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Giannaki CD, Grigoriou SS, George K, Karatzaferi C, Zigoulis P, Lavdas E, Chaniotis D, Stefanidis I, Sakkas GK. Nine Months of Hybrid Intradialytic Exercise Training Improves Ejection Fraction and Cardiac Autonomic Nervous System Activity. Sports (Basel) 2023; 11:sports11040079. [PMID: 37104153 PMCID: PMC10143437 DOI: 10.3390/sports11040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Cardiovascular disease is the most common cause of death in hemodialysis (HD) patients. Intradialytic aerobic exercise training has a beneficial effect on cardiovascular system function and reduces mortality in HD patients. However, the impact of other forms of exercise on the cardiovascular system, such as hybrid exercise, is not clear. Briefly, hybrid exercise combines aerobic and strength training in the same session. The present study examined whether hybrid intradialytic exercise has long-term benefits on left ventricular function and structure and the autonomous nervous system in HD patients. In this single-group design, efficacy-based intervention, twelve stable HD patients (10M/2F, 56 ± 19 years) participated in a nine-month-long hybrid intradialytic training program. Both echocardiographic assessments of left ventricular function and structure and heart rate variability (HRV) were assessed pre, during and after the end of the HD session at baseline and after the nine-month intervention. Ejection Fraction (EF), both assessed before and at the end of the HD session, appeared to be significantly improved after the intervention period compared to the baseline values (48.7 ± 11.1 vs. 58.8 ± 6.5, p = 0.046 and 50.0 ± 13.4 vs. 56.1 ± 3.4, p = 0.054 respectively). Regarding HRV assessment, hybrid exercise training increased LF and decreased HF (p < 0.05). Both conventional Doppler and tissue Doppler imaging indices of diastolic function did not change after the intervention period (p > 0.05). In conclusion, long-term intradialytic hybrid exercise training was an effective non-pharmacological approach to improving EF and the cardiac autonomous nervous system in HD patients. Such exercise training programs could be incorporated into HD units to improve the patients’ cardiovascular health.
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Affiliation(s)
- Christoforos D. Giannaki
- Department of Life Sciences, University of Nicosia, Nicosia 2417, Cyprus
- Research Centre for Exercise and Nutrition (RECEN), Nicosia 2417, Cyprus
| | - Stefania S. Grigoriou
- School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100 Trikala, Greece
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L2 2QP, UK
| | - Christina Karatzaferi
- School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100 Trikala, Greece
| | - Paris Zigoulis
- Department of Medicine, School of Health Science, University of Thessaly, 38221 Larissa, Greece
| | - Eleftherios Lavdas
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Dimitrios Chaniotis
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Ioannis Stefanidis
- Department of Medicine, School of Health Science, University of Thessaly, 38221 Larissa, Greece
| | - Giorgos K. Sakkas
- School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100 Trikala, Greece
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK
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Michou V, Liakopoulos V, Roumeliotis S, Roumeliotis A, Anifanti M, Tsamos G, Papagianni A, Zempekakis P, Deligiannis A, Kouidi E. Effects of Home-Based Exercise Training on Cardiac Autonomic Neuropathy and Metabolic Profile in Diabetic Hemodialysis Patients. Life (Basel) 2023; 13:life13010232. [PMID: 36676181 PMCID: PMC9866875 DOI: 10.3390/life13010232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/26/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
Background: This study aimed to investigate the effects of a home-based exercise training program on Cardiac Autonomic Neuropathy (CAN) and metabolic profile in Diabetic Kidney Disease (DKD) patients undergoing maintenance hemodialysis (HD). Method: Twenty-eight DKD patients undergoing hemodialysis were randomly assigned into two groups. The exercise (EX) group followed a 6-month combined exercise training program at home, while the control (CO) group remained untrained. All participants at baseline and the end of the study underwent cardiopulmonary exercise testing (CPET), biochemical tests for glucose and lipid profile, and 24-h electrocardiographic monitoring for heart rate variability (HRV) analysis and heart rate turbulence (HRT). Results: At the end of the study, compared to the CO, the EX group showed a significant increase in serum high-density lipoprotein (HDL) by 27.7% (p = 0.01), peak oxygen uptake (VO2peak) by 9.3% (p < 0.05), the standard deviation of R-R intervals (SDNN) by 34.3% (p = 0.03), percentage of successive RR intervals higher than 50ms (pNN50) by 51.1% (p = 0.02), turbulence slope (TS) index by 18.4% (p = 0.01), and decrease in (glycated hemoglobin) HbA1c by 12.5% (p = 0.04) and low-frequency power LF (ms2) by 29.7% (p = 0.01). Linear regression analysis after training showed that VO2peak was correlated with SDNN (r = 0.55, p = 0.03) and HF (r = 0.72, p = 0.02). Multiple regression analysis indicated that the improvement of sympathovagal balance and aerobic capacity depended on patients’ participation in exercise training. Conclusion: In conclusion, a 6-month home-based mixed-type exercise program can improve cardiac autonomic function and metabolic profile in DKD patients on HD.
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Affiliation(s)
- Vassiliki Michou
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Maria Anifanti
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Georgios Tsamos
- Laboratory of Hygiene, Department of Internal Medicine, Agios Dimitrios Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University, 57001 Thessaloniki, Greece
| | - Pantelis Zempekakis
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-69-3704-0265
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Mitsiou M, Dimitros E, Roumeliotis S, Liakopoulos V, Kouidi E, Deligiannis A. Effects of a Combined Intradialytic Exercise Training Program and Music on Cardiac Autonomic Nervous System Activity in Hemodialysis Patients. Life (Basel) 2022; 12:life12081276. [PMID: 36013455 PMCID: PMC9410492 DOI: 10.3390/life12081276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to examine the effect of an intradialytic exercise program in combination with music on heart rate variability (HRV) indices and functional capacity in patients on maintenance hemodialysis (HD). Methods: Forty HD patients were randomized to four training groups for six months: the combined music and exercise group (Group A), the exercise group (Group B), the music group (Group C), and the control group (Group D). At baseline and after 6 months, all participants underwent both short- (for 30 min) and long- (for 24 h) term measurements of HRV and functional capacity assessment with a 6 min walking test (6MWT). Patients of groups A and C listened to preferred music. Results: Long-term HRV analysis showed that standard deviation of all normal-to-normal RR intervals (SDNN) and the square root of the mean squared differences of successive RR intervals (rMSSD) were significantly higher at the end of the study in groups A (by 13.2% and 47.3%), B (by 15.1% and 50%), and C (by 9.0% and 30.1%), compared to group D (p < 0.05). Values of rMSSD and percentage of RR intervals differing by more than 50 ms from the preceding RR interval (pNN50) were elevated in groups A (by 35.6% and 142.9%), B (by 36.1% and 75%), and C (by 15.2% and 28.6%), compared to baseline measurements (p < 0.05). Also, pNN50 was increased in group A compared to groups B (by 21.4%), C (by 88.9%), and D (by 142.9%) (p < 0.05). Similar results were noted by short-term HRV analysis. Functional capacity was improved at the end of the 6-month study in groups A (by 20.3% and 25.7%) and B (by 15.8% and 21.1%) compared to groups C and D (p < 0.05). Conclusions: Intradialytic exercise combined with music-listening can improve the functional capacity and cardiac autonomic nervous system activity in hemodialysis patients.
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Affiliation(s)
- Maria Mitsiou
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Eleftherios Dimitros
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-231-099-4694
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
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Junqué‐Jiménez A, Morera‐Mas A, Pérez‐Ventana‐Ortiz C, Andreu‐Periz L, Segura‐Ortí E. Home‐based exercise programs in patients with chronic kidney disease: A systematic review and META‐analysis. Worldviews Evid Based Nurs 2022; 19:322-337. [DOI: 10.1111/wvn.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/16/2022] [Accepted: 02/26/2022] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - Lola Andreu‐Periz
- Departament d'Infermeria Fonamental i Medicoquirúrgica, Facultat de Medicina i Ciències de la Salut Universitat de Barcelona Barcelona Spain
| | - Eva Segura‐Ortí
- Phyiotherapy Department Universidad Cardenal Herrera‐CEU, CEU Universities València Spain
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Wundersitz DWT, Wright BJ, Gordon BA, Pompei S, Lavie CJ, Nadurata V, Nolan K, Kingsley MIC. Sympathovagal Balance Is a Strong Predictor of Post High-Volume Endurance Exercise Cardiac Arrhythmia. Front Physiol 2022; 13:848174. [PMID: 35388290 PMCID: PMC8978599 DOI: 10.3389/fphys.2022.848174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Regular physical activity is important for cardiovascular health. However, high-volume endurance exercise has been associated with increased number of electrocardiogram (ECG) abnormalities, including disturbances in cardiac rhythm (arrhythmias) and abnormalities in ECG pattern. The aim of this study was to assess if heart rate variability (HRV) is associated with ECG abnormalities. Fifteen participants with previous cycling experience completed a 21-day high-volume endurance exercise cycle over 3,515 km. Participants wore a 5-lead Holter monitor for 24 h pre- and post-exercise, which was used to quantify ECG abnormalities and export sinus R-to-R intervals (NN) used to calculate HRV characteristics. As noise is prevalent in 24-h HRV recordings, both 24-h and heart rate collected during stable periods of time (i.e., deep sleep) were examined. Participants experienced significantly more arrhythmias post high-volume endurance exercise (median = 35) compared to pre (median = 12; p = 0.041). All 24-h and deep sleep HRV outcomes were not different pre-to-post high-volume endurance exercise (p > 0.05). Strong and significant associations with arrhythmia number post-exercise were found for total arrhythmia (total arrhythmia number pre-exercise, ρ = 0.79; age, ρ = 0.73), supraventricular arrhythmia (supraventricular arrhythmia number pre-exercise: ρ = 0.74; age: ρ = 0.66), and ventricular arrhythmia (age: ρ = 0.54). As a result, age and arrhythmia number pre-exercise were controlled for in hierarchical regression, which revealed that only deep sleep derived low frequency to high frequency (LF/HF) ratio post high-volume endurance exercise predicted post total arrhythmia number (B = 0.63, R2Δ = 34%, p = 0.013) and supraventricular arrhythmia number (B = 0.77, R2Δ = 69%, p < 0.001). In this study of recreationally active people, only deep sleep derived LF/HF ratio was associated with more total and supraventricular arrhythmias after high-volume endurance exercise. This finding suggests that measurement of sympathovagal balance during deep sleep might be useful to monitor arrhythmia risk after prolonged high-volume endurance exercise performance.
