Think:Health cultivates and articulates the best in health research and news.
The following episode, which aired on Sunday 20 March 2016, features:
- The physiology of tennis and how athletes train for endurance and flexibility (01:13);
- Pelvic floor dysfunction in the nursing and midwifery workforce (11:45); and
- How early childhood teachers can be better trained in social emotional development and emotional intelligence (21:38).
Academic guests:
-
Associate Professor Rob Duffield - Associate Professor of Sport and Exercise Science at the UTS Faculty of Health
-
Heather Pierce - PhD Candidate at the UTS Faculty of Health
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Professor Lawrence Lam - Professor of Public Health at the UTS Faculty of Health
Host/s:
- Ellen Leabeater, 2ser
- Jake Morcom, 2ser
START OF TRANSCRIPT
Ellen Leabeater: Hello. Welcome to the program. Ellen Leabeater with you. Today, pelvic floor dysfunction among nurses and midwives.
Heather Pierce: Nurses holding on because they have to hold on or reducing their fluids because they're perhaps in theatre and they can't get to the toilet and leave the operating theatre. So we know that there are perhaps workforce issues surrounding nurses being able to have that, what we would call a healthy bladder.
Ellen Leabeater: And how early childhood teachers in Hong Kong are becoming more emotionally aware of their students.
But first on the program, do you ever watch a sports game on TV and think why aren't those athletes collapsing in exhaustion? For tennis players it's all about the training and it's as intense as you might think.
Tennis players train for endurance so they can play for hours on end and for flexibility to make quick sprinting movements across the court in every direction.
Rob Duffield is an Associate Professor in Sport and Exercise Science at UTS. He spoke to Jake Morcom about the strategy behind tennis training in what's called exercise physiology.
Rob Duffield: Exercise physiology relates to how the systems and the cells of the body respond to both acute exercise stimuli and how they adapt over time to chronic training stimulus.
Jake Morcom: So how is that then tracked? How is that put into practice for those who play sport?
Rob Duffield: Yeah, well you can look at a whole body model of how the overall organism functions or you can look at specific systemic physiology, so how the heart or the lungs or the hormonal or the muscular skeletal system responds. You can have measures of either that systemic level or as just a whole body outcome or a whole body performance marker.
Jake Morcom: Let's look at an example, so it can be aside from tennis, it can be anything, what's the benefit from using it?
Rob Duffield: So you can, say from a start of pre-season to end of pre-season, get a range of tests, either in the field or in a laboratory, determine how the athlete responds to a particular exercise intensity or a workload and see how they then adapt. So see how successful that training program is, benchmark players for their physiological state, as well as more importantly their performance outcomes and track them over time to monitor whether they're adapting appropriately, whether they're over-training, whether they're under-training and then adjust the program accordingly.
Jake Morcom: Looking at tennis in particular what are the biggest demands in the sport?
Rob Duffield: Tennis is a complex one. It's essentially a skill-based sport and any skill-based sport requires prolonged, ongoing, high repetition of those skilled movements. The movement competencies is what it's termed, but the development of groundstrokes, of serves, that takes time, that takes exposure to training and it takes large volumes of skill repetition.
That skill repetition, if it's done in a non-competitive or a non-physically demanding way won't develop the physiological or physical capacities. You need high speed, high power because the actual key outcomes of tennis are to produce high power and high force for velocity through the groundstroke.
You need a high aerobic capacity because matches have long durations and they're consecutive days and repeated matches over many days, so you need fatigue resistance.
You also need the neuro, mechanical, and balance control because footwork and patterns to set up for the groundstroke are critical. So if you train all those independently you're already at probably 25 hours a day of training which is obviously impossible. So then you need to be aware of what the athlete can actually handle and then appropriately train all those different capacities and demands in only a couple of sessions or two or three sessions a day with adequate recovery between them.
The diverse demands make it quite complex and so then how you meet all those demands in enough training that doesn't over-train is the million dollar question.
Jake Morcom: How does tennis fair; I know each sport has its own physical demands, but with tennis, even as what you were saying there, it's each and every area that they have to be so good and proficient at because they're running around the court, they're making really acute movements but then they have to have real power behind it. Matches can go on for upwards of four hours, so how does it compare in terms of its demand to other sports?
Rob Duffield: In some ways it's probably, not that it's irrelevant to compare, because you only train for the competition, you know, and a lot of sports have suffered from the idea of oh well that sport's very fit so we should copy that sport or how that sport trains.
