Effects of a combined aerobic and core stabilization exercise training program on functional capacity, pain, and health-related quality of life in hemodialysis and kidney transplant patients.

BACKGROUND: Chronic kidney disease (CKD) poses a significant public health challenge globally while impacting patients' physical function and quality of life. Addressing the issues of physical inactivity and pain management is essential during treatment to improve health-related quality of life. The present study investigated the effect of an aerobic training program with core stabilization exercises for hemodialysis (HD) patients on a transplant waiting list and renal transplant (RTx) patients. METHODS: A total of 45 patients with CKD were included in the 12-week study: 25 patients receiving HD (12 HD treatment group, 13 HD control group) and 20 patients with RTx (9 RTx treatment group, 11 RTx control group). Functional capacity was measured using the 6-min walk test, pain was measured using the visual analog scale, and health-related quality of life was measured using the Kidney Disease Quality of Life-Short Form 12 questionnaire. Nonparametric statistical tests were performed at a significance level of 0.05. RESULTS: Both the HD and RTx treatment groups showed significantly reduced times for the 6-min walking test (p = 0.002 and p = 0.008, respectively), significantly reduced pain severity (p = 0.002 and p = 0.008, respectively), and significantly improved quality of life scores (p = 0.006 and p = 0.041, respectively) by the end of the study compared with control groups. CONCLUSION: Based on the results, structured exercise programs could be effective therapies in CKD management. Therefore, health providers should promote their integration into routine care practices to enhance patient outcomes and well-being.

Association between physical activity and quality of life in haemodialysed and peritoneal dialyzed patients in Hungary.

BACKGROUND: Patients with end-stage kidney disease (ESKD) receiving peritoneal dialysis (PD) or haemodyalisis (PD) appear to be less physically active than healthy persons, a situation that could lead to reductions in quality of life. The aim of the present study was to assess and compare physical activity and health-related quality of life in renal patients on HD and PD programs. METHODS: In May 2020, 130 patients (106 HD and 24 PD) were enrolled in a study of chronic dialysis programs. All participants received a questionnaire containing information on demographics, treatment, and co-morbidities. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and quality of life was measured using the Kidney Disease Quality of Life-Short Form 12 (KDQOL-SF-12) questionnaire comprising mental (MCS) and physical components (PCS). Non-parametric statistical tests were executed with 0.05 as the level of significance. RESULTS: The physical activity of patients treated in both HD and PD programs could be considered as low, without a statistically significant difference between the two modalities. For the quality of life measures, we found a significant (p = .004) difference regarding Physical Component Summary (PCS) scores, with higher PCS scores in patients treated in the PD programme compared to HD. Furthermore, higher physical activity levels were associated with better quality of life parameters in both groups. CONCLUSION: This study confirms the importance of physical activity among dialysis patients with ESKD, suggesting that greater activity could be associated with a better quality of life.

Efficiency of Printed Patient Information Leaflets Written for Total Knee and Hip Arthroplasty Patients to Reduce Their Fear of Surgery.

Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients' fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00-40.00 vs. median 20.00 IQR 16.00-24.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 20.00 IQR 16.00-22.00). A control group with TKA (median 37.50 IQR 30.00-40.00 vs. median 64.50 IQR 54.00-82.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 73.00 IQR 56.00-81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00-10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.

Effectiveness of hospital-based low intensity and inspected aerobic training on functionality and cardiorespiratory fitness in unconditioned stroke patients: Importance of submaximal aerobic fitness markers.

INTRODUCTION: The purpose of our study was to evaluate the effectiveness of low-to moderate intensity aerobic training on cardiorespiratory functions in chronic unconditioned stroke patients. The oxygen uptake efficiency slope (OUES) and the ventilatory threshold (VO2-VT) could represent the aerobic capacity in submaximal test. Our study examined the application of the submaximal parameters for evaluating aerobic capacity of chronic stroke patients. MATERIALS AND METHODS: In our assessor-blinded controlled pilot study 37 patients were randomized into 2 groups named: intervention group (IG, n: 21) and control group (CG, n:16), respectively. Cardiorespiratory functions were evaluated by ergospirometer before and after the 4-week (20 days) program. Both groups participated in daily occupational therapy (30 minutes) and conventional, customized physiotherapy CG (60 minutes), IG (30 minutes). Only IG performed aerobic training by bicycles (30 minutes) aiming to reach low-to moderate training intensity. Outcome measures included peak oxygen uptake (VO2 peak), OUES, VO2-VT, functional exercise capacity 6-Minute Walking Test (6MWT) and Functional Independence Measure. RESULTS: Thirty-five subjects completed the study. The VO2 peak uptake was very low in both groups (IG: 11.9 mL/kg/min, CG: 12.45 mL/kg/min) and did not improve after the program, but submaximal parameters such as VO2-VT (P < .01) and OUES (P < .001) have shown significant improvement, but only in IG regardless of insufficient impact on VO2 peak. Each participant in both groups was unable to permanently reach the moderate intensity zone. Functional Independence Measure changed for the better in both groups, but 6MWT only in the IG. DISCUSSION AND CONCLUSIONS: Four-week exercise training even at low intensity by lower limb cycle ergometer may provide benefit on aerobic and functional capacity without improvement of VO2 peak on unconditioned chronic stroke patients.

Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients.

Feasibility of six-point Goal Attainment Scale among stroke patients were examined. Thirty-five subacute and chronic stroke patients with upper limb function problems were included (December 2015-March 2017). Sixty-minute conventional therapy and 30-minute occupational therapy was provided on every consecutive weekday, for 4 weeks. Beside Functional Independence Measure, Action Reach Arm test, Fugl-Meyer upper extremity assessment motor function subtest and six-point Goal Attainment Scale were collected. The content of the previous tests was linked with International Classification of Functioning, Disability and Health domains. Feasibility characteristics were checked according to previous feasibility studies and the following aspects: acceptability, demand, implementation, practicality, integration, and expansion. Data analysis was done in 2018. Participants' global functions were described with the Functional Independence Measure median points were 116.5. All of the outcome measures showed significant improvement at group level (P < 0.001). Most of the goals matched to one or more International Classification of Functioning, Disability and Health domains but were not covered with the Action Reach Arm test or the Fugl-Meyer tests. Association between clinically relevant change of the first Goal Attainment Scale and the other tests was not significant. Six-point Goal Attainment Scale proved to be a feasible outcome measure among subacute and chronic stroke participants. It completed the functional picture of a patient, beside standardized measures. Further studies needed to complete the psychometric properties of six-point Goal Attainment Scale among stroke patients and in other patient groups.

The effect of low-intensity aerobic training on cognitive functions of severely deconditioned subacute and chronic stroke patients: a randomized, controlled pilot study.

Our objective was to investigate the impact of low-intensity aerobic training on cognitive functions in severely deconditioned subacute and chronic stroke patients. For this purpose, a randomized, controlled pilot study was designed involving subacute and chronic stroke patients. Thirty-seven eligible patients participated in the 4-week-long randomized, controlled pilot study. Patients were randomized into study group and control group and both groups participated in conventional physiotherapy included occupational therapy. Only the study group's patients participated in a low-intensity aerobic training by cycle ergometer. Cognitive evaluations (Functional Independence Measure Cognitive part - FIM-cog; Coding and Symbol Search tasks of the Processing Speed index and Digit Span task of Working Memory index of Wechsler Adult Intelligence Scale-Fourth Edition) were performed before and after the programme. In-group analysis showed a significant improvement in study group patients regarding Coding subtest of Processing Speed domain (P = 0.003). Symbol Search subtest of Processing Speed showed significant improvements in both groups by the end of the programme (study group, P = 0.041; control group, P = 0.006). There were no significant changes in the FIM-cog and Digit Span task. The intergroup analysis did not find significant difference between the two groups. It was concluded that even the low-intensity aerobic training may improve special domains of cognitive function after stroke. Further studies are needed to confirm the impact of low-intensity aerobic training on cognitive functions.

Effectiveness of the conductive educational approach added to conventional physiotherapy in the improvement of gait parameters of poststroke patients: randomized-controlled pilot study.

Our objective was to assess the benefits of the conductive education (CE) approach added to conventional physiotherapy in gait functions of poststroke, hemiparetic patients. A randomized-controlled trial was designed in a rehabilitation clinic. Late and chronic poststroke patients with gait disturbances (n=17, median age: 55 years, range: 41-72 years) were enrolled in the study. All patients received conventional physiotherapy. However, patients of only one group took part in therapy on the basis of the CE approach. The gait parameters, semiobjective outcome measures, functional independence measure, and International Classification of Functioning, Disability and Health domains were collected. The effectiveness of the CE approach was underlined by those outcome measures that were only significant (P≤0.05) in the conductive group: functional independence measure motor subscale; maintaining body position and walking long distances; and muscle strength in some muscle groups. The results suggest that CE could have an additive effect on gait improvement of stroke patients.

Hemodialysis and hemodiafiltration differently modulate left ventricular diastolic function.

BACKGROUND: Renal replacement therapy may have a favorable effect on diastolic left ventricular function, but it is not clear whether hemodiafiltration is superior to hemodialysis in this field. Nitric oxide (NO) and asymmetric dimethylarginine (ADMA) may play a role in the changes of intracardiac hemodynamics, but it is not clear whether the different renal replacement methods have disparate influence on the metabolism of these materials. METHODS: Thirty patients on renal replacement therapy were investigated. First, data was analyzed while patients received hemodiafiltration over a period of three months. Then, the same patients were evaluated during treatment with hemodialysis for at least another three months. Echocardiography was performed before and after renal replacement therapy. RESULTS: No significant difference was found in the volume removals between hemodialysis and hemodiafiltration. The left atrial diameter and transmitral flow velocities (E/A) decreased significantly only during hemodiafiltration. A positive correlation was observed between the left atrial diameter and E/Ea representing the left ventricular pressure load during hemodiafiltration. Significant correlations between NO and A and E/A were observed only in the case of hemodiafiltration. CONCLUSION: Hemodiafiltration has a beneficial effect on echocardiographic markers representing left ventricular diastolic function. This could be attributed to the differences between the dynamics of volume removal and its distribution among liquid compartments.