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Affiliation(s)
- Daniel W. T. Wundersitz
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
- *Correspondence: Daniel W. T. Wundersitz,
| | - Bradley J. Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Brett A. Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Stephanie Pompei
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, United States
| | | | - Kimberly Nolan
- Cardiology Department, Bendigo Health, Bendigo, VIC, Australia
| | - Michael I. C. Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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6
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Bernier-Jean A, Beruni NA, Bondonno NP, Williams G, Teixeira-Pinto A, Craig JC, Wong G. Exercise training for adults undergoing maintenance dialysis. Cochrane Database Syst Rev 2022; 1:CD014653. [PMID: 35018639 PMCID: PMC8752366 DOI: 10.1002/14651858.cd014653] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. OBJECTIVES To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. SEARCH METHODS In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. DATA COLLECTION AND ANALYSIS Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. MAIN RESULTS We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to the meta-analyses. Seven studies included adults undergoing peritoneal dialysis. Fifty-six studies reported aerobic exercise interventions, 21 resistance exercise interventions and 19 combined aerobic and resistance training within the same study arm. The interventions lasted from eight weeks to two years and most often took place thrice weekly during dialysis treatments. A single study reported death and no study reported long-term cardiovascular events. Five studies directly assessed fatigue, 46 reported HRQoL and 16 reported fatigue or pain through their assessment of HRQoL. Thirty-five studies assessed functional capacity, and 21 reported resting peripheral blood pressure. Twelve studies reported adherence to exercise sessions, and nine reported exercise-related adverse events. Overall, the quality of the included studies was low and blinding of the participants was generally not feasible due to the nature of the intervention. Exercise had uncertain effects on death, cardiovascular events, and the mental component of HRQoL due to the very low certainty of evidence. Compared with sham or no exercise, exercise training for two to 12 months may improve fatigue in adults undergoing dialysis, however, a meta-analysis could not be conducted. Any exercise training for two to 12 months may improve the physical component of HRQoL (17 studies, 656 participants: MD 4.12, 95% CI 1.88 to 6.37 points on 100 points-scale; I² = 49%; low certainty evidence). Any exercise training for two to 12 months probably improves depressive symptoms (10 studies, 441 participants: SMD -0.65, 95% CI -1.07 to -0.22; I² = 77%; moderate certainty evidence) and the magnitude of the effect may be greater when maintaining the exercise beyond four months (6 studies, 311 participants: SMD -0.30, 95% CI 0.14 to -0.74; I² = 71%). Any exercise training for three to 12 months may improve pain (15 studies, 872 participants: MD 5.28 95% CI -0.12 to 10.69 points on 100 points-scale; I² = 63%: low certainty evidence) however, the 95% CI indicates that exercise training may make little or no difference in the level of pain. Any exercise training for two to six months probably improves functional capacity as it increased the distance reached during six minutes of walking (19 studies, 827 participants: MD 49.91 metres, 95% CI 37.22 to 62.59; I² = 34%; moderate certainty evidence) and the number of sit-to-stand cycles performed in 30 seconds (MD 2.33 cycles, 95% CI 1.71 to 2.96; moderate certainty evidence). There was insufficient evidence to assess the safety of exercise training for adults undergoing maintenance dialysis. The results were similar for aerobic exercise, resistance exercise, and a combination of both aerobic and resistance exercise. AUTHORS' CONCLUSIONS It is uncertain whether exercise training improves death, cardiovascular events, or the mental component of HRQoL in adults undergoing maintenance dialysis. Exercise training probably improves depressive symptoms, particularly when the intervention is maintained beyond four months. Exercise training is also likely to improve functional capacity. Low certainty evidence suggested that exercise training may improve fatigue, the physical component of quality of life, and pain. The safety of exercise training for adults undergoing dialysis remains uncertain.
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Affiliation(s)
- Amelie Bernier-Jean
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Nadim A Beruni
- Resident Support Unit, Western Sydney Local Health District, Westmead, Australia
| | - Nicola P Bondonno
- School of Biomedical Sciences, The University of Western Australia, Royal Perth Hospital, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Gabrielle Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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7
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Kouidi EJ, Kaltsatou A, Anifanti MA, Deligiannis AP. Early Left Ventricular Diastolic Dysfunction, Reduced Baroreflex Sensitivity, and Cardiac Autonomic Imbalance in Anabolic-Androgenic Steroid Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136974. [PMID: 34209901 PMCID: PMC8295852 DOI: 10.3390/ijerph18136974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 12/30/2022]
Abstract
The effects of androgen anabolic steroids (AAS) use on athletes’ cardiac autonomic activity in terms of baroreflex sensitivity (BRS), and heart rate variability (HRV) have not yet been adequately studied. Furthermore, there is no information to describe the possible relationship between the structural and functional cardiac remodeling and the cardiac autonomic nervous system changes caused by AAS abuse. Thus, we aimed to study the effects of long-term AAS abuse on cardiac autonomic efficacy and cardiac adaptations in strength-trained athletes. In total, 80 strength-trained athletes (weightlifters and bodybuilders) participated in the study. Notably, 40 of them using AAS according to their state formed group A, 40 nonuser strength-trained athletes comprised group B, and 40 healthy nonathletes (group C) were used as controls. All subjects underwent a head-up tilt test using the 30 min protocol to evaluate the baroreflex sensitivity and short HRV modulation. Furthermore, all athletes undertook standard echocardiography, a cardiac tissue Doppler imaging (TDI) study, and a maximal spiroergometric test on a treadmill to estimate their maximum oxygen consumption (VO2max). The tilt test results showed that group A presented a significantly lower BRS and baroreflex effectiveness index than group B by 13.8% and 10.7%, respectively (p < 0.05). Regarding short-term HRV analysis, a significant increase was observed in sympathetic activity in AAS users. Moreover, athletes of group A showed increased left ventricular (LV) mass index (LVMI) by 8.9% (p < 0.05), compared to group B. However, no difference was found in LV ejection fraction between the groups. TDI measurements indicated that AAS users had decreased septal and lateral peak E’ by 38.0% (p < 0.05) and 32.1% (p < 0.05), respectively, and increased E/E’ by 32.0% (p < 0.05), compared to group B. This LV diastolic function alteration was correlated with the year of AAS abuse. A significant correlation was established between BRS depression and LV diastolic impairment in AAS users. Cardiopulmonary test results showed that AAS users had significantly higher time to exhaustion by 11.0 % (p < 0.05) and VO2max by 15.1% (p < 0.05), compared to controls. A significant correlation was found between VO2max and LVMI in AAS users. The results of the present study indicated that long-term AAS use in strength-trained athletes led to altered cardiovascular autonomic modulations, which were associated with indices of early LV diastolic dysfunction.
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Deligiannis A, D'Alessandro C, Cupisti A. Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health. Clin Kidney J 2021; 14:ii25-ii33. [PMID: 33981417 PMCID: PMC8101623 DOI: 10.1093/ckj/sfaa273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022] Open
Abstract
Dialysis patients show a high rate of reduced functional capacity, morbidity and mortality. Cardiovascular disorders, muscle atrophy and malnutrition play an essential role among the aetiological factors. Sedentary lifestyle characterizes them and contributes to the aggravation of the disorders. On the contrary, exercise training is an important preventive and therapeutic tool both for cardiovascular problems and for the appearance of muscle atrophy in dialysis patients. Regular exercise causes both central (cardiac) and peripheral (muscular) adaptations, improving functional capacity. In particular, circulatory system clinical trials in haemodialysis (HD) patients documented that exercise has favourable effects on heart function, promotes balance on the cardiac autonomic nervous system and contributes to the management of arterial hypertension. In the muscular system, it prevents muscle atrophy or contributes significantly to its treatment. The main preventive mechanisms of the beneficial effect of exercise on the muscles constitute the inhibition of the apoptotic processes and protein degradation. Exercise training in HD patients leads to an increase of muscle fibers, mitochondria and capillaries, and the combination of regular exercise and dietary strategies is even more effective in preventing or treating muscle atrophy. Finally, an improvement in functional capacity and quality of life was found also in peritoneal dialysis patients following exercise training.