The reality of training is that you want to prepare that athlete for the competition demands that athlete will meet. Tennis does capture a range of demands but it probably doesn’t exacerbate some of those demands like other sports.
So AFL will run 15 to 18 kilometres and much higher intensity running. Rugby will have its collision-based but with a lower volume. Tennis has those acute muscular skeletal demands, particularly through the serve and between, through hip rotation for groundstroke, as well as the shoulder and then have a radius of probably three to five metres where all the movements are in. Those movements are not high-velocity or high-speed, but they're very high acceleration and deceleration.
So that's kind of the specific demands that you try and develop in your training that an athlete can perform competition, as you say for upwards of five hours and sometimes on consecutive days or multiple days with limited recovery.
Jake Morcom: When we're talking about endurance in tennis and talking about surviving the duration of the match, what exactly are they doing in training to prepare for that or is it just this correlation of everything that they have to do to be able to survive because it's so demanding?
Rob Duffield: Yeah a little bit. I mean training should theoretically prepare you for the worst situations you will find in competition. The worst situation you will find in tennis competition is a bit hard to replicate because, say if you look at the, if the truly elite level, you could have at a grand slam, if you're wanting to win a grand slam you have to play say seven matches within 13 days.
Any one of those matches could be upwards of say five hours; normally three to five hours. Within that three to five hour match you will hit potentially 1000 groundstrokes plus serves and those groundstrokes need to be above 100 kilometres per hour. Then the movement will be around about six, or probably five to eight kilometres within that single match, then repeated over multiple days.
So to train for that is very very difficult. Just the sheer volume of capacities and elements you need to train; so within any given training day a key outcome for a tennis player is stroke play. The repetition of stroke play is critical. But then if you try and train that isolated, just on court, just with the key repetition then you're not going to necessarily train your aerobic capacity or you won't necessarily train speed and power.
If you then try and train them separately that's two - and you train them together - you're training two different energy systems in two different ways to recruit muscle and you're either not going to train them effectively or you need to separate them in which case you're now up to three hard training sessions a day which is not going to work.
So the perfect world is to then collate most of those ideas or most those training into one key session, maybe two key sessions and then that comes down to how you prescribe your drills. So if you're training drills on court are fundamentally just standing and hitting in one similar position with limited movement, you're not going to train those movement abilities.
If you start creating different drills that sequence one another, that train both the ability to hit, the ability to hit in different positions as well as start taxing movement demands and aerobic capacity, then you can start to get - you know not the magic potion of all in one - but you can start training multiple factors in the one session or in less than three or four sessions a day; which is impossible to do.
Jake Morcom: How about time off the court? How important is rest in say a period of - you know it's however many matches over a short period - how can they go from such extreme conditions on the court to them relaxing and not completely exhausting themselves?
Rob Duffield: Well there are probably two parts to that. One is from a training perspective where tennis players will actually do a lot of off court training as well. So they may then additionally train say aerobic capacity.
Because of the demands of tennis on court, sometimes it's difficult to really tax the aerobic energy system at maximal levels. You can get fatigue resistance from hitting for long durations, but that doesn't necessarily improve your aerobic capacity.
So off court tennis players will often then try and get off their legs, so it's on the bikes, on the steppers, just aerobic conditioning that doesn't involve body weight. Or separate to that it's muscular skeletal conditioning, so strength and conditioning, but not necessarily heavy lifting. It's more training the weaker muscles of any joint.
So that's one part of a lot of training happens off court to really focus on targeted areas.
In match conditions and particularly on tour it becomes a slightly different issue, because if you're playing regularly then that time between is ideally recovery time, but if you use it too much as recovery time then you lack training time.
So when you're in tournament mode and you're playing regularly, winning or losing, if you're not able to train then over a period of time match play doesn't necessarily make your fitter. It hardens you for match play which is critical, so there's a real balance when in tournament mode between having recovery because you need recovery from that match load and then/or missing training because you're in a recovery mode too much.
So that's real balance depending on the athlete, depending on the tournament schedule, depending on the type of match.
Ellen Leabeater: Associate Professor Rob Duffield from Sport and Exercise Science at UTS speaking to Jake Morcom.
Jake Morcom: You're listening to Think Health on 2SER 107.3.
