroencephalography (EEG) in a critical age-range for social and emotional development (8–12-year-olds). The participants were assigned to 4 weeks of either an emotional IC training program, a neutral IC training program, or a waitlisted control, and were tested using cognitive, emotional, and EEG measures. The training was computerized and completed remotely. At baseline, IC accuracy scores were negatively related to both anxiety and depression levels (N = 42). Additionally, increased right lateral frontal alpha asymmetry was predictive of increased anxiety/depression scores. A series of multivariate analyses of covariance and post-hoc tests were conducted to compare effects in the participants that completed the full 16 sessions of training (N = 32). Overall the emotional and neutral training conditions showed similar improvements in IC accuracy, as well as reductions in anxiety compared to the waitlist condition. Minimal neurophysiological changes occurred from pre-to-post; however, lateral frontal asymmetry shifted leftward in the emotional training group. These findings highlight the potential of computerized IC training for mitigating negative emotional functioning in preadolescents. Future research is necessary to determine the long-term effects of IC training and whether longer training intervals facilitate persisting impacts.

Frontoparietal Connectivity Neurofeedback Training for Promotion of Working Memory: An fNIRS Study in Healthy Male Participants

Neurofeedback cognitive training is a promising tool used to promote cognitive functions effectively and efficiently. In this study, we investigated a novel functional near-infrared spectroscopy (fNIRS)-based frontoparietal functional connectivity (FC) neurofeedback training paradigm related to working memory, involving healthy adults. Compared with conventional cognitive training studies, we chose the frontoparietal network, a key brain region for cognitive function modulation, as neurofeedback, yielding a strong targeting effect. In the experiment, 10 participants (test group) received three cognitive training sessions of 15 min using fNIRS-based frontoparietal FC as neurofeedback, and another 10 participants served as the control group. Frontoparietal FC was significantly increased in the test group (p D 0.03), and the cognitive functions (memory and attention) were significantly promoted compared with the control group (accuracy of 3-back test: p D 0.0005, reaction time of 3-back test: p D 0.0009). After additional validations on long-term training effect and on different patient populations, the proposed method exhibited considerable potential to be developed as a fast, effective, and widespread training approach for cognitive function enhancement.

A pilot study of the implementation and evaluation of a leadership program for medical undergraduate students: Lessons learned.

Most Indian medical schools lack formal leadership training though students are expected to evolve into leaders. The Student Leadership Program (SLP) was designed and evaluated with an objective to incorporate and strengthen leadership skills in undergraduates and to initiate change in organizational practice through the development of a Student Leadership Society. The SLP was designed using best evidence guidelines in medical education. Competencies and learning outcomes were identified in four domains: reflective writing, self-management, team management, and experiential learning. A stepwise program was implemented over 6 months in which participants wrote reflections at the end of each program session. So as to gain objective evidence of behavioral change in participants in relation to the leadership training, their reflections were qualitatively analyzed and corresponding codes and themes were derived. We describe the content and stepwise process of implementation of our pilot leadership program, which included 24 final-year students. Results of qualitative analysis are presented in relation to the domains of self-management, team management, and evaluation of experimental learning. Among the findings were: students viewed assertive skills training as the most powerful learning experience within self-management, and in team management, the session on "Myers-Briggs Type Indicator for understanding one's own leadership style" was seen as the most powerful learning tool, while the session on conflict management was the most difficult in this domain. A Student Leadership Society was instituted. In this study, students' reflections helped us better understand factors (the "how" and "why") that make leadership training more effective. The SLP, with a strong evidence base, achieved the intended learning outcomes. A Student Leadership Society was constituted as a networking platform to explore the long-term effects of leadership training on organizational practice. The content and process of our pilot leadership program and lessons learned through understanding of students' perspectives should be applicable to subsequent iterations of student leadership development programs here and in other settings.

Short and long-term effects of high-intensity interval training applied alone or with whole-body cryostimulation on glucose homeostasis and myokine levels in overweight to obese subjects.