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Affiliation(s)
- Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thermi, Greece
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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9
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Garibotto G, Saio M, Aimasso F, Russo E, Picciotto D, Viazzi F, Verzola D, Laudon A, Esposito P, Brunori G. How to Overcome Anabolic Resistance in Dialysis-Treated Patients? Front Nutr 2021; 8:701386. [PMID: 34458305 PMCID: PMC8387577 DOI: 10.3389/fnut.2021.701386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023] Open
Abstract
A current hypothesis is that dialysis-treated patients are "anabolic resistant" i. e., their muscle protein synthesis (MPS) response to anabolic stimuli is blunted, an effect which leads to muscle wasting and poor physical performance in aging and in several chronic diseases. The importance of maintaining muscle mass and MPS is often neglected in dialysis-treated patients; better than to describe mechanisms leading to energy-protein wasting, the aim of this narrative review is to suggest possible strategies to overcome anabolic resistance in this patient's category. Food intake, in particular dietary protein, and physical activity, are the two major anabolic stimuli. Unfortunately, dialysis patients are often aged and have a sedentary behavior, all conditions which per se may induce a state of "anabolic resistance." In addition, patients on dialysis are exposed to amino acid or protein deprivation during the dialysis sessions. Unfortunately, the optimal amount and formula of protein/amino acid composition in supplements to maximixe MPS is still unknown in dialysis patients. In young healthy subjects, 20 g whey protein maximally stimulate MPS. However, recent observations suggest that dialysis patients need greater amounts of proteins than healthy subjects to maximally stimulate MPS. Since unneccesary amounts of amino acids could stimulate ureagenesis, toxins and acid production, it is urgent to obtain information on the optimal dose of proteins or amino acids/ketoacids to maximize MPS in this patients' population. In the meantime, the issue of maintaining muscle mass and function in dialysis-treated CKD patients needs not to be overlooked by the kidney community.
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Affiliation(s)
- Giacomo Garibotto
- Department of Internal Medicine, University of Genoa, Genova, Italy
- *Correspondence: Giacomo Garibotto
| | - Michela Saio
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Francesca Aimasso
- Clinical Nutrition Unit, Istituto di Ricerca a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniela Picciotto
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Alessandro Laudon
- Division of Nephrology and Dialysis, Ospedale Santa Chiara, Trento, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuliano Brunori
- Division of Nephrology and Dialysis, Ospedale Santa Chiara, Trento, Italy
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10
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Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach. Nutrients 2020; 12:nu12061814. [PMID: 32570738 PMCID: PMC7353433 DOI: 10.3390/nu12061814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Sustained physical activity extends healthy life years while a lower activity due to sarcopenia can reduce them. Sarcopenia is defined as a decrease in skeletal muscle mass and strength due not only to aging, but also from a variety of debilitating chronic illnesses such as cancer and heart failure. Patients with chronic kidney disease (CKD), who tend to be cachexic and in frail health, may develop uremic sarcopenia or uremic myopathy due to an imbalance between muscle protein synthesis and catabolism. Here, we review clinical evidence indicating reduced physical activity as renal function deteriorates and explore evidence-supported therapeutic options focusing on nutrition and physical training. In addition, although sarcopenia is a clinical concept and difficult to recapitulate in basic research, several in vivo approaches have been attempted, such as rodent subtotal nephrectomy representing both renal dysfunction and muscle weakness. This review highlights molecular mechanisms and promising interventions for uremic sarcopenia that were revealed through basic research. Extensive study is still needed to cast light on the many aspects of locomotive organ impairments in CKD and explore the ways that diet and exercise therapies can improve both outcomes and quality of life at every level.
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11
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Comparison of clinical outcomes following early rehabilitation in 3 cases of nephrotic syndrome with different treatment courses. CEN Case Rep 2020; 9:365-369. [PMID: 32390106 DOI: 10.1007/s13730-020-00486-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
There have been few published reports regarding rehabilitation for nephrotic syndrome. We compared the clinical outcomes of three cases of nephrotic syndrome with different treatment courses during 5 weeks of early rehabilitation.We report on three cases of nephrotic syndrome. Case 1 was a 67-year-old male who showed good progress after steroid treatment. Quadriceps torque and exercise capacity were increased after intervention. Case 2, a 78-year-old male, demonstrated resistance to steroid treatment. Quadriceps torque was decreased and exercise capacity was increased after intervention. Case 3 was an 83-year-old male who received nutrition therapy and diuretics without steroid treatment. Quadriceps torque and exercise capacity were decreased post-intervention.Early rehabilitation should be considered even if the steroid treatment course is different; furthermore, it is necessary to carefully consider the optimal exercise load in patients with nephrotic syndrome for whom regardless of whether or not steroid treatment is used.
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12
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Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials. J Clin Med 2019; 9:jcm9010043. [PMID: 31878176 PMCID: PMC7019709 DOI: 10.3390/jcm9010043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 01/22/2023] Open
Abstract
There is a lack of agreement on the efficacy of different exercise interventions in hemodialysis patients. We analyzed which exercise type is the most beneficial in terms of functional fitness and inflammation. A literature search of seven databases yielded 33 studies that met the inclusion criteria. Compared with an inactive control, the intervention group showed moderate effects (ES = 0.74; 95% CI 0.35 to 1.14; p < 0.001; and ES = 0.70; 95% CI 0.39 to 1.01; p < 0.001; respectively) on functional capacity (six-minute walk test) and oxygen consumption. Small nonsignificant effects were observed for aerobic (ES = -0.36; 95% CI -0.85 to 0.13; p = 0.154) and resistance (ES = -0.44; 95% CI -1.07 to 0.19; p = 0.169) training types, whereas moderate effects were found for combined (ES = -0.69; 95% CI -1.47 to 0.10; p = 0.088) training type based on a 10-repetition sit-to-stand test. Further, large and small effects were observed for aerobic (ES = -1.21; 95% CI -1.94 to -0.49; p = 0.001) and resistance training (ES = -0.54; 95% CI -0.90 to -0.17; p = 0.004) types on C-reactive protein. Overall, the results showed the numerically largest effect sizes for combined types compared to solely aerobic or resistance training types, with the differences between training types not reaching statistical significance. There was a significant modifying impact of age, training frequency, and session duration on performance and inflammatory outcomes.
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13
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Aerobic exercise in adults with chronic kidney disease (CKD): a meta-analysis. Int Urol Nephrol 2019; 51:1787-1795. [PMID: 31332699 DOI: 10.1007/s11255-019-02234-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/15/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Patients with chronic kidney disease (CKD) are frail and have high risk of cardiovascular disease. This study was performed to assess the effects of aerobic exercise training in adults with CKD. METHODS MEDLINE, EMBASE, CENTRAL, Web of Science were searched up to December 2018 to identify eligible randomized controlled trials (RCTs) that studied aerobic exercise in adults with CKD. Primary outcomes include oxygen consumption at peak exercise (VO2 peak), exercise capacity, blood pressure, heart rate, and health-related quality of life (HRQoL). Statistical analysis was performed using Review Manager 5.2.1 software. RESULTS Thirty-one trials, containing 1305 adults with CKD, were included. The most used aerobic exercise program was characterized as moderate intensity (15/31), 3 times/week frequency (22/31), 30 min duration (9/31) and 3 months follow-up (12/31). Significant improvement was observed in cardiorespiratory function (VO2 peak) (P < 0.0001), exercise duration (P < 0.0001), HDL-C (P = 0.03) and pain (P = 0.007), physical role (P = 0.03), general health (P = 0.007) of HRQoL after aerobic exercise in patients with CKD. A marginal difference was observed in HR max (P = 0.07). However, no statistical difference was noticed in exercise capacity, blood pressure, resting heart rate, serum lipid and serum creatinine between aerobic training group and control. No subgroup differences were altered in all outcomes when studies were divided based on intensity of exercise training, the treatment of dialysis or the length of intervention. CONCLUSIONS Aerobic exercise training could benefit adult CKD patients in increasing cardiorespiratory function, exercise duration, HDL-C level and improve health quality of life.
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Yamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, Konta T, Fujii N, Kanda E, Sofue T, Ishizuka K, Kitagawa M, Kono K, Hinamoto N, Miyai T, Koike K, Toda S, Hasegawa J, Yamanouchi M, Yoshimura R, Ishii R, Goto S, Kawarazaki H, Takase K, Taki F, Matsumura M, Raita Y, Sakurai S, Shimizu T, Yamanoto S, Kawaguchi T, Oguchi H, Tsujita M, Yazawa M, Uchida A, Ando Y, Kaneko S, Matsunaga A, Harada T, Ito O, Kohzuki M. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0209-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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15
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Maia TO, Paiva DN, Sobral Filho DC, Cavalcanti FCB, Rocha LG, Andrade CCA, Macedo Júnior ARA, Marinho PEM. Does whole body vibration training improve heart rate variability in kidney transplants patients? A randomized clinical trial. J Bodyw Mov Ther 2019; 24:50-56. [PMID: 32507152 DOI: 10.1016/j.jbmt.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Whole-body vibration (WBV) is an exercise modality that can promote improvements in heart rate variability (HRV) with lower patient overload, and consequently reduce cardiovascular risk in renal transplant patients. The aim of this study was to evaluate the effects of a 12-week WBV training program of two weekly sessions on HRV. METHODS A double-blind, randomized controlled clinical trial with 12 kidney transplant recipients of both genders who underwent WBV training (35 Hz) twice a week for 12 weeks on alternate days (WBV Group) and training with sub-therapeutic WBV (8 Hz) (Sham Group). Variables were evaluated in time and frequency domains of HRV through the 24-h Holter monitor, heart rate (HR), blood pressure (BP) and maximum oxygen consumption (VO2max) through an exercise stress test. RESULTS The delta between Sham and WBV groups showed an increase in the low frequency (Δ = 959.05 Hz; p = 0.01) and in the high frequency (Δ = 204.42 Hz; p = 0.04) of the HRV compared to Sham group. No changes in the ergometric variables were observed for any of the groups. CONCLUSION The present study evidenced an increase in the low and high frequency of HRV in individuals who participated in the Sham WBV group. There was no improvement in the autonomic balance in the groups, in the other HRV parameters, or the exercise test after the WBV training period.
