Rosanne A Coutts

The effect of short-term use of testosterone enanthate on muscular strength and power in healthy young men

Use of testosterone enanthate has been shown to significantly increase strength within 6–12 weeks of administration (2, 9), however, it is unclear if the ergogenic benefits are evident in less than 6 weeks. Testosterone enanthate is classified as a prohibited substance by the World Anti- Doping Agency (WADA) and its use may be detected by way of the urinary testosterone/epitestosterone (T/E) ratio (16). The two objectives of this study were to establish (a) if injection of 3.5 mg·kg-1 testosterone enanthate once per week could increase muscular strength and cycle sprint performance in 3–6 weeks; and (b) if the WADA-imposed urinary T/E ratio of 4:1 could identify all subjects being administered 3.5 mg·kg-1 testosterone enanthate. Sixteen healthy young men were match-paired and were assigned randomly in a double-blind manner to either a testosterone enanthate or a placebo group. All subjects performed a structured heavy resistance training program while receiving either testosterone enanthate (3.5 mg·kg-1) or saline injections once weekly for 6 weeks. One repetition maximum (1RM) strength measures and 10-second cycle sprint performance were monitored at the pre (week 0), mid (week 3), and post (week 6) time points. Body mass and the urinary T/E ratio were measured at the pre (week 0) and post (week 6) time points. When compared with baseline (pre), 1RM bench press strength and total work during the cycle sprint increased significantly at week 3 (p < 0.01) and week 6 (p < 0.01) in the testosterone enanthate group, but not in the placebo group. Body mass at week 6 was significantly greater than at baseline in the testosterone enanthate group (p < 0.01), but not in the placebo group. Despite the clear ergogenic effects of testosterone enanthate in as little as 3 weeks, 4 of the 9 subjects in the testosterone enanthate group (−44%) did not test positive to testosterone under current WADA urinary T/E ratio criteria.

Older Australians’ perceptions and practices in relation to a healthy diet for old age: A qualitative study

ObjectiveTo explore older independently-living Australians’ perceptions and practices about what constitutes a healthy diet for older people.DesignQualitative methodology, focus groups.SettingIndependently-living retirees in Northern NSW, Australia.ParticipantsA total of 29 participants in five focus groups, ranging in age from 60–93 years, with a mean age of 73.3 ± 8.8years; the majority (79%) were women.ResultsThematic analysis of the focus group interviews revealed four themes that best represent older people’s perceptions and practices in relation to healthy eating for old age. These included: 1) healthy foods — participants believed in a hierarchy of perceived healthfulness or importance of foods; 2) quantity — participants believed that ageing was associated with a reduced dietary intake and less need for meat; 3) personal circumstances — participants acknowledged that food costs, social situations and health conditions influenced their food choices; and 4) good intention — participants acknowledged that the desire to regain or maintain wellbeing and to preserve health positively influenced their food choices. Participants were unaware of the national nutrient targets for older Australians.ConclusionThe trend towards reduced dietary intake of meat and the indifference to dairy products expressed by many participants in this study suggests that they are at risk of not achieving the requirements for protein and calcium in particular. Failure to meet these age-adjusted nutrient targets has important implications for the health and functional capacity of older people.

Evidence for the impact of assessment on mood and motivation in first-year students

Learning, and particularly assessment practices, that encourages a self‐determined approach enhances feelings of well‐being and achievement motivation. Students (n = 137) in a common first‐year unit were the participants for an evaluation of the impact of assessment. The Intrinsic Motivation Inventory and the Brunel Mood Scale were used to assess psychological reactions. A repeated measures comparison for each motivation and mood variable was conducted using mixed‐model analysis. Changes in all moods were significant at week 7, when the greatest number of assessment items per student was due. For this particular week, negative moods also increased, along with a decrease in the positive mood of vigour. The intrinsic motivation variables of interest/enjoyment and perceived competence were significantly lower in week 7, with pressure/tension being significantly higher. For this group of students the demands of assessment have been shown to have a psychological impact.