Increased hair selenium concentration in hyperlipidemic patients.

Selenium is an essential trace element with potential anti-atherogenic and antioxidant effects. Experimental data suggest that selenium might be beneficial in the prevention of atherosclerosis and its complications, whereas human epidemiological studies have yielded conflicting results. Data on hair selenium status in hyperlipidemic patients are still lacking. Therefore, we analysed selenium concentrations by X-ray fluorescence in the hair of 81 statin-naïve patients with newly diagnosed Fredrickson-type IIa and IIb hyperlipoproteinemia and compared their data with 43 healthy volunteers. We also assessed the frequency of other classical risk factors of atherosclerosis. Hair selenium levels were found to be significantly higher in hyperlipidemic patients compared with volunteers with normal lipid levels. Also, a significantly increased number of traditional atherosclerosis risk factors were observed in hyperlipidemic patients with hair selenium concentrations above the median in contrast to those with below. Our results suggest that high hair selenium status might be associated with adverse blood lipid profile together with an increased number of traditional risk factors in a selenium-deplete population. These findings warrant further investigations to study the impact of selenium supplementation on the incidence of cardiovascular events.

Anthracycline causes impaired vascular endothelial function and aortic stiffness in long term survivors of childhood cancer.

Vascular and endothelial functions were investigated in long term survivors of childhood cancer exposed to anthracycline treatment. We enrolled 96 long-term survivors (57 males and 39 females, mean age 14.9 ± 5.3 year) of different childhood cancers and 72 age-, sex-, bodyweight- and blood pressure matched controls (39 males and 33 females, mean age 13.7 ± 4.9 year). Aortic stiffness was characterized by echocardiography. Brachial artery endothelial function was assessed by flow-mediated dilatation (FMD%) and nitrate-mediated dilatation (NTG%). Results were compared between three subgroups: anthracycline treated, only chemotherapy treated and control subgroups. The cumulative anthracycline dose was less than 350 mg/m². The healthy control subgroup had a significantly greater FMD response (13.13 ± 2.40 %), and lower stiffness index (2.08 ± 0.6) than both the anthracycline (7.12 ± 6.28 % and 6.45 ± 3.25, respectively) and only chemotherapy treated (10.17 ± 4.23 % and 4.12 ± 2.32, respectively) subgroups. In the anthracycline treated subgroup a significantly (p < 0.01) lower FMD% response, and higher stiffness index were detected than in the only chemotherapy treated subgroup. Higher triglyceride level, higher cumulative anthracycline dose and lower age at the start of treatment were found to be associated independently with impairment of FMD% response and aortic stiffness. We found a significant negative correlation between FMD and aortic stiffness (p < 0.001) and a positive correlation between FMD and distensibility (p < 0.0001). Childhood cancer long term survivors exposed to anthracycline treatment exhibit a marked preclinical vasculopathy, characterized by endothelial dysfunction and increased arterial stiffness, contributing to a deteriorated cardiovascular function.

[Complex assessment of late side effects affecting quality of life - the "Debrecen model"]. / Életminõséget befolyásoló késõi mellékhatások komplex felmérése - a debreceni modell.

As the outcome of childhood cancer improved substantially during the last 3 decades, the attitude of pediatric oncology has changed from "cure at any cost" to "cure at least cost". We investigated factors affecting quality of life in long-term survivors of childhood cancer in the in- and outpatient clinics of the Department of Pediatric Hematology-oncology, Institute of Pediatrics, Medical and Health Science Center, Debrecen. As a part of a comprehensive follow-up care program, we focused our attention on nephrotoxicity, osteoporosis and on cardiovascular morbidity. For long-term survivors of childhood cancer sensitive and cost-effective diagnostic algorithms were developed that can help in guiding secondary and tertiary prevention programs, in addition to assessing accurately the condition of patients. We found that anti-cancer treatments, including some of the supportive interventions, have adverse effects on glomerular (10%) and tubular functions (37%), impair the balance of bone resorption and formation (69%) and increase the frequency of cardiovascular risk factors (62%) in a significant proportion of patients. Our data confirm and extend the findings of other investigators and cooperative groups. In conclusion, we consider it important that the treatment plans of high-risk patients with cancer should be aimed at preserving the anticancer potential of therapy, without enhancing the frequency and severity of complications. The presented "Debrecen model" may help in achieving this goal and in increasing quality of life of long-term survivors of childhood cancer.