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Affiliation(s)
- Tuíra O Maia
- Post-Graduation Program Health Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil.
| | - Dulciane N Paiva
- Post-Graduation Program in Health Promotion, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil.
| | - Dário C Sobral Filho
- Coronary Care Unit of Pernambuco Cardiac Emergency Hospital, Universidade de Pernambuco, Recife, PE, Brazil.
| | | | - Lívia G Rocha
- Post-Graduation Program in Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil.
| | - Camila C A Andrade
- Integrated Multiprofessional Residency Program in Health, Clinics Hospital of Universidade Federal de Pernambuco, Brazil.
| | | | - Patrícia E M Marinho
- Post-Graduation Program Health Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil; Post-Graduation Program in Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil.
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16
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Abstract
Clinical manifestations of functional and morphological muscular abnormalities in dialysis patients are muscle weakness and low exercise capacity, possibly leading to a sedentary life style with low physical activity. Low cardiorespiratory fitness and muscle atrophy and weakness contribute to the development of frailty and affect patients' ability to physically navigate their environment. While many dialysis patients may appear too frail to participate in moderate-to-vigorous aerobic exercise training, those who can complete such programs appear to derive substantial benefit. Less vigorous aerobic exercise, resistance training, and alternative forms of exercise can also be beneficial. Most patients on dialysis are not too frail to perform resistance exercise of adequate intensity to achieve increases in muscle size and strength, therefore, frailty should not be considered a contraindication to exercise.
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Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota.,Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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17
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Evaluation of the safety, effectiveness, and health-related QOL impact of early rehabilitation in patients with nephrotic syndrome. Clin Exp Nephrol 2019; 23:606-612. [PMID: 30607657 DOI: 10.1007/s10157-018-1681-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the safety, effectiveness, and health-related QOL impact of early rehabilitation in patients with nephrotic syndrome. METHODS Subjects consisted of 23 patients with nephrotic syndrome who had previously received steroid treatment. Patients worked performed quadriceps resistance training and aerobic training 5 days per week for 5 weeks. Urinary protein, albumin (Alb), creatinine (Cre), and blood urea nitrogen (BUN) were monitored once every week over a 5-week period based on medical records. The 36-item short form health survey (SF-36) score was used to evaluate health-related QOL. RESULTS There was no significant difference in quadriceps force and no significant effect of age as shown by ANCOVA. Anaerobic threshold (AT) and peak oxygen consumption (peak VO2) both increased significantly. AT was affected by the degree of change in body weight according to ANCOVA. Cre and BUN were not significantly altered. Urinary protein showed a significant decrease and Alb was significantly increased. Only physical function (PF) in the SF-36 showed a significant improvement following the intervention. CONCLUSION Our data indicate that early rehabilitation involving quadriceps resistance training and aerobic training for nephrotic syndrome is safe and effective.
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18
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Scapini KB, Bohlke M, Moraes OA, Rodrigues CG, Inácio JF, Sbruzzi G, Leguisamo CP, Sanches IC, Tourinho Filho H, Irigoyen MC. Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis. J Physiother 2019; 65:4-15. [PMID: 30581137 DOI: 10.1016/j.jphys.2018.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 06/27/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
QUESTIONS Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes? DESIGN Systematic review with network meta-analysis of randomised trials. PARTICIPANTS Adults requiring haemodialysis for end-stage renal disease. INTERVENTION Aerobic training, resistance training, combined training and control (no exercise or placebo). OUTCOME MEASURES Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency. RESULTS Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (-9 mmHg, 95% CI -13 to -4) and diastolic (-5 mmHg, 95% CI -6 to -3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure. CONCLUSION Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease. REGISTRATION PROSPERO CRD42015020531.
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Affiliation(s)
- Kátia B Scapini
- Heart Institute, Faculty of Medicine, University of São Paulo, Brazil; São Judas Tadeu University, São Paulo, Brazil.
| | | | - Oscar A Moraes
- Heart Institute, Faculty of Medicine, University of São Paulo, Brazil
| | | | - José Fs Inácio
- Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Hugo Tourinho Filho
- Ribeirão Preto School of Physical Education and Sports, University of São Paulo, Brazil
| | - Maria C Irigoyen
- Heart Institute, Faculty of Medicine, University of São Paulo, Brazil
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19
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Wang YY, Zhang WW, Feng L, Gao D, Liu C, Zhong L, Ren JW, Wu YZ, Huang L, Fu LL, He YN. Development and Preliminary Validation of a Depression Assessment Tool for Maintenance Hemodialysis Patients. Ther Apher Dial 2018; 23:49-58. [PMID: 30239119 DOI: 10.1111/1744-9987.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Yun-yan Wang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Wei-wei Zhang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Lei Feng
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Dong Gao
- Department of Sleep and Psychology, Institute of Surgery Research, Daping Hospital; Third Military Medical University; Chongqing China
| | - Chun Liu
- Department of Nephrology; The Third People's Hospital of Chongqing; Chongqing China
| | - Ling Zhong
- Department of Nephrology, The Second Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - Jiang-wen Ren
- Department of Nephrology; The First People's Hospital of Jiulongpo District; Chongqing China
| | - Ya-zhou Wu
- Department of Statistics, Preventive Medicine; Third Military Medical University; Chongqing China
| | - Long Huang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Li-li Fu
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Ya-ni He
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
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Iwai K, Hatanaka Y. A pilot study to relationship between urinary protein excretion and muscle strengthening in patients with acute onset renal disease. Phys Ther Res 2018; 21:59-64. [PMID: 30697511 PMCID: PMC6336437 DOI: 10.1298/ptr.e9939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/30/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to investigate urine protein excretion and the effect of muscle strengthening in patients with renal disease. SUBJECTS Twenty-eight patients (18 to 87 years old) with acute onset renal disease were treated with steroids at the Hospital of Shiga University of Medical Science. Maximum quadriceps force was measured, and 20-minutes sessions in resistance training were started. After 5 weeks, maximum quadriceps force was measured again. RESULTS Quadriceps force showed no significant difference between before and after intervention. There was negative correlation between mean urinary protein excretion and amount of change in quadriceps force over the 5 weeks (r=-0.40, p=0.038). CONCLUSIONS We observed the patients with reduced urine protein excretion are tends to easier to obtain muscle strengthening. On the other hand, there is a possibility that the patients with increased urine protein excretion are hard to obtain muscle strengthening, during the intervention.
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Affiliation(s)
- Kohji Iwai
- Department of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science
- Graduate school of Health Science, Suzuka University of medical Science
| | - Yasuhiko Hatanaka
- Graduate school of Health Science, Suzuka University of medical Science
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21
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Harada M, Matsuzawa R, Aoyama N, Uemura K, Horiguchi Y, Yoneyama J, Hoshi K, Yoneki K, Watanabe T, Shimoda T, Takeuchi Y, Naito S, Yoshida A, Matsunaga A. Asymptomatic peripheral artery disease and mortality in patients on hemodialysis. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0159-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Cheng XS, Myers JN, Chertow GM, Rabkin R, Chan KN, Chen Y, Tan JC. Prehabilitation for kidney transplant candidates: Is it time? Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Xingxing S. Cheng
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
| | - Jonathan N. Myers
- Division of Cardiology; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Glenn M. Chertow
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
| | - Ralph Rabkin
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Khin N. Chan
- Division of Cardiology; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
| | - Yu Chen
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Jane C. Tan
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
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Barriers to exercise for patients with renal disease: an integrative review. J Nephrol 2017; 30:729-741. [PMID: 28689231 DOI: 10.1007/s40620-017-0420-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
Renal disease is a common health condition that leads to loss of physical function, frailty, and premature loss of independence in addition to other severe comorbidities and increased mortality. Increased levels of physical activity and initiation of exercise training is recommended in the current guidelines for all patients with renal disease, but participation and adherence rates are low. The barriers to exercise and physical activity in patients with renal disease are not well defined and currently based on patient provider perception and opinion. There have been no published reviews that have synthesized published findings on patient reported barriers to exercise. This integrative literature review therefore aimed to identify the current understanding of patient reported barriers to regular exercise. This integrative review found that patient perceived barriers to exercise are not consistent with the barriers that have been identified by renal disease specialists and healthcare providers, which were disinterest, lack of motivation, and being incapable of exercise. The patient reported barriers identified through this review were complex and diverse, and the most frequently reported patient perceived barrier to exercise was low energy levels and fatigue. It is clear that additional research to identify patient perceived barriers to exercise is needed and that patient directed interventions to address these barriers should be developed. This integrative review provides information to the interdisciplinary nephrology team that can be used to tailor their assessment of barriers to exercise and provide exercise education for patients with renal disease.