Ellen Leabeater: Currently 4.8 million Australians live with incontinence or pelvic floor dysfunction. The number is one in three for women who have had a baby.
You've probably heard of urinary incontinence. This is where urine leakages occur and there is also faecal incontinence where you can't control your stools.
Pelvic floor dysfunction is the umbrella term for these types of incontinence and another 250 types. It's a condition that has a lot of stigma and as you can imagine affects the way you work.
Nurses and midwives are especially susceptible to pelvic floor dysfunction as their bladder habits aren't always healthy. Taking a bathroom break isn't exactly an option when you're in the operating theatre.
Heather Pierce is a PhD Candidate in the Faculty of Health at UTS. She talks us through what pelvic floor dysfunction is and the implications it has for the nursing and midwifery workforce.
Heather Pierce: The pelvic floor is made up of muscle tissue that's connected to ligaments that are also connected to fascia or stretchy tissue that helps to support things at the base of the pelvis, organs at the base of the pelvis and it's also innovated with nerves.
When we talk about the pelvic floor and pelvic floor dysfunction, firstly we're talking about a pelvic floor that is a unit and supporting in females the bladder and the uterus and the bowel. Dysfunction in the unit can be related to dysfunction in those systems and the functioning of those systems.
Ellen Leabeater: What's the prevalence of pelvic floor dysfunctions in Australian females?
Heather Pierce: If you've had a baby the prevalence is about one in three. So there is some well-established literature around the prevalence in females who have had babies. We say that around one in three women who have ever had a baby wet themselves.
The prevalence increases as age increases as well, so when you look at prevalence rates you need to look at the age group and as women get older urinary incontinence prevalence increases with around parity - around childbearing - and it also increases around the time of menopause.
Ellen Leabeater: What are the different types of pelvic floor dysfunction?
Heather Pierce: Because the pelvic floor involves the - in a female involves the uterus, the bladder and the bowel, dysfunction is described according to dysfunction in the functioning of those organs.
The International Continence Society has given us direction in terms of terminology and there are actually over 250 different definitions for female pelvic floor dysfunction.
Ellen Leabeater: Two hundred and fifty?
Heather Pierce: Yeah. So it's a complex area.
Ellen Leabeater: What are some of the types of pelvic dysfunction that people would be most familiar with?
Heather Pierce: Incontinence, so urinary incontinence which is the leaking of urine and that can be connected with activity, jumping on a trampoline, jogging. It can also be connected with coughing, sneezing, laughing. There is also a leakage of urine that can occur if you can't get to the toilet in time, so leaking before you make it to pass urine under control in the toilet.
There is also the back passage. It's not something that we often like to talk about necessarily, but we always universally have a giggle about incontinence of flatus, which is wind, passing wind without wanting to.
There is also incontinence, anal incontinence and faecal incontinence which is losing a stool; not being able to control the stool.
Ellen Leabeater: What causes pelvic floor dysfunctions?
Heather Pierce: There are a lot of different causes. A lot of different causes.
Ellen Leabeater: Well let's look at women, because that's where your research is focused on.
Jake Morcom: In the childbearing years and particularly women who have had a vaginal delivery or trauma surrounding vaginal delivery, they are more likely to have some form of pelvic floor dysfunction. It could be connected to nerve, nervous input into the muscles. It could be weakness of the muscles, trauma to the muscles. So stress incontinence is the most common form.
Ellen Leabeater: Having this pelvic floor dysfunction is obviously a bit embarrassing and would effect on people's work, correct?
Heather Pierce: That's right. If you're concerned about leaking urine there is a lot of stigma that can be associated with that. It can be kind of stressful if you can't get to the bathroom, if you can't get to the bathroom to empty your bladder.
There has been a little bit of research around looking at the nurses' bladder; nurses holding on because they have to hold on or reducing their fluids because they're perhaps in theatre and they can't get to the toilet and leave the operating theatre. So we know that there are perhaps workforce issues surrounding nurses being able to have that, what we would call a healthy bladder habits.
Ellen Leabeater: You have been looking at nurses and midwives in particular. You've just done a review. What have you found about their pelvic floor dysfunctions?
Heather Pierce: Well one of the main findings of the review is that we don’t know a lot. The majority of nurses are female and so we know, I think it's around 90 per cent of the nursing and midwifery workforce are female. Also nurses and midwives are getting older so we also know that pelvic floor dysfunction or the prevalence of different types of dysfunction increase increases with age.
