The role of exercise training on cardiovascular risk factors and heart disease in patients with chronic kidney disease G3-G5 and G5D: A Clinical Consensus Statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the European Association of Rehabilitation in Chronic Kidney Disease (EURORECKD).

Cardiovascular (CV) morbidity and mortality is high in patients with chronic kidney disease (CKD). Most patients reveal a high prevalence of CV risk factors such as diabetes or arterial hypertension and many have manifest cardiovascular disease (CVD), such as coronary artery disease and chronic heart failure with an increased risk of clinical events including sudden cardiac death. Diabetes mellitus and hypertension contribute to the development of CKD and the prevalence of CKD is in the range of 20%-65% in diabetic and 30%-50% in hypertensive patients. Therefore, prevention and optimal treatment of CV risk factors and comorbidities are key strategies to reduce CV risk and improve survival in CKD. Beyond common CV risk factors, patients with CKD are often physically inactive and have low physical function leading to subsequent frailty with muscle fatigue and weakness, sarcopenia and increased risk of falling. Consequently, the economic health burden of CKD is high, requiring feasible strategies to counteract this vicious cycle. Regular physical activity and exercise training have been shown to be effective in improving risk factors, reducing CVD and reducing frailty and falls. Nonetheless, combining exercise training and a healthy lifestyle with pharmacological treatment is not frequently applied in clinical practice. For that reason, this Clinical Consensus Statement reviews the current literature and provides evidence-based data regarding the role of exercise training in reducing CV and overall burden in patients with CKD. The aim is to increase awareness among cardiologists, nephrologists, and health care professionals of the potential of exercise therapy in order to encourage implementation of exercise training in clinical practice, eventually reducing CV risk and disease, as well as reducing frailty in patients with CKD G3 to G5D.

Needs, barriers and facilitators for a healthier lifestyle in haemodialysis patients: The GoodRENal project.

BACKGROUND: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well-being are often reported in patients on haemodialysis (HD). AIMS: We aimed to explore needs, barriers and facilitators-as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well-being. METHODS: This is an observational cross-sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal-aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well-being from the perspective of patients, their carers and HCPs. RESULTS: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. CONCLUSIONS: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support.

Effect of a Virtual Reality Exercise on Patients Undergoing Haemodialysis: A Randomised Controlled Clinical Trial Research Protocol.

High levels of inflammatory markers have been associated with a greater deterioration of renal function and cardiovascular morbidity and mortality. For its part, physical exercise has been shown to be beneficial in improving the functional, psychological, and inflammatory states of patients with chronic kidney failure (CKF) undergoing haemodialysis (HD) treatment, improving their health-related quality of life. In recent years, virtual reality (VR) has been studied and described as an effective and safe tool that improves patients' adherence to exercise programs. For these reasons, we propose to analyse the effect of VR exercise on the functional, psychological, and inflammatory states of patients on HD, as well as their levels of adherence to exercise, and compare them with static pedalling exercises. We will randomise 80 patients with CKF into two blind groups: an experimental group, which will carry out an intradialytic exercise program with non-immersive VR (n = 40), and a control group, which will exercise with a static pedal (n = 40). Functional capacity, inflammatory and phycological status, and exercise adherence will be analysed. Higher levels of adherence to exercise are expected in the VR group, which will have greater effects on the patients' functional capacity and psychological and inflammatory status.

Association Between Protocols of the Sit-to-Stand Test and Lower Limb Muscle Force Output in Patients on Hemodialysis and Subjects Without Chronic Kidney Disease.

OBJECTIVE: To evaluate the association of three protocols of the sit-to-stand (STS) test with muscle force output of knee extension (KE) and knee flexion (KF) in patients on hemodialysis and subjects without chronic kidney disease. METHODS: This cross-sectional study included a hemodialysis group [n = 60, 59.5 (16.8) years, 55% female] and a control group [n = 60, 43.0 (11.8) years, 50% female]. The assessments were performed in 2 days, and the participants were submitted to three protocols of STS test (5-repetition STS, 10-repetition STS and 30-s STS) or muscle force output of the KE and KF evaluation by handheld dynamometer based on randomization. RESULTS: The hemodialysis group presented reduced muscle force output of the KE and KF, a longer time to perform the 5 STS and 10 STS tests, and a lower number of repetitions in the 30-s STS test. The three STS tests were associated with muscle force output of the KE in the hemodialysis group, in which the 10-repetition STS test showed the best association (R2 = 0.47; adjusted R2 = 0.42). However, the only association between the STS test and muscle force output of the KE in the control group was found in the 10-repetition STS test (R2 = 0.20; adjusted R2 = 0.13). CONCLUSIONS: The three protocols of STS tests were associated with muscle force output of the KE in patients on hemodialysis. However, the 10-repetition STS test was the best protocol to estimate the quadriceps muscle torque in these patients.