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Wei L, Zhao WB, Ye HW, Chen YH, Zhang XP, Huang Y, Cai YF, Chen QF, Pan SY. Heart Rate Variability in Patients with Acute Ischemic Stroke at Different Stages of Renal Dysfunction: A Cross-sectional Observational Study. Chin Med J (Engl) 2017; 130:652-658. [PMID: 28303846 PMCID: PMC5358413 DOI: 10.4103/0366-6999.201599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction. Methods: This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography (ECG). Autonomic function was measured based on the heart rate variability (HRV) using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate (eGFR), and stroke severity was rated according to the National Institutes of Health Stroke Scale (NIHSS). The Barthel index and modified Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression. Results: In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval (SDANN) index (P = 0.022), very low frequency (VLF) (P = 0.043), low frequency (LF) (P = 0.023), and ratio of low-to-high frequency power (LF/HF) (P = 0.001) were significantly lower than those in the patients with a normal eGFR. A multinomial linear regression indicated that eGFR (t = 2.47, P = 0.014), gender (t = −3.60, P < 0.001), and a history of hypertension (t = −2.65, P = 0.008) were the risk factors of LF/HF; the NIHSS score (SDANN index: t = −3.83, P < 0.001; VLF: t = −3.07, P = 0.002; LF: t = −2.79, P = 0.006) and a history of diabetes (SDANN index: t = −3.58, P < 0.001; VLF: t = −2.54, P = 0.012; LF: t = −2.87, P = 0.004) were independent factors for the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project (t = −2.38, P = 0.018) was related to the SDANN index. Conclusions: Autonomic dysfunction is aggravated with the progression of eGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfunction.
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Affiliation(s)
- Lin Wei
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515; Department of Neurology, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Wen-Bo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510632, China
| | - Huan-Wen Ye
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Yan-Hua Chen
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Xiao-Pei Zhang
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Yan Huang
- Department of Cardiovascular Medicine, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Ye-Feng Cai
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Quan-Fu Chen
- Intensive Care Unit, Guangdong Province Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
| | - Su-Yue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
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Clyne N, Hellberg M, Kouidi E, Deligiannis A, Höglund P. Relationship between declining glomerular filtration rate and measures of cardiac and vascular autonomic neuropathy. Nephrology (Carlton) 2017; 21:1047-1055. [PMID: 26714273 DOI: 10.1111/nep.12706] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 11/29/2022]
Abstract
AIM Cardiac and vascular autonomic neuropathy contributes to increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to analyze the effects of a decline in glomerular filtration rate (GFR) on heart rate variability (HRV) and nocturnal blood pressure dipping. METHODS This cross-sectional study comprises 124 patients (46 women, 78 men; age 66 ± 14 years) with chronic kidney disease (CKD) 3-5, not on renal replacement therapy. GFR was measured with iohexol clearance, HRV with 24 h Holter electrocardiogram (ECG) and nocturnal dipping with 24 hour ambulatory blood pressure. RESULTS The GFR was 22.5 ± 8.5 mL/min per 1.73 m2 . The main finding was a significant curvilinear association between the 24 h standard deviation of NN interval (24SDNN) in the HRV analysis and GFR (P = 0.01), logGFR (P = 0.006), diabetes mellitus (P = 0.05) and beta blocker treatment (0.03), respectively. The effect of diabetes mellitus on 24SDNN corresponded to a decline in GFR from 30 to 12 mL/min per 1.73 m2 . There were significant curvilinear associations between systolic nocturnal dipping (P = 0.02) and diastolic nocturnal dipping (P = 0.05), respectively, and diabetes mellitus but not with GFR or logGFR. CONCLUSION In conclusion, cardiac sympathetic overdrive and decreased vagal control appear during CKD 4 and 5. The association with GFR is curvilinear. Diabetes mellitus was significantly associated with both cardiac and vascular autonomic neuropathy, as measured by heart rate variability and nocturnal blood pressure dipping, respectively. Knowing that arrhythmias, often due to sympathetic hyperactivity, are an important cause of sudden death in the dialysis population, this study contributes important knowledge on possible intervention thresholds.
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Affiliation(s)
- Naomi Clyne
- Department of Nephrology, Institution of Clinical Sciences, Lund
| | | | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education & Sport Sciences, Aristotle University of Thessaloniki, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education & Sport Sciences, Aristotle University of Thessaloniki, Greece
| | - Peter Höglund
- Department of Clinical Chemistry and Pharmacology, Institution of Laboratory Medicine, Lund University, Sweden
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Associations of parathyroid hormone levels and mineral parameters with heart rate variability in patients with end-stage renal disease. Int Urol Nephrol 2017; 49:1079-1085. [PMID: 28243964 DOI: 10.1007/s11255-017-1513-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/16/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Parathormone (PTH) is a very potent uraemic toxin, which affects calcium/phosphate homeostasis in patients with end-stage renal disease (ESRD). It also plays the role in uraemic autonomic neuropathy. The aim of the study was to investigate the relationship between elevated PTH levels and cardiac autonomic neuropathy assessed by frequency-domain measures of heart rate variability. METHODS 24-h ECG was performed in 106 ESRD patients and 65 healthy controls. Very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were computed. LF/HF ratio was calculated. RESULTS We found that most heart rate variability indices were lower in ESRD patients than in healthy controls. Variables including demographics (age, sex, body mass index, dialysis vintage, systolic pressure, and diastolic pressure), laboratory values (Hb, Hct, glucose, Alb, and triglyceride), and bone metabolism panel (Ca, P, ALP, and iPTH) were selected as independent variables in the multivariable models. In multivariate analysis, serum intact PTH (iPTH) was correlated with mean normal-to-normal R-R intervals, mean heart rate, and VLF, serum calcium was correlated with standard deviation of 5-min average of normal R-R intervals (SDANN), and serum phosphorus was correlated with VLF and LF/HF. Serum iPTH was independently correlated with mean normal-to-normal R-R intervals (NN), mean HR, and VLF. Serum Ca was independently correlated with SDANN, and serum P was independently correlated with VLF and LF/HF. The results remained significant after the adjustment for iPTH. CONCLUSIONS In conclusion, high PTH levels and disorders of mineral metabolism are associated with decreased heart rate variability in ESRD patients.
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Abe Y, Matsunaga A, Matsuzawa R, Yoneki K, Harada M, Watanabe T, Kutsuna T, Kimura M, Shigeta K, Takeuchi Y, Yoshida A. Evaluating the association between walking speed and reduced cardio-cerebrovascular events in hemodialysis patients: a 7-year cohort study. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0063-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Jeong JH, Wu PT, Kistler BM, Fitschen PJ, Biruete AG, Phillips SA, Ali MM, Fernhall B, Wilund KR. The presence and impact of diastolic dysfunction on physical function and body composition in hemodialysis patients. J Nephrol 2015; 28:739-47. [PMID: 25753450 PMCID: PMC10413439 DOI: 10.1007/s40620-015-0188-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiovascular (CV) diseases are the main cause of death in maintenance hemodialysis (MHD) patients. Muscle wasting and physical function decline are common in MHD patients, and significantly impair their quality of life. These can result from abnormalities in cardiac function, which can be further worsened by physical deconditioning. Left ventricular diastolic function parameters were recently shown to be a better predictor of exercise capacity than systolic measures in patients with CV complications. But little is known about the relationship between cardiac function and physical function in MHD patients. METHODS In 82 MHD patients, left ventricular systolic dysfunction (LVSD) was assessed by ejection fraction and fractional shortening with echocardiography, and left ventricular diastolic dysfunction (LVDD) was assessed by pulse wave and tissue Doppler indices. Physical function was assessed by gait speed, performance on a shuttle walk test, and leg muscle strength. Dual-emission X-ray absorptiometry (DXA) was used to measure whole body lean mass (WBLM). RESULTS The prevalence of LVDD and LVSD was 48.8 and 12.2%, respectively. Gait speed, shuttle walk time, leg strength, and WBLM% were significantly higher in the group without LVDD than with LVDD (p < 0.05 for all). However, there was no significant difference in any measure of physical function or body composition between patients with and without LVSD. CONCLUSION These data suggest that LVDD is more closely related to physical function and body composition than LVSD in MHD patients, and hence that LVDD may be an important therapeutic target.
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Affiliation(s)
- Jin Hee Jeong
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, IL, USA.
| | - Pei-Tzu Wu
- School of Nursing, University of California, Los Angeles, Los-Angeles, CA, USA
| | - Brandon Michael Kistler
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, IL, USA
| | - Peter John Fitschen
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Annabel Guzman Biruete
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shane Aaron Phillips
- University of Illinois at Chicago, Kinesiology, Nutrition, and Rehabilitation, Chicago, IL, USA
| | - Mohamed M Ali
- University of Illinois at Chicago, Kinesiology, Nutrition, and Rehabilitation, Chicago, IL, USA
| | - Bo Fernhall
- University of Illinois at Chicago, Kinesiology, Nutrition, and Rehabilitation, Chicago, IL, USA
| | - Kenneth Robert Wilund
- University of Illinois at Urbana-Champaign, Kinesiology and Community Health, Urbana, IL, USA
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Moraes Dias CJ, Anaisse Azoubel LM, Araújo Costa H, Costa Maia E, Rodrigues B, Silva-Filho AC, Dias-Filho CAA, Claúdia Irigoyen M, Leite RD, de Oliveira Junior MS, Mostarda CT. Autonomic modulation analysis in active and sedentary kidney transplanted recipients. Clin Exp Pharmacol Physiol 2015; 42:1239-44. [DOI: 10.1111/1440-1681.12481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | - Ednei Costa Maia
- Medical School of Federal University of São Paulo; São Paulo Brazil
| | - Bruno Rodrigues
- School of Physical Education; University of Campinas - UNICAMP; Campinas Brazil
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Barcellos FC, Santos IS, Umpierre D, Bohlke M, Hallal PC. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J 2015; 8:753-65. [PMID: 26613036 PMCID: PMC4655802 DOI: 10.1093/ckj/sfv099] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/14/2015] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease (CKD) is a public health problem. Although physical activity is essential for the prevention and treatment of most chronic diseases, exercise is rarely prescribed for CKD patients. The objective of the study was to search for and appraise evidence on the effectiveness of exercise interventions on health endpoints in CKD patients. A systematic review was performed of randomized clinical trials (RCTs) designed to compare exercise with usual care regarding effects on the health of CKD patients. MEDLINE, EMBASE, Cochrane Central, Clinical Trials registry, and proceedings of major nephrology conference databases were searched, using terms defined according to the PICO (Patient, Intervention, Comparison and Outcome) methodology. RCTs were independently evaluated by two reviewers. A total of 5489 studies were assessed for eligibility, of which 59 fulfilled inclusion criteria. Most of them included small samples, lasted from 8 to 24 weeks and applied aerobic exercises. Three studies included only kidney transplant patients, and nine included pre-dialysis patients. The remaining RCTs allocated hemodialysis patients. The outcome measures included quality of life, physical fitness, muscular strength, heart rate variability, inflammatory and nutritional markers and progression of CKD. Most of the trials had high risk of bias. The strongest evidence is for the effects of aerobic exercise on improving physical fitness, muscular strength and quality of life in dialysis patients. The benefits of exercise in dialysis patients are well established, supporting the prescription of physical activity in their regular treatment. RCTs including patients in earlier stages of CKD and after kidney transplantation are urgently required, as well as studies assessing long-term outcomes. The best exercise protocol for CKD patients also remains to be established.
