Does regular resistance exercise improve resting and intradialytic pain and haemodynamic measures in sedentary chronic haemodialysis women?

Pain is one of the major problems in haemodialysis patients. Regular resistance exercise (RE), as an effective lifestyle modification, may play a role in reducing pain through changes in blood pressure (BP). Therefore, we aimed to evaluate the effect of RE training on pain, BP, and heart rate. In a randomised controlled trial, eighteen sedentary women completed the study in RE (n=10) or control (n=8) groups. In the exercise group, the patients had a circuit RE program in non-dialysis days, two times a week, for six weeks. The RE protocol consisted of six exercises performing with 10 repetitions at 50-60% of 1-repetition maximum. Resting and intradialytic pain threshold (algometer using a 1 kg pressure load), BP, and heart rate were measured 48 h before and after the intervention. There were no significant differences from pre- to post-intervention, or between the groups regarding pain threshold, systolic and diastolic BP, and heart rate at rest and during the haemodialysis process (P>0.05). Although the 6-week low-intensity RE training in non-dialysis days was safe for chronic haemodialysis women, it could not change resting and intradialytic pain and hemodynamic measures.

Substrate oxidation during exercise in taekwondo athletes: impact of aerobic fitness status

The present study aimed to investigate the potential effect of different aerobic fitness levels on substrate oxidation in trained taekwondo athletes. 57 male athletes (age 21.10±7.79 years; VO2max 50.67±6.67 ml/kg/min) with regular weekly taekwondo training and training experience of at least three years completed a graded exercise test to exhaustion on a treadmill. Maximal fat oxidation (MFO), the exercise intensity related to MFO (Fatmax), and carbohydrate (CHO) oxidation rate were measured using indirect calorimetry methods. The athletes then were divided into a low (<50 ml/kg/min, n=18) and high (>50 ml/kg/min, n=39) VO2max group. The average MFO was higher in the high VO2max group than in the low VO2max group (0.46±0.19 vs 0.28±0.11 g/min; P<0.001). Although Fatmax tended toward higher values in the high VO2max group, no difference was observed between the groups (49.15±15.22 vs 42.42±12.37% of VO2max; P=0.18). It was also shown that the high VO2max group had a lower CHO oxidation rate and a higher fat oxidation rate at given exercise intensities. In conclusion, it seems that MFO and substrate oxidation rates in taekwondo athletes can be influenced by aerobic fitness level such that the athletes with higher VO2max appeared to use more fat as a fuel source for energy supply during a given exercise.

Pain in severe dementia: A comparison of a fine-grained assessment approach to an observational checklist designed for clinical settings

Background

Fine‐grained observational approaches to pain assessment (e.g. the Facial Action Coding System; FACS) are used to evaluate pain in individuals with and without dementia. These approaches are difficult to utilize in clinical settings as they require specialized training and equipment. Easy‐to‐use observational approaches (e.g. the Pain Assessment Checklist for Limited Ability to Communicate‐II; PACSLAC‐II) have been developed for clinical settings. Our goal was to compare a FACS‐based fine‐grained system to the PACSLAC‐II in differentiating painful from non‐painful states in older adults with and without dementia.

Method

We video‐recorded older long‐term care residents with dementia and older adult outpatients without dementia, during a quiet baseline condition and while they took part in a physiotherapy examination designed to identify painful areas. Videos were coded using pain‐related behaviours from the FACS and the PACSLAC‐II.

Results

Both tools differentiated between painful and non‐painful states, but the PACSLAC‐II accounted for more variance than the FACS‐based approach. Participants with dementia scored higher on the PACSLAC‐II than participants without dementia.

Conclusion

The results suggest that easy‐to‐use observational approaches for clinical settings are valid and that there may not be any clinically important advantages to using more resource‐intensive coding approaches based on FACS. We acknowledge, as a limitation of our study, that we used as baseline a quiet condition that did not involve significant patient movement. In contrast, our pain condition involved systematic patient movement. Future research should be aimed at replicating our results using a baseline condition that involves non‐painful movements.

Significance

Examining older adults with and without dementia, a brief observational clinical approach was found to be valid and accounted for more variance in differentiating pain‐related and non‐pain‐related states than did a detailed time‐consuming fine‐grained approach.