Background: COVID-19 pandemic has exacerbated the problem of physical inactivity and weight gain. Consequently, new strategies to counteract weight gain are being sought. Because of their accessibility, interval training and cold therapy are the most popular such strategies. We here aimed to examine the effect of 6 units of high-intensity interval training (HIIT), applied alone or in combination with 10 sessions of whole-body cryotherapy (WBC; 3 min at -110 ∘C per session) on incretins, myokines, and adipokines levels. Materials and methods: The study involved 65 subjects (body mass index of approximately 30 kg•m-2). The subjects were randomly divided into training group (TR; n = 27) and training supported by WBC group (TR-WBC; n = 38). Blood samples were collected before, immediately following, and 4 weeks after the intervention. Results: Fibroblast growth factor 21 (FGF21) levels significantly increased (p = 0.03) and adiponectin levels increased in the TR group (p = 0.05) compared with those recorded in TR-WBC group 24 h after the end of experimental protocol. Beneficial changes in the lipid profile (p = 0.07), a significant drop in visfatin levels (p < 0.05), and the improvement in β-cell function (HOMA-B; p = 0.02) were also observed in the TR group in the same time point of study. While TR-WBC did not induce similar changes, it ameliorated blood glucose levels (p = 0.03). Changes induced by both interventions were only sustained for 4 weeks after treatment. Conclusion: Collectively, HIIT, alone and in combination with WBC, positively affects metabolic indicators, albeit, most likely, different mechanisms drive the beneficial effects of different treatments.

A novel walking cane with haptic biofeedback reduces knee adduction moment in the osteoarthritic knee

Knee osteoarthritis is a leading cause of ambulatory disability in adults. The most prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading and reduce the knee adduction moment (KAM).To determine; 1) the short-term efficacy of a novel walking cane using haptic biofeedback to encourage proper cane loading and 2) the effects of the novel cane on KAM.Cane loading and KAM, peak knee adduction moment (PKAM), and knee adduction angular impulse (KAAI)) while walking were calculated under five conditions: 1) naïve, 2A) after scale training (apply 20%BW to cane while standing, using a beam scale), 2B) scale recall (attempt to load the cane to 20%BW), 3A) after haptic training (vibrotactile biofeedback delivered when target cane load achieved), and 3B) haptic recall (attempt to load the cane to 20%BW with vibrotactile biofeedback delivered). Compared to the naïve condition all interventions significantly increased cane loading and reduced PKAM and KAAI. No differences between haptic recall and scale recall condition were observed.The haptic biofeedback cane was shown to be an effective and simple way to increase cane loading and reduced knee loading. Haptic biofeedback and scale training were equally effective at producing immediate short-term improvements in cane loading and knee loading. Future studies should examine the long-term effects of scale training and canes with haptic biofeedback on knee joint health, pain, and osteoarthritis disease progression.

Long-Term Effects of Mental Training on Manual and Cognitive Skills in Surgical Education – A Prospective Study

Limited training opportunities and expanding requirements are challenging surgical education, calling for alternative training methods like simulation or mental training. The aim of this study is to evaluate short- and long-term effects of a structured mental training on surgical performance. Medical students without laparoscopic experience were randomly assigned to 3 groups: (1) control (2) video training, and (3) video plus mental training performing 2 E-BLUS (European Training in Basic Laparoscopic Urological Skills) exercises, "peg transfer" (PT) and "cutting a circle" (CC). Group 3 performed a structured mental training course (identification of procedural key steps, relaxation, mental vocalization, and imaging). Longitudinal assessment including binominal checklists, global rating scales (GRS), procedural times, and Test of Performance Strategies (TOPS) were performed at baseline, day 2, 14, and after 16 months. Statistical analysis included ANOVA and general linear models with repeated measures. The study was conducted in "Olympus Training and Education Center Hamburg West" and "Endo Club Academy" at the University Medical Center Hamburg-Eppendorf. Participants were eligible if they were medical students with no experience in laparoscopy. 24 participants were recruited and finished the study. The mental training group maintained significantly better GRS scores at 16 months for PT (mean score 24.6 [95% CI: 21-28.25]) and CC (mean score 22.5 [18.4-26.6]) (both p < 0.01) and performed faster in the latter (261 seconds [Std. Dev 116] vs. 427 seconds [SD 132] vs. 368 seconds [SD 78]) compared to the other groups (p = 0.004). Longitudinally, mental training had a significant effect on TOPS scores and procedural times (p < 0.001 and p = 0.005, respectively). In addition to short time efficacy, our study is the first to ascertain a positive long-term effect of mental training on manual and cognitive skills and might be a useful and cost-effective tool in surgical education.