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Affiliation(s)
- Franklin C Barcellos
- Postgraduate Program in Epidemiology, Federal University of Pelotas , Pelotas , Brazil ; School of Medicine, Dialysis and Transplantation Unit, Catholic University of Pelotas , Pelotas , Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas , Pelotas , Brazil
| | - Daniel Umpierre
- Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Maristela Bohlke
- School of Medicine, Dialysis and Transplantation Unit, Catholic University of Pelotas , Pelotas , Brazil
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas , Pelotas , Brazil
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Physical excercise programs in CKD: lights, shades and perspectives: a position paper of the “Physical Exercise in CKD Study Group” of the Italian Society of Nephrology. J Nephrol 2015; 28:143-50. [DOI: 10.1007/s40620-014-0169-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
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Heiwe S, Jacobson SH. Exercise Training in Adults With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2014; 64:383-93. [DOI: 10.1053/j.ajkd.2014.03.020] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 03/18/2014] [Indexed: 01/23/2023]
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Relationship between lower extremity muscle strength and all-cause mortality in Japanese patients undergoing dialysis. Phys Ther 2014; 94:947-56. [PMID: 24578522 DOI: 10.2522/ptj.20130270] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Skeletal muscle wasting is common and insidious in patients who are undergoing hemodialysis. However, the association between lower extremity muscle strength and all-cause mortality remains unclear in this population. OBJECTIVE The purpose of this study was to investigate the prognostic significance of lower extremity muscle strength on 7-year survival in a cohort of patients who were clinically stable and undergoing hemodialysis. DESIGN A prospective cohort study was conducted. METHODS A total of 190 Japanese outpatients who were undergoing maintenance hemodialysis 3 times per week at a hemodialysis center were followed for up to 7 years. Lower extremity muscle strength was evaluated using a handheld dynamometer at the time of patient enrollment in the study. Muscle strength data were divided by dry weight and expressed as a percentage. A Cox proportional hazards regression model was used to assess the contribution of lower extremity muscle strength to all-cause mortality. RESULTS The median age (25th and 75th percentiles) of this study population was 64 years (57 and 72 years), 53.2% of the patients were women, and the time on hemodialysis was 39.0 months (15.9 and 110.5 months) at baseline. During a median follow-up of 36.0 months, there were 30 deaths. With a multivariate Cox model, the hazard ratio in the group with a knee extensor strength of <40% was 2.73 (95% confidence interval=1.14-6.52) compared with that in the ≥40% group. LIMITATIONS This was a small-scale observational study, and the mechanisms underlying the higher mortality risk in patients with poor muscle strength undergoing hemodialysis than in other patients undergoing hemodialysis remain to be elucidated. CONCLUSIONS Decreased lower extremity muscle strength was strongly associated with increased mortality risk in patients undergoing hemodialysis.
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Drawz PE, Babineau DC, Brecklin C, He J, Kallem RR, Soliman EZ, Xie D, Appleby D, Anderson AH, Rahman M. Heart rate variability is a predictor of mortality in chronic kidney disease: a report from the CRIC Study. Am J Nephrol 2013; 38:517-28. [PMID: 24356377 DOI: 10.1159/000357200] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/12/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIMS Low heart rate variability (HRV) is a risk factor for adverse outcomes in the general population. We aimed to determine the factors associated with HRV and evaluate the association between low HRV and clinical outcomes in patients with chronic kidney disease (CKD). METHODS A 10-second electrocardiogram was obtained at baseline in the Chronic Renal Insufficiency Cohort (CRIC) Study. HRV was measured by the standard deviation of all R-R intervals (SDNN) and the root mean square of successive differences between R-R intervals (RMSSD). RESULTS In 3,245 CRIC participants with available baseline SDNN and RMSSD, lower HRV was associated with older age, lack of exercise, heart failure, elevated phosphorus and hemoglobin A1c, and low estimated glomerular filtration rate. After a median follow-up of 4.2 years, in fully adjusted models, lower HRV was not associated with renal [SDNN: hazard rate, HR = 0.96 (95% confidence interval, CI 0.88-1.05); RMSSD: HR = 0.97 (95% CI 0.88-1.07)] or cardiovascular outcomes [SDNN: HR = 1.02 (95% CI 0.92-1.13); RMSSD: HR = 1.00 (95% CI 0.90-1.10)]. There was a nonlinear relationship between RMSSD and all-cause mortality with increased risk with both low and high RMSSD (p = 0.04). CONCLUSIONS In a large cohort of patients with CKD, multiple risk factors for renal and cardiovascular diseases were associated with lower HRV. Lower HRV was not associated with increased risk for renal or cardiovascular outcomes, but both low and high RMSSD were associated with increased risk for all-cause mortality. In conclusion, HRV measured by RMSSD may be a novel and independent risk factor for mortality in CKD patients.
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Affiliation(s)
- Paul E Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minn., USA
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Riess KJ, Haykowsky M, Lawrance R, Tomczak CR, Welsh R, Lewanczuk R, Tymchak W, Haennel RG, Gourishankar S. Exercise training improves aerobic capacity, muscle strength, and quality of life in renal transplant recipients. Appl Physiol Nutr Metab 2013; 39:566-71. [PMID: 24766239 DOI: 10.1139/apnm-2013-0449] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Renal transplant recipients (RTR) have reduced peak aerobic capacity, muscle strength, arterial function and an unfavorable cardiovascular disease risk (CVD) profile. This study compared the effects of 12 weeks of supervised endurance and strength training (EST, n = 16) versus usual care (UC, n = 15) on peak aerobic capicity, cardiovascular and skeletal muscle function, CVD risk profile, and quality of life (QOL) in RTR (55 ± 13 years). Peak aerobic capacity and exercise hemodynamics, arterial compliance, 24-h blood pressure, muscle strength, lean body mass, CVD risk score, and QOL were assessed before and after 12 weeks. The change in peak aerobic capacity (EST: 2.6 ± 3.1 vs. UC: -0.5 ± 2.5 mL/(kg·min)), cardiac output (EST: 1.7 ± 2.6 vs. UC: -0.01 ± 0.8 L/min), leg press (EST: 48.7 ± 34.1 vs. UC: -10.5 ± 37.7 kg) and leg extension strength (EST: 9.5 ± 10.3 vs. UC: 0.65 ± 5.5 kg) improved significantly after EST compared with UC. The overall change in QOL improved significantly after 12 weeks of EST compared with UC. No significant difference was found between groups for lean body mass, arterial compliance, 24-h blood pressure or CVD risk score. Supervised EST is an effective intervention to improve peak exercise aerobic capacity and cardiac output, muscle strength and QOL in clinically stable RTR.
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Affiliation(s)
- Kenneth James Riess
- a Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
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Sotiriou P, Kouidi E, Samaras T, Deligiannis A. Linear and non-linear analysis of heart rate variability in master athletes and healthy middle-aged non-athletes. Med Eng Phys 2013; 35:1676-81. [DOI: 10.1016/j.medengphy.2013.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/11/2013] [Accepted: 06/23/2013] [Indexed: 11/24/2022]
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Smart NA, Williams AD, Levinger I, Selig S, Howden E, Coombes JS, Fassett RG. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. J Sci Med Sport 2013; 16:406-11. [DOI: 10.1016/j.jsams.2013.01.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/19/2013] [Accepted: 01/23/2013] [Indexed: 01/09/2023]
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Udo T, Mun EY, Buckman JF, Vaschillo EG, Vaschillo B, Bates ME. Potential side effects of unhealthy lifestyle choices and health risks on basal and reactive heart rate variability in college drinkers. J Stud Alcohol Drugs 2013; 74:787-96. [PMID: 23948539 PMCID: PMC3749321 DOI: 10.15288/jsad.2013.74.787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/08/2013] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Emerging adults often begin making independent lifestyle choices during college, yet the association of these choices with fundamental indicators of health and adaptability is unclear. The present study examined the relationship between health risks and neurocardiac function in college drinkers. METHOD Heart rate variability (HRV) was assessed at baseline and in reaction to a paced breathing challenge in 212 college drinkers (53.8% women). Basal HRV served as a general indicator of health. Reactive HRV (during paced breathing) was used as a marker of an individual's adaptability to challenge. The relationship of HRV to alcohol use, cigarette use, exercise, sleep, and body mass index (BMI) was assessed. RESULTS Greater alcohol use and less exercise were associated with lower basal HRV. BMI was unrelated to basal HRV but was negatively associated with reactive HRV during the breathing challenge. CONCLUSIONS High levels of alcohol use and lack of exercise are negative correlates of cardiovascular and general health, even in apparently healthy college drinkers. The negative relationship between BMI and reactive HRV suggests that overweight individuals have reduced ability to psychophysiologically adapt to challenges; understanding the temporal course of this relationship is needed. This study highlights the importance of examining HRV at baseline and in response to a challenge to capture the active neurocardiac processes that contribute to health and adaptive responding. The suppressive effects of health risks on HRV are modifiable; thus, HRV may be useful in evaluating the health benefits of lifestyle change and in promoting change behaviors in college drinkers.