Another factor that influences things is obesity so we know that if you're overweight or obese it doubles your risk of having all different types of incontinence.
We know that it's in the workforce, but what we don't know is whether it affects a nurse or a midwife's ability to do their work, so their work productivity.
If we define productivity as either being absent - so having sick leave or leaving the workforce or being at work but not being able to perform fully to do what's required in their job, then nurses and midwives may change their positions or leave certain positions, particularly if they're not able to get to the toilet or control that urine leakage - if it's a urine leakage problem.
Ellen Leabeater: You've done this review, what's the next step in your research?
Heather Pierce: Two studies turned up; there weren't many studies that looked particularly at pelvic floor dysfunction in workforce groups and workforce groups as in identifying which particular workforce.
There are some large studies that look at the dysfunction of something called overactive bladder. An overactive bladder is where you need to run to the toilet a lot; or looked at incontinence itself.
We know that from those large population-based studies that having overactive bladder or having incontinence does impact, it seems to impact your work productivity. However we haven't looked at particular workforce groups like nurses and midwives and we know, as I said before, that predominantly they're female.
Ellen Leabeater: So the next phase of your research is going to be looking at nurses and midwives in particular; what their lower urinary symptoms are and how that affects their productivity.
Heather Pierce: Yeah, well I'm going to look at not just incontinence but the broader definition of lower urinary tract symptoms. Going to be asking nurses and midwives about their work habits and their bladder habits and also looking at their productivity. So trying to match up and to see whether those symptoms of leakage or those bladder symptoms whether they make a difference to the nurse's ability to do her work and whether, if they have symptoms, whether they predict their choices about leaving their role or in fact leaving the workforce.
The research will also be hoping to provide recommendations for the workforces, so by interviewing and talking to nurses and midwives about their experience, not only identifying the problem and if there is an impact on their ability to work as nurses and midwives, but providing employers with strategies for what we call pelvic floor health promotion.
Ellen Leabeater: If you do have a pelvic floor dysfunction can it be fixed?
Heather Pierce: Well that's the good news. Yes. In a lot of cases - because this is a fairly intimate problem it's not something that a lot of us talk about. I think even as women, as nurses and midwives, it's embarrassing. It can be embarrassing to admit to anybody really that you leak urine. So there is often a big cover up. You know you will use your pads; you'll go to the toilet more frequently just in case so that you don’t have those symptoms.
So part of the importance of this research is talking about it and talking about it so that we can develop strategies that help promote what we know is the evidence. The evidence particular around your incontinence is that it can be helped.
There is very strong evidence and we call it a Level 1 evidence and a Grade A recommendation to do pelvic floor muscle training to help with incontinence and also for bladder training to help with symptoms of urge incontinence or an overactive bladder.
Those strategies should be guided by a health professional.
Ellen Leabeater: Heather Pierce, PhD Candidate in the Faculty of Health at UTS.
Compere: You're listening to Think Health on 2SER - 107.3.
Ellen Leabeater: Welcome back to the program. Ellen Leabeater with you.
Early childhood educators are vital to a child's development but how much do they know about childhood trauma? For example, when an otherwise content toddler starts having tantrums that are very out of character how should their pre-school teacher react?
Professor Lawrence Lam has been looking at how to better train early educators in their knowledge of social emotional development and emotional intelligence.
Lawrence is a Professor of Public Health at UTS. He's been training early childhood teachers in Hong Kong about emotional intelligence and how to weave that into curriculums.
Lawrence Lam: Early child teachers actually play a very important role in the development and growth of young children. Given that young children, the most crucial sort of input for the growth and development would be from their parents definitely as well as their close relatives. Nowadays a lot of young children actually spend quite a lot of time in kindergarten, so early educators or early childhood educators play a very very crucial role for the overall development of course, but also for the socioemotional development of young children.
Ellen Leabeater: Your research is mainly focused in Hong Kong. What sort of education do early educators get in Hong Kong?
Lawrence Lam: The early educators or the early childhood teachers will receive different types of training. All depends on whether they will be able to get into a degree program.
There are degree-based, what we call the early childhood teachers. They're fully trained. They have basic sort of training in early childhood development as well as early child pedagogy, curriculum design and all these sorts of things as a full degree program. It's a Bachelor degree in education for early childhood.
