Exercise improves quality of life in indigenous Polynesian peoples with type 2 diabetes and visceral obesity.

BACKGROUND: To evaluate the differential effect of 2, group-based exercise modalities on quality of life (QoL) in indigenous Polynesian peoples with type 2 diabetes (T2DM) and visceral obesity. METHODS: Participants were randomized to resistance training or aerobic training performed 3 times per for 16 weeks. The Short-Form 36 was administered at baseline and post intervention to assess 8 domains and physical and mental component scales (PCS and MCS) of QoL. RESULTS: With the exception of Mental Health and MCS, all scores were lower at baseline than general population norms. Significant improvements were documented in several QoL scores in each group post intervention. No group x time interactions were noted. Pooled analyses of the total cohort indicated significantly improved Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Role-Emotional, PCS and MCS. Adaptation ranged from 5%-22%, and demonstrated a moderate-to-large effect (Cohen's d = 0.64-1.29). All measures of QoL increased to near equivalent, or greater than general norms. CONCLUSION: Exercise, regardless of specific modality, can improve many aspects of QoL in this population. Robust trials are required to investigate factors mediating improvements in QoL, and create greater advocacy for exercise as a QoL intervention in this and other indigenous populations with T2DM.

Effect of acute acupuncture treatment on exercise performance and postexercise recovery: a systematic review.

BACKGROUND: Preliminary evidence suggests that acupuncture applied proximally during a single bout of exercise can enhance exercise performance and/or expedite postexercise recovery. The purpose of this investigation was to review trials, systematically and critically, that have investigated such hypotheses and delineate areas for future research. METHOD: A systematic review using computerized databases was performed. RESULTS: Four trials were found: Three involved within-subjects designs and one used a parallel group design. Few participants were enrolled (n=10-20). Fourteen acupuncture sites were used across the four trials: DU 20, LI 15, LI 13, PC 6, ST 36, SP 6, PC 5, LU 7, LI 4, GB 37, GB 39, GB 34, and LI 11, and LR 3. PC 6, and ST 36 were the most commonly used sites. Three trials evaluated the effect of acupuncture on exercise performance. One of these trials noted that electroacupuncture stimulation of either PC 5 and PC 6 or LU 7 and LI4 significantly increased peak power output, blood pressure, and rate pressure product (RPP) versus control. However, two trials documented no effect of acupuncture on exercise performance using point combinations of either DU 20, LI 15, LI 13, PC 6, ST 36, and SP 6 or DU 20, ST 36, GB 34, LI 11, LR 3. One trial evaluated the effect of acupuncture on postexercise recovery and found that heart rate, oxygen consumption, and blood lactate were significantly reduced secondary to acupuncturing of PC 6 and ST 36 versus control and placebo conditions at 30 or 60 minutes postexercise. CONCLUSIONS: There is preliminary support for the use of acupuncture as a means to enhance exercise performance and postexercise recovery, but many limitations exist within this body of literature. Adequately powered, RCTs with thorough and standardized reporting of research methods (e.g., acupuncture and exercise interventions) and results are required to determine more adequately the effect of acupuncture methods on exercise performance and postexercise recovery. Future investigations should involve appropriate placebo methods and blinding of both participants and investigators.

Effect of resistance training during hemodialysis on circulating cytokines: a randomized controlled trial.

The purpose of this study was to evaluate the effect of a 12-week intradialytic progressive resistance training (PRT) regimen on circulating pro- and anti-inflammatory cytokines. Forty-nine patients (62.6 ± 14.2 years) were recruited from the outpatient hemodialysis unit of the St. George Public Hospital, Sydney, Australia. Patients were randomized to: PRT + usual care (n = 24) or usual care control (n = 25). The PRT group performed two sets of 10 exercises at high intensity using free-weights, 3 times per week for 12 weeks during dialysis, while the control group did not exercise. Tumor necrosis factor-alpha, interleukin-1b, interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10, and interleukin-12 were measured in serum before and after the intervention period. Muscle cross-sectional area (CSA), intramuscular lipid, intermuscular adipose tissue, and subcutaneous and total thigh fat, evaluated via computed tomography of the non-dominant mid-thigh, were also collected at both time points. All cytokines were significantly elevated in the total cohort at baseline compared with normative data. There were no cytokine changes over time or between groups (p > 0.05). In secondary analyses pooling the groups, changes in logIL-6 and IL-8 were inversely related to changes subcutaneous thigh fat (p < 0.05) while changes in logIL-6 were also inversely related to changes in thigh muscle CSA, and total thigh fat (p < 0.03). These data suggest that 12 weeks of intradialytic progressive resistance training does not improve circulating pro- and anti-inflammatory markers. Further research is required to elucidate the implications and mechanisms of the relationships between IL-6 and IL-8 and body composition in ESRD.

Review article: Tackling the survival issue in end-stage renal disease: time to get physical on haemodialysis.

Life expectancy in haemodialysis patients is reduced fourfold on average versus healthy age-matched individuals. The purpose of this review is to present empirical evidence that intradialytic exercise can mitigate primary independent risk factors for early mortality in end-stage renal disease. These risk factors include measures of skeletal muscle wasting, systemic inflammation, cardiovascular functioning and dialysis adequacy. Overall, the available literature provides support for the integration of exercise within the conventional outpatient haemodialysis unit. The amelioration of various physiological risk factors through an appropriate exercise prescription may enhance survival in this vulnerable cohort. Investigations are required to determine the effects of various doses of intradialytic exercise on a broad range of clinical outcomes, and more thoroughly elucidate the relationship between exercise-induced adaptations and survival advantage in end-stage renal disease.