Symptoms of muscle dysmorphia, body dysmorphic disorder, and eating disorders in a nonclinical population of adult male weightlifters in Australia

Abstract Nieuwoudt, JE, Zhou, S, Coutts, RA, and Booker, R. Symptoms of muscle dysmorphia, body dysmorphic disorder, and eating disorders in a nonclinical population of adult male weightlifters in Australia. J Strength Cond Res 29(5): 1406–1414, 2015—The current study aimed to (a) determine the rates of symptoms of muscle dysmorphia (MD), body dysmorphic disorder (BDD), and eating disorder; (b) determine the relationships among symptoms of MD, BDD, and eating disorders; and (c) provide a comprehensive comparison of symptoms of MD, BDD, and eating disorders in a nonclinical population of adult male weightlifters in Australia. The participants (N = 648, mean age = 29.5 years, SD = 10.1) participated in an online survey, consisting of Muscle Appearance Satisfaction Scale, the Body Dysmorphic Disorder Questionnaire, and the Eating Attitude Test-26. Results indicated that 110 participants (17%) were at risk of having MD, 69 participants (10.6%) were at risk of having BDD, and 219 participants (33.8%) were at risk of having an eating disorder. Furthermore, 36 participants (5.6%) were found at risk of having both MD and BDD, and 60 participants (9.3%) were at risk of having both MD and an eating disorder. Significant correlations and associations were found between symptoms of MD and BDD, and symptoms of MD and eating disorders. Support was provided for the comorbidity of, and symptomatic similarities between, symptoms of MD and BDD, and symptoms of MD and eating disorders. This may reflect a shared pathogenesis between symptoms of MD, BDD, and eating disorders. Strength and conditioning professionals, exercise scientists, athletic trainers, and personal trainers should be aware that adult males who are working out with weights (i.e., free weights or machines) may be at increased risk of having MD, BDD, and eating disorders.

Developing a viva exam to assess clinical reasoning in pre-registration osteopathy students.

BackgroundClinical reasoning (CR) is a core capability for health practitioners. Assessing CR requires a suite of tools to encompass a wide scope of contexts and cognitive abilities. The aim of this project was to develop an oral examination and grading rubric for the assessment of CR in osteopathy, trial it with senior students in three accredited university programs in Australia and New Zealand, and to evaluate its content and face validity.MethodsExperienced osteopathic academics developed 20 cases and a grading rubric. Thirty senior students were recruited, 10 from each university. Twelve fourth year and 18 fifth year students participated. Three members of the research team were trained and examined students at an institution different from their own. Two cases were presented to each student participant in a series of vignettes. The rubric was constructed to follow a set of examiner questions that related to each attribute of CR. Data were analysed to explore differences in examiner marking, as well as relationships between cases, institutions, and different year levels. A non-examining member of the research team acted as an observer at each location.ResultsNo statistical difference was found between the total and single question scores, nor for the total scores between examiners. Significant differences were found between 4th and 5th students on total score and a number of single questions. The rubric was found to be internally consistent.ConclusionsA viva examination of clinical reasoning, trialled with senior osteopathy students, showed face and content validity. Results suggested that the viva exam may also differentiate between 4th and 5th year students’ capabilities in CR. Further work is required to establish the reliability of assessment, to further refine the rubric, and to train examiners before it is implemented as a high-stakes assessment in accredited osteopathy programs.

Understanding clinical reasoning in osteopathy: a qualitative research approach

BackgroundClinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions.MethodsThis study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories.ResultsAccording to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions.ConclusionsThe use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary decision-making and potentially enhance the quality of patient care.Where commonalities exist in the clinical reasoning processes of osteopathy and other health professions, shared learning opportunities may be available, including the exchange of scaffolded clinical reasoning exercises and assessment practices among health disciplines.

Identifying common values among seven health professions: An interprofessional analysis

ABSTRACT This article reviews the competency frameworks of seven Australian health professions to explore relationships among health professions of similar status as reflected in their competency frameworks and to identify common themes and values across the professions. Frameworks were compared using a constructivist grounded theory approach to identify key themes, against which individual competencies for each profession were mapped and compared. The themes were examined for underlying values and a higher order theoretical framework was developed. In contrast to classical theories of professionalism that foreground differentiation of professions, our study suggests that the professions embrace a common structure and understanding, based on shared underpinning values. We propose a model of two core values that encompass all identified themes: the rights of the client and the capacity of a particular profession to serve the healthcare needs of clients. Interprofessional practice represents the intersection of the rights of the client to receive the best available healthcare and the recognition of the individual contribution of each profession. Recognising that all health professions adhere to a common value base, and exploring professional similarities and differences from that value base, challenges a paradigm that distinguishes professions solely on scope of practice.

