ABSTRACT
Background : The effects of rehabilitation on hemodialysis patients are unknown. We assessed the effects and investigated the association between rehabilitation treatment effects and all-cause mortality. Methods : This prospective cohort study included 120 patients on maintenance hemodialysis. ADL was assessed using the Functional Independence Measure (FIM) score (total points, 126), which comprises 13 motor items (total points, 91) and five cognitive items (total points, 35). A survival curve was constructed using the Kaplan-Meier analysis and stratified into an increase or no-increase of the FIM score. Multivariable logistic regression analysis was used to determine factors associated with the effects of rehabilitation. Discriminative sensitivity of FIM cognitive items for an increase in total FIM was estimated using the area under the receiver operating characteristic (AuROC) curve. Results : The average total FIM score increased from 64.2±3.6 to 75.8±3.0, and the increase in FIM motor and cognitive items was 11.0±1.3 and 0.5±0.6, respectively. The cumulative survival rate within 2.5 years was significantly higher in the FIM increase group than that in the FIM no-increase group. FIM cognitive items and anemia were significantly associated with rehabilitation effects, and AuROC showed that a cutoff of 34 points in cognitive FIM had moderate discriminative sensitivity for a total FIM increase (AuC, 0.719 ; <i>p</i><0.0008). Conclusions : Rehabilitating hemodialysis patients improved their FIM score (particularly the motor items), and a higher FIM score resulted in a better prognosis. The effectiveness of rehabilitation depends on maintaining a perfect FIM cognitive score.
ABSTRACT
This report deals with the response of heart rate, blood pressure and respiratory rate when the subjects of different ages and sexes worked on a bicycle ergometer. The subjects were 126 healthy persons of both sexes. They consisted of 8 groups : prepuberty male (N=15) and female (N=16), puberty male (N=20) and female (N=18), young adult male (N=15) and female (N=16), middle aged male (N=17) and female (N=9) . All subjects tried pedalling exercise with 3 kinds of loads, i.e., 5kgm/kg/min, 10kgm/kg/min and 12.5 kgm/kg/min for 6 minutes.<BR>Heart rate was calculated from chest lead ECG and respiratory rate was measured by the thermistor method continuously recorded before, during and after exercise. Blood pressure was measured by Riva Rocci sphygmomanometer before exercise, at the early stage of recovery and in 10 minutes after exercise.<BR>The results of this study are summarized as follows<BR>1) In both sexes the heart rate decreased with age in resting status and exponentially increased during moderate and heavier exercise. A linear relationship was found between the work load and the exercise heart rate.<BR>In males the heart rate during light exercise was high in the prepuberty and the puberty, low in the young adult and the middle aged. But the heart rate during heavy exercise in the middle aged was extremely high. The heart rate in females was higher than that in males when the same work load was given in both sexes. The rising phase of heart rate in prepuberty was the earliest of 4 age groups.<BR>2) The systolic blood pressure and the pulse pressure in resting status increased with age. As for the blood pressure during exercise, it was low in the youth and high in the middle aged. The blood pressure after exercise in the middle aged males was the highest of 4 groups. Generally in all females the systolic blood pressure and the pulse pressure increased with work load, but the former levelled off during heavy exercise.<BR>3) The respiratory rate during exercise increased rapidly, but when the exercise was stopped, the increased respiratory rate returned rapidly to the resting level. As for the respiratory rate, in both sexes it decreased with age from the prepuberty to the middle aged in resting status and during exercise. The sex difference of the respiratory rate during heavy exercise was large.<BR>4) In the youth the correlation coefficient between the heart rate and the blood pressure was high. Therefore, it was suggested that the heart rate was important in adaptation to exercise.