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Affiliation(s)
- Tomoko Udo
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Eun-Young Mun
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Jennifer F. Buckman
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Evgeny G. Vaschillo
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Bronya Vaschillo
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Marsha E. Bates
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Zhang J, Yu X, Sun B, Bai J, Wei Y, Zha X, Cui Y, Zeng M, Zhang J, Liu J, Mao H, Zhang B, Ren H, Ge Y, Xu X, Shen Z, Xing C, Cao K, Wang N. Parathyroidectomy and heart rate variability in patients with stage 5 CKD. Clin J Am Soc Nephrol 2013; 8:1378-87. [PMID: 23660181 DOI: 10.2215/cjn.10381012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Lower heart rate variability implies increased risk of cardiovascular disease. This study aimed to evaluate the relationship between mineral metabolism and heart rate variability and longitudinal changes of heart rate variability after parathyroidectomy in stage 5 CKD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This cross-sectional study included 118 stage 5 CKD patients, 87 controls, and a prospective study in two subgroups classified as successful (n=17) and unsuccessful (n=4) parathyroidectomy follow-up enrolled from March of 2011 to December of 2012. Blood examination and 24-hour Holter for heart rate variability were measured. RESULTS Most heart rate variability indices were lower in stage 5 CKD patients. In multivariate stepwise regression models, serum intact parathyroid hormone was correlated with mean normal-to-normal R-R intervals, mean heart rate, and very low frequency, serum calcium was correlated with SD of 5-minute average of normal R-R intervals, and serum phosphorus was correlated with very low frequency and low frequency/high frequency. Compared with baseline, the successful parathyroidectomy subgroup had significant improvements in mean normal-to-normal R-R intervals, mean heart rate, SD of normal-to-normal R-R intervals, SD of 5-minute average of normal R-R intervals, very low frequency, high frequency, and low frequency/high frequency. There was no significant change of heart rate variability in patients after unsuccessful parathyroidectomy. CONCLUSIONS Disorders of mineral metabolism are associated with decreased heart rate variability in stage 5 CKD. Successful parathyroidectomy may contribute to reverse this cardiovascular disease risk in severe secondary hyperparathyroidism patients.
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Affiliation(s)
- Jing Zhang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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Heart rate and blood pressure: any possible implications for management of hypertension? Curr Hypertens Rep 2013; 14:478-84. [PMID: 22972532 DOI: 10.1007/s11906-012-0306-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hypertension is a common clinical problem and a major risk factor for cardiovascular disease and stroke. Elevated heart rate is associated with elevated blood pressure, increased risk for hypertension, and, among hypertensives, increased risk for cardiovascular disease. Despite these important relationships, heart rate is generally not a major consideration in choosing antihypertensive medications. In part, this is due to a lack of evidence supporting heart rate lowering as a therapeutic strategy in hypertension. Additionally, while there is a positive correlation between heart rate and peripheral blood pressure, there is an inverse relationship between heart rate and central blood pressure. The use of antihypertensive medications, specifically medications that affect heart rate, may not reliably reduce central blood pressure to a similar extent as observed peripherally. We review the relationship between heart rate and peripheral and central blood pressure, with a focus on the implications for chronotropic therapy in hypertension.
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Zhang J, Wang N. Prognostic significance and therapeutic option of heart rate variability in chronic kidney disease. Int Urol Nephrol 2013; 46:19-25. [DOI: 10.1007/s11255-013-0421-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 03/13/2013] [Indexed: 11/25/2022]
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Mendonca GV, Pereira FD, Fernhall B. Heart rate recovery and variability following combined aerobic and resistance exercise training in adults with and without Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:353-361. [PMID: 23006505 DOI: 10.1016/j.ridd.2012.08.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/31/2012] [Accepted: 08/31/2012] [Indexed: 06/01/2023]
Abstract
Persons with Down syndrome (DS) are at high risk for cardiovascular morbidity and mortality, and there is compelling evidence of autonomic dysfunction in these individuals. The main purpose of this study was to determine whether a combined aerobic and resistance exercise intervention produces similar results in cardiac autonomic function between adults with and without DS. Twenty-five participants (13 DS; 12 non-DS), aged 27-50 years, were included. Aerobic training was performed 3 days/week for 30 min at 65-85% of peak oxygen uptake (VO(2peak)). Resistance training was prescribed for 2 days/week and consisted of two rotations in a circuit of 9 exercises at 12-repetition-maximum. There was a significant improvement in the VO(2peak) and muscle strength of participants with and without DS after training. Heart rate recovery improved at 1 min post-exercise, but only in participants with DS. Both groups of participants exhibited a similar increase in normalized high frequency power and of decrease in normalized low frequency power after training. Therefore, 12 weeks of exercise training enhanced the heart rate recovery in adults with DS, but not in those without DS. Contrasting, the intervention elicited similar gains between groups for cardiovagal modulation.
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Affiliation(s)
- Goncalo V Mendonca
- Center of Human Performance, CIPER, Faculty of Human Kinetics, Technical University of Lisbon, Portugal.
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Smart N, McFarlane J, Cornelissen V. The Effect of Exercise Therapy on Physical Function, Biochemistry and Dialysis Adequacy in Haemodialysis Patients: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojneph.2013.31005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kouidi E, Vergoulas G, Anifanti M, Deligiannis A. A randomized controlled trial of exercise training on cardiovascular and autonomic function among renal transplant recipients. Nephrol Dial Transplant 2012; 28:1294-305. [PMID: 23129823 DOI: 10.1093/ndt/gfs455] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There are conflicting data regarding the effects of renal transplantation (RT) on uraemic autonomic dysfunction. Moreover, no study has examined the impact of physical training on the cardiac autonomic function in RT patients. Thus, we studied the effects of exercise training on heart rate variability (HRV) and arterial baroreflex sensitivity (BRS), which are sensitive markers of cardiac autonomic outflow, in RT recipients. METHODS Eleven patients (Exercise group-aged 52.1 ± 5.6 years) were studied before and after 6 months of exercise training. Twelve age- and sex- matched RT patients (Sedentary) and 12 healthy sedentary individuals (Healthy), who remained untrained, served as controls. At baseline and follow-up, all the subjects underwent cardiopulmonary exercise testing for the evaluation of peak oxygen consumption (VO2peak), a tilt test for the evaluation of BRS and baroreflex effectiveness index (BEI) and an ambulatory 24-h Holter monitoring for time- and frequency-domain measures of HRV. RESULTS In the exercise group, VO2peak increased by 15.8% (P < 0.05) and all depressed HRV and BRS indices were significantly improved after training. Specifically, the standard deviation of all normal-to-normal (NN) intervals (SDNN) significantly increased by 92.5%, the root-mean-square of the differences between consecutive NN intervals by 45.4%, the percentage value of NN50 count by 58.2%, the high-frequency by 74.8% and low-frequency spectral power by 41.6%, BRS by 43.7% and BEI by 57.3%. None of the variables studied was altered over time in either control group. CONCLUSIONS The increased cardiorespiratory fitness by exercise training was associated with an improved BRS function and a modification of the sympathovagal control of HRV towards a persistent increase in parasympathetic tone. These alterations may lead to a better cardiovascular prognosis in RT recipients.
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Affiliation(s)
- Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Matsuzawa R, Matsunaga A, Wang G, Kutsuna T, Ishii A, Abe Y, Takagi Y, Yoshida A, Takahira N. Habitual physical activity measured by accelerometer and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol 2012; 7:2010-6. [PMID: 22977216 DOI: 10.2215/cjn.03660412] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The association between mortality and physical activity based on self-report questionnaire in hemodialysis patients has been reported previously. However, because self-report is a subjective assessment, evaluating true physical activity is difficult. This study investigated the prognostic significance of habitual physical activity on 7-year survival in a cohort of clinically stable and adequately dialyzed patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A total of 202 Japanese outpatients who were undergoing maintenance hemodialysis three times per week at the hemodialysis center of Sagami Junkanki Clinic (Japan) from October 2002 to February 2012 were followed for up to 7 years. Physical activity was evaluated using an accelerometer at study entry and is expressed as the amount of time a patient engaged in physical activity on nondialysis days. Cox proportional hazard regression was used to assess the contribution of habitual physical activity to all-cause mortality. RESULTS The median patient age was 64 (25th, 75th percentiles, 57, 72) years, 52.0% of the patients were women, and the median time on hemodialysis was 40.0 (25th, 75th percentiles, 16.8, 119.3) months at baseline. During a median follow-up of 45 months, 34 patients died. On multivariable analysis, the hazard ratio for all-cause mortality per 10 min/d increase in physical activity was 0.78 (95% confidence interval, 0.66-0.92; P=0.002). CONCLUSIONS Engaging in habitual physical activity among outpatients undergoing maintenance hemodialysis was associated with decreased mortality risk.