Focus group interviews with older Australians to explore their awareness of the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets

Promoting a healthy, nutritious diet is central to the goal of assisting individuals to age well. This study used focus groups to explore older peoples awareness of the current age-adjusted nutrient recommendations and age-adjusted core food groups, and to capture their views about these dietary guidelines. Thematic analysis was applied to aggregate data into categories of frequently occurring responses. Data were collected from five focus groups: a total of 29 participants, aged 60-98 years of age. Analysis of responses revealed that participants were generally unaware of government-endorsed dietary guidelines or nutrient recommendations for older people. Their suggestions for assisting older people to meet these age-adjusted dietary targets included: targeted media campaigns to raise awareness about older peoples nutrient requirements; the need for practical meal plans that do meet their dietary needs; and the removal of barriers to supermarket food choices, such as problems with opening jars and excessive packaging.

Evaluating the reliability and validity of the proposed muscle dysmorphia criteria

This study aimed to: (a) determine the inter-rater reliability of the proposed muscle dysmorphia criteria, (b) investigate if muscle dysmorphia (MD) represented a syndrome of frequently co-occurring symptoms, and (c) determine the level of correlation between the proposed MD criteria and the Muscle Appearance Satisfaction Scale. Men (N = 48) aged 18 years and older who were currently participating in resistance training were assessed using the Muscle Appearance Satisfaction Scale and a one-on-one interview. Two qualified psychologists assigned a diagnosis of MD to those participants who appeared to meet the proposed criteria for MD. Inter-rater reliability and the frequency of co-occurring symptoms in participants were assessed. The correlation between MD and the Muscle Appearance Satisfaction Scale was explored. The inter-rater reliability between the researchers was low (Cohens kappa = .39; p ≤ .05). A Binomial test revealed that MD represented a syndrome of frequently co-occurring symptoms; there was a significant probability (>.70) of a participant with one diagnostic symptom of MD (criterion 2a or 3) to exhibit another symptom (criterion 1) of the disorder. Point-biserial correlation indicated that the proposed MD criteria, excluding criterion 2b, were significantly correlated with the total score of the Muscle Appearance Satisfaction Scale and its subscales, excluding Muscle Satisfaction. The study provides some evidence to question the acceptance of the proposed MD criteria.

Graded versus Intermittent Exercise Effects on Lymphocytes in Chronic Fatigue Syndrome.

PURPOSE There is increasing evidence of immune system dysfunction in chronic fatigue syndrome (CFS), but little is known of the regular exercise effects on immune cell parameters. This pilot study investigated the effects of graded and intermittent exercise on CD4 lymphocyte subset counts and activation compared with usual care. METHODS Twenty-four CFS patients (50.2 ± 10 yr) were randomized to graded exercise (GE), intermittent exercise (IE), or usual care (UC) groups; 18 sedentary non-CFS participants (50.6 ± 10 yr) were controls (CTL) for blood and immunological comparisons. Outcome measures were pre- and postintervention flow cytometric analyses of circulating lymphocyte subset cell counts; expression of CD3, CD4, CD25, and CD134; full blood counts; and V˙O2peak. RESULTS Preintervention, CD3 cell counts, and expression of CD4, CD25, CD134, and CD4CD25CD134 were significantly lower in GE, IE, and UC compared with CTL (P < 0.05). Total lymphocyte concentration was significantly lower in GE and IE groups compared with CTL. There were significant postintervention increases in i) expression of CD4 and CD4CD25CD134 for GE and IE, but CD25 and CD134 for IE only; ii) circulating counts of CD3 and CD4 for GE, and CD3, CD4, CD8, CD3CD4CD8, CD3CD16CD56, CD19, and CD45 for IE; iii) neutrophil concentration for GE; and iv) V˙O2peak and elapsed test time for IE and GE, V˙Epeak for IE. CONCLUSIONS Twelve weeks of GE and IE training significantly improved CD4 lymphocyte activation and aerobic capacity without exacerbating CFS symptoms. IE may be a more effective exercise modality with regard to enhanced CD4 activation in CFS patients.