Rotator cuff tear in an elderly woman performing progressive resistance training: case report from a randomized controlled trial.

The purpose of this article is to document a rotator cuff tear sustained by an elderly woman performing progressive resistance training (PRT) in a recent randomized controlled clinical trial. The patient was a sedentary 73-y-old Caucasian woman. Investigation revealed an acute, full-thickness tear of the right supraspinatus secondary to performing a shoulder press exercise. Further investigation via MRI revealed degenerative disease of the acromioclavicular joint including lateral downsloping of the acromion and an anteroinferior acromial spur, which would presdispose to impingement. Conservative management was implemented in this case for over 6 months with minimal success. The patient remained functionally limited in virtually all activities of daily living. Given the medical history, health status, physical condition, and age of our patient, it is probable that degenerative changes predisposed the patient to the injury. To our knowledge this is the first published report of an older adult sustaining a rotator cuff tear during PRT.

Progressive resistance training and nutrition in renal failure.

Nutrition and exercise are an integral part of the medical management of many chronic and complex conditions. They are interrelated and share many common metabolic pathways that may affect disease processes and their management. In nephrology, nutritional interventions have been relatively well studied and are recommended in many evidence-based clinical practice guidelines for managing people with chronic kidney disease (CKD). Over the past 20 years, growing evidence has suggested that aerobic exercise interventions are efficacious, and that the rationale for progressive resistance training (PRT) is strong, particularly in this population, despite a more limited evidence base to date. In the small number of clinical trials that have included patients with CKD, PRT programs have proved safe, feasible to administer, and efficacious. They have been shown to improve clinical, physical, and functional outcomes.

Full-body exercise training improves fitness and quality of life in survivors of breast cancer.

This study evaluated the safety and effectiveness of an 8-week full-body resistance and aerobic exercise program for 27 survivors of breast cancer (age, 57.7 +/- 7.2 years; years posttreatment, 0.8- 21.0) with prior upper-body conditioning. Physical fitness and quality-of-life (QOL) measures were obtained before and after the training period. Lymphedema, evaluated via arm volume measurement at baseline, was self-monitored throughout the trial. Sum of skinfolds, waist girth, and hip girth were significantly reduced posttraining (p < 0.01), although body weight did not change. Significant improvements (p < 0.01) were observed in upper-body strength (35.6 +/- 16.4%) and endurance (167.4 +/- 55.4%), lower-body strength (50.7 +/- 32.3%) and endurance (273.1 +/- 120.7%), Vo(2peak), trunk flexibility, and flexibility of the ipsilateral (surgical) and contralateral shoulder joint. Psychological QOL and overall QOL, evaluated via the World Health Organization Quality of Life Assessment Scale-Abbreviated Version. Inventory also improved significantly (p < 0.01). No incidents of lymphedema or injury were reported. These findings suggest that survivors of breast cancer can safely benefit from engaging in a full-body exercise regimen.

Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials.

BACKGROUND: Exercise is not routinely advocated in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (HD), compared to best practice in other chronically diseased cohorts. Lack of widespread awareness of the exercise in HD literature may be contributing to these shortcomings of clinical practice. Therefore, our objectives are: (1) to systematically review trials of exercise training involving adult HD patients; (2) to provide empirical evidence that exercise can elicit health-related adaptations in this cohort, and (3) to provide recommendations for future investigations. METHOD: A systematic review of the literature using computerized databases was performed. RESULTS: According to the 29 trials reviewed, HD patients can safely derive a myriad of health-related adaptations from engaging in appropriately structured exercise regimens involving aerobic and/or resistance training. However, methodological limitations within this body of literature may be partially responsible for minimal advocacy for exercise in this cohort. CONCLUSIONS: Robustly designed RCTs with thorough, standardized reporting are required if clinical practice and quality of life of this cohort is to be enhanced through the integration of exercise training and mainstream medical practice. Future trials should demonstrate the clinical importance, and long-term feasibility and applicability of exercise training for this vulnerable patient population.

A rationale for intradialytic exercise training as standard clinical practice in ESRD.

The purpose of this article is to present a rationale for intradialytic exercise training in patients with end-stage renal disease based on the empirical evidence to date and determine whether this evidence has translated into enhanced renal rehabilitation practices throughout the world. According to the published literature, intradialytic exercise improves exercise adoption and adherence in this cohort, is performed safely, and is feasible to administer. Moreover, intradialytic exercise can improve solute removal, dialysis adequacy, intradialytic protein synthesis, muscular strength, peak oxygen consumption, nutritional status, and quality of life. Despite these findings, there currently are no policies or position stands regarding exercise prescription for hemodialysis patients in Australia. According to a telephone survey we conducted, intradialytic exercise programs are essentially nonexistent in this country. However, such programs are being implemented successfully as standard clinical practice in dialysis units in Germany, and there is reason to believe that this practice can be expanded throughout the world. At present, additional research is indicated. There is a lack of large-scale, robustly designed, randomized, controlled trials of intradialytic exercise training. Such research is needed to conclusively show the clinical importance of intradialytic exercise for hemodialysis patients, which may influence current standard clinical practice among nephrologists and, as such, improve the health and quality of life of this vulnerable cohort.