There is also another layer of or another avenue for training for those who would like to get involved in that industry. There is a profession of training courses, like in those what we call the vocational training institutes.
Ellen Leabeater: Your research has been looking at trauma. How much do early educators learn about childhood trauma?
Lawrence Lam: In terms of trauma - childhood trauma actually has got a very broad sort of definition. What I'm really interested in is more of the socio, more of the emotional and psychological type of trauma.
Ellen Leabeater: So what would you define as emotional and psychological trauma?
Lawrence Lam: Well any incidents that actually cause discomfort to the child and it may actually have sort of psychological impact.
Ellen Leabeater: Can you give us some examples?
Lawrence Lam: In terms of physical trauma of course when you experience a car crash or whatever, you have a physical component or a physical injury, but at the same time you also have psychological effect. Of course that will be the trauma that, more of the psychological trauma associated with the incident.
There are other types of trauma that children may experience will just be quite common in a lot of families, like for example parents having a dispute. So those are actually very traumatic experiences for children, particularly for young children. They may not be able to express it. They may not be able to verbalise it, but nevertheless there is kind of an impact on them.
Ellen Leabeater: So you said that children often can't verbalise what's happening to them. Are there other ways that they may express that they're going through psychological or emotional trauma?
Lawrence Lam: Absolutely. A lot of young kids, when they have experienced that sort of emotional and psychological trauma, if they couldn't express it verbally they will express it in another way like in their behaviour. They may actually experience difficulties in their sleep. They may actually have kind of, what we call aggression.
For example young kids, very young kids, after they have gone through the toilet training period, they could be able to control their bowel, could be able to control their toiletry habit, but once they experience that sort of traumatic experience they may actually have some sort of regression.
Ellen Leabeater: Are early educators trained to recognise these signs and symptoms?
Lawrence Lam: Not that I am aware of, particularly in Hong Kong - [in situations] in Hong Kong because early child educators or teachers they are not; it is not their role really in…
Ellen Leabeater: So that's probably the domain of child psychologists.
Lawrence Lam: Strictly speaking it should be. No doubt early childhood educators or teachers they do have some basic understanding and training in early childhood development, but in terms of identifying socioemotional problems and sometimes an emotion, actually emotional difficulties within the early childhood period, it's not that easy.
Some of those teachers may just be sort of mislabelling just naughtiness or sometimes it's other behavioural issues.
Ellen Leabeater: You've actually done a project recently where you've addressed this with early childhood educators. Can you tell us a bit about what you actually did?
Lawrence Lam: Yes. The project I am actually sort of conducting in Hong Kong is really to provide training in specific areas of socioemotional development for early childhood educators, particularly in the aspect that we would like to enhance their so-called socioemotional literacy. That means we want to enhance their understanding and the appreciation of the socioemotional sort of development of young children.
On top of that we also would like to provide some sort of help and support for the early childhood teachers and educators in terms of their own personal socioemotional growth. So in a sense we would like to enhance their so-called socioemotional intelligence so that they will be able to understand not just the children's development but also their own personal need.
Ellen Leabeater: So it's all about getting teachers to recognise the emotions of their students?
Lawrence Lam: That's right. Yes exactly. That is really correct. We would like them to, not just to recognise but also to also enhance those positive emotions and also to have some of the basic skills of handling some of the negative emotions.
Like for example if a young child is throwing a tantrum in class and sometimes the teacher may not really understand why, the reason for that sort of behaviour and how to handle it right there. It may not necessarily need to be able to resolve the emotion, but at least if the teacher has some basic training in handling right at that moment and diverting the anger or the aggression in some other sort of way or in some other sort of avenue, then that can actually be quite positive.
On one hand the class will not be disrupted. On the other hand the child would be able to, in a sense protected and in a safe environment, and also the teacher would be able to handle and also talk to the kids later on and try to resolve the emotion.
Ellen Leabeater: Lawrence Lam, Professor of Public Health at UTS.
Don’t forget, if you'd like to find out more about anything you've heard today you can visit us at 2SER.com/thinkhealth. We're also available on demand, just search for Think Health in your favourite podcast app.
Please remember that you should not consider the contents of this show medical advice. If we have made you ask questions go and see your GP.
This show is produced with the support of the University of Technology Sydney Faculty of Health.
I'm Ellen Leabeater. See you next week for more in health research and news.
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