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Affiliation(s)
- Ryota Matsuzawa
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
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Kooman JP, Usvyat L, van der Sande FM, Thijssen S, Levin N, Leunissen KM, Kotanko P. 'Time and time again': oscillatory and longitudinal time patterns in dialysis patients. Kidney Blood Press Res 2012; 35:534-48. [PMID: 22890114 DOI: 10.1159/000340022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Oscillatory and longitudinal time patterns play a major role in human physiology. In chronic hemodialysis patients, abnormalities in both time patterns have been observed, while time patterns can also influence the response of patients to the treatment. Abnormal oscillatory patterns have been observed for ultradian rhythms (cycle time <20 h), such as an impaired heart rate variability and circadian rhythms, as reflected by reduced day-night blood pressure differences. Conversely, the circadian rhythm of body temperature may influence the hemodynamic tolerance to the dialysis treatment. With regard to infradian (cycle time >28 h) rhythms, large seasonal differences in mortality, but also in blood pressure and interdialytic weight gain, have been observed in dialysis patients. The most important longitudinal pattern is the general reduction of life span in dialysis patients. One explanation of this phenomenon relates to the concept of accelerated aging in dialysis patients, for which there are various supportive arguments. From a phenomenological point of view, this concept translates into the high prevalence of frailty, even in young dialysis patients. A multidimensional approach appears necessary to adequately address this problem. In this review, the relevance of disturbed time patterns in dialysis patients is discussed. The changes may reflect an impairment or reduction in homeostatic/homeodynamic control in dialysis patients and also may have important prognostic and therapeutic implications.
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Affiliation(s)
- Jeroen P Kooman
- University Hospital Maastricht, Maastricht, The Netherlands.
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Reboredo MM, Neder JA, Pinheiro BV, Henrique DM, Faria RS, Paula RB. Constant Work-Rate Test to Assess the Effects of Intradialytic Aerobic Training in Mildly Impaired Patients With End-Stage Renal Disease: A Randomized Controlled Trial. Arch Phys Med Rehabil 2011; 92:2018-24. [DOI: 10.1016/j.apmr.2011.07.190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/12/2011] [Accepted: 07/12/2011] [Indexed: 10/14/2022]
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Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide public health problem. In the National Kidney Foundation Disease Outcomes Quality Initiative guidelines it is stressed that lifestyle issues such as physical activity should be seen as cornerstones of the therapy. The physical fitness in adults with CKD is so reduced that it impinges on ability and capacity to perform activities in everyday life and occupational tasks. An increasing number of studies have been published regarding health effects of various regular exercise programmes in adults with CKD and in renal transplant patients. OBJECTIVES We aimed to: 1) assess the effects of regular exercise in adults with CKD and kidney transplant patients; and 2) determine how the exercise programme should be designed (e.g. type, duration, intensity, frequency of exercise) to be able to affect physical fitness and functioning, level of physical activity, cardiovascular dimensions, nutrition, lipids, glucose metabolism, systemic inflammation, muscle morphology and morphometrics, dropout rates, compliance, adverse events and mortality. SEARCH STRATEGY We searched the Cochrane Renal Group's specialised register, CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, Biosis, Pedro, Amed, AgeLine, PsycINFO and KoreaMed. We also handsearched reference lists of review articles and included studies, conference proceeding's abstracts. There were no language restrictions.Date of last search: May 2010. SELECTION CRITERIA We included any randomised controlled trial (RCT) enrolling adults with CKD or kidney transplant recipients undergoing any type of physical exercise intervention undertaken for eight weeks or more. Studies using less than eight weeks exercise, those only recommending an increase in physical activity, and studies in which co-interventions are not applied or given to both groups were excluded. DATA COLLECTION AND ANALYSIS Data extraction and assessment of study and data quality were performed independently by the two authors. Continuous outcome data are presented as standardised mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CI). MAIN RESULTS Forty-five studies, randomising 1863 participants were included in this review. Thirty two studies presented data that could be meta-analysed. Types of exercise training included cardiovascular training, mixed cardiovascular and resistance training, resistance-only training and yoga. Some studies used supervised exercise interventions and others used unsupervised interventions. Exercise intensity was classed as 'high' or 'low', duration of individual exercise sessions ranged from 20 minutes/session to 110 minutes/session, and study duration was from two to 18 months. Seventeen per cent of studies were classed as having an overall low risk of bias, 33% as moderate, and 49% as having a high risk of bias.The results shows that regular exercise significantly improved: 1) physical fitness (aerobic capacity, 24 studies, 847 participants: SMD -0.56, 95% CI -0.70 to -0.42; walking capacity, 7 studies, 191 participants: SMD -0.36, 95% CI-0.65 to -0.06); 2) cardiovascular dimensions (resting diastolic blood pressure, 11 studies, 419 participants: MD 2.32 mm Hg, 95% CI 0.59 to 4.05; resting systolic blood pressure, 9 studies, 347 participants: MD 6.08 mm Hg, 95% CI 2.15 to 10.12; heart rate, 11 studies, 229 participants: MD 6 bpm, 95% CI 10 to 2); 3) some nutritional parameters (albumin, 3 studies, 111 participants: MD -2.28 g/L, 95% CI -4.25 to -0.32; pre-albumin, 3 studies, 111 participants: MD - 44.02 mg/L, 95% CI -71.52 to -16.53; energy intake, 4 studies, 97 participants: SMD -0.47, 95% CI -0.88 to -0.05); and 4) health-related quality of life. Results also showed how exercise should be designed in order to optimise the effect. Other outcomes had insufficient evidence. AUTHORS' CONCLUSIONS There is evidence for significant beneficial effects of regular exercise on physical fitness, walking capacity, cardiovascular dimensions (e.g. blood pressure and heart rate), health-related quality of life and some nutritional parameters in adults with CKD. Other outcomes had insufficient evidence due to the lack of data from RCTs. The design of the exercise intervention causes difference in effect size and should be considered when prescribing exercise with the aim of affecting a certain outcome. Future RCTs should focus more on the effects of resistance training interventions or mixed cardiovascular- and resistance training as these exercise types have not been studied as much as cardiovascular exercise.
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Affiliation(s)
- Susanne Heiwe
- Karolinska Institutet, Department of Medicine and Department of Clinical Sciences, Clinical Research Center Norra, Building 8, Stockholm, Sweden, SE 182 88
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Abstract
The elderly, (age ≥ 65 years) hemodialysis (HD) patient population is growing rapidly across the world. The risk of accidental falls is very high in this patient population due to multiple factors which include aging, underlying renal disease and adverse events associated with HD treatments. Falls, the most common cause of fatal injury among elderly, not only increase morbidity and mortality, but also increase costs to the health system. Prediction of falls and interventions to prevent or minimize fall risk and associated complications will be a major step in helping these patients as well as decreasing financial and social burdens. Thus, it is vital to learn how to approach this important problem. In this review, we will summarize the epidemiology, risk factors, pathophysiology and complications of falls in elderly HD patients. We will also focus on available methods to assess and predict the patients at higher risk of falling and will provide recommendations for interventions to reduce the occurrence of falls in this population.
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Affiliation(s)
- E M Abdel-Rahman
- Division of Nephrology, Department of Medicine, University of Virginia Health System, PO Box 800133, Charlottesville, VA 22908, USA
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Test-retest reliability and minimal detectable change scores for sit-to-stand-to-sit tests, the six-minute walk test, the one-leg heel-rise test, and handgrip strength in people undergoing hemodialysis. Phys Ther 2011; 91:1244-52. [PMID: 21719637 DOI: 10.2522/ptj.20100141] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Determining the relative and absolute reliability of outcomes of physical performance tests for people undergoing hemodialysis is necessary to discriminate between the true effects of exercise interventions and the inherent variability of this cohort. OBJECTIVE The aims of this study were to assess the relative reliability of sit-to-stand-to-sit tests (the STS-10, which measures the time [in seconds] required to complete 10 full stands from a sitting position, and the STS-60, which measures the number of repetitions achieved in 60 seconds), the Six-Minute Walk Test (6MWT), the one-leg heel-rise test, and the handgrip strength test and to calculate minimal detectable change (MDC) scores in people undergoing hemodialysis. DESIGN This study was a prospective, nonexperimental investigation. METHODS Thirty-nine people undergoing hemodialysis at 2 clinics in Spain were contacted. Study participants performed the STS-10 (n=37), the STS-60 (n=37), and the 6MWT (n=36). At one of the settings, the participants also performed the one-leg heel-rise test (n=21) and the handgrip strength test (n=12) on both the right and the left sides. Participants attended 2 testing sessions 1 to 2 weeks apart. RESULTS High intraclass correlation coefficients (≥.88) were found for all tests, suggesting good relative reliability. The MDC scores at 90% confidence intervals were as follows: 8.4 seconds for the STS-10, 4 repetitions for the STS-60, 66.3 m for the 6MWT, 3.4 kg for handgrip strength (force-generating capacity), 3.7 repetitions for the one-leg heel-rise test with the right leg, and 5.2 repetitions for the one-leg heel-rise test with the left leg. Limitations A limited sample of patients was used in this study. CONCLUSIONS The STS-16, STS-60, 6MWT, one-leg heel rise test, and handgrip strength test are reliable outcome measures. The MDC scores at 90% confidence intervals for these tests will help to determine whether a change is due to error or to an intervention.
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