Effectiveness of a Supervised Group-Based Otago Exercise Program on Functional Performance in Frail Institutionalized Older Adults: A Multicenter Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Because of its high prevalence and association with negative health-related outcomes, frailty is considered one of the most important issues associated with human aging and its mitigation is among the essential public health goals for the 21st century. However, very few studies have focused on institutionalized older adults, despite the knowledge that frailty can be reversible when identified and treated from its earliest stages. Therefore, the objective of this study was to evaluate the effects of a supervised group-based multicomponent exercise program intervention with or without oral nutritional supplementation on functional performance in frail institutionalized older adults. METHODS: This was a multicenter randomized controlled trial study with a 6-month intervention period. A total of 111 frail institutionalized older adults (75 years or older) who met at least 3 of the 5 Fried frailty criteria were randomly allocated to the control group (CG; n = 34, mean age = 87.3 ± 5.3 years), a supervised group-based multicomponent Otago Exercise Program group (OEP; n = 39, mean age = 86 ± 5.9 years), or a supervised group-based multicomponent exercise program intervention with oral nutritional supplementation (OEP+N; n = 38, mean age = 84.9 ± 6 years). Measurements included the Timed Up and Go test (TUG), Berg Balance Scale (BBS), Short Physical Performance Battery, repeated chair stand test (STS-5), handgrip strength (HGS), 10-m walking test, and 6-minute walking test, both at baseline and after the 6-month intervention period. RESULTS AND DISCUSSION: The between-group analysis by 2-way analysis of covariance showed significant improvement in the TUG [{OEP vs CG: -8.2 seconds, 95% CI [-13.3 to -2.9]; P < .001}; {OEP vs OEP+N: -7.3 seconds, 95% CI [-12.4 to -2.2]; P = .002}], BBS [{OEP vs CG; 8.2 points, 95% CI [5.2 to 11.2]; P < .001}; [{OEP+N vs CG: 4.6 points, 95% CI [1.6 to 7.6]; P < .001}; {OEP vs OEP+N: 3.5 points, 95% CI [0.6 to 6.5]; P = .011}], and HGS [{OEP vs CG: 3.4 kg, 95% CI [1.5 to 5.3]; P < .001}; {OEP+N vs CG: 3.6 kg, 95% CI [1.7 to 5.5]; P < .001}]. Additionally, the within-group analysis showed a significant improvement in the TUG (-6.9 seconds, 95% CI [-9.8 to -4.0]; P < .001) and BBS (4.3 points, 95% CI [2.6 to 5.9]; P < .001) in the OEP group. A significant decrease in the BBS and HGS was shown in the CG. CONCLUSIONS: A 6-month supervised group-based multicomponent exercise intervention improved the levels of mobility, functional balance, and HGS in frail institutionalized older adults. Further research will be required to evaluate the nutritional supplementation effects on functional performance to better determine its clinical applicability for tackling frailty.

A nurse-led home-based exercise program for patients with chronic kidney disease.

BACKGROUND: Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. AIM: To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4-5 (with or without dialysis). METHODS: A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. RESULTS: Fifty-three patients were included (mean age = 67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3 s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. LINKING EVIDENCE TO ACTION: The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Impact of COVID-19 Pandemic on Health-Related Quality of Life and Physical Activity of Patients in Hemodialysis.

Chronic dialysis patients have an increased risk of severe COVID-19 infection-related complications. The aim of this study was to quantify the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and physical activity levels of patients undertaking hemodialysis (HD). This was an observational study that compared data from two periods of time, before the COVID-19 pandemic vs pandemic. We used the Medical Outcomes Survey Short Form (SF-36) to measure the HRQoL and the Human Activity Profile (HAP) questionnaire was used to measure the physical activity. Data were analyzed with a mixed ordinal linear regression. A total of 27 eligible participants were interviewed during COVID-19 pandemic (median age 78 years). The linear regression model showed that the pandemic, after controlling for the covariates age, comorbidity, albumin, and hemoglobin, had a significant impact on the HRQoL. Physical function (-15.7) and social functioning subscales (-28.0) worsened (p = 0.001), and the physical component scale also showed a significant decrease (-3.6; p = 0.05). Time had a significant impact on the Human Activity Profile, with an average activity score diminished with the pandemic (-13.9; p = 0.003). The COVID-19 pandemic had a very negative impact on HRQoL and physical activity level of subjects undertaking hemodialysis. Interventions to improve HRQoL and activity levels of patients undertaking HD are recommended.

Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis.

BACKGROUND: Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. MATERIALS AND METHODS: Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. RESULTS: The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. CONCLUSION: The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.

Home-based exercise programs in patients with chronic kidney disease: A systematic review and META-analysis.

BACKGROUND: Intradialysis exercise programs in renal patients result in improved functional capacity, muscle strength, symptoms of depression, and health-related quality of life. Home-based exercise programs are an alternative to overcome logistical and human resource problems. However, the implementation of these programs is not an easy task and there is a lack of knowledge regarding the benefits associated with home-based exercise programs. AIM: To determine whether home-based exercise programs improve functional capacity, health-related quality of life, muscle strength, and symptoms of depression among patients with stage III-V chronic kidney disease. METHODS: A systematic review and meta-analyses following PRISMA guidelines were utilized. Relevant articles were collected and independently assessed for their inclusion eligibility. Effects of home-based exercise were summarized by the standardized mean differences and represented by forest plots (Review Manager 5.4). RESULTS: Eight studies were included, none of which reported any adverse effects. The intervention was usually aerobic, 76% of these programs lasted 3-6 months, and exercise adherence was 60-87.5%. Four studies measured health-related quality of life and found significant improvements in several subscales. Regarding functional capacity, five studies used the six-minute walking test (44.9 meters; 95% CI [30.45, 59.30]; p ≤ .001), three studies used the sit-to-stand-to-sit test (-0.45 seconds; 95% CI [-0.46, -0.26]; p ≤ .001), and two studies used the timed up-and-go test (-0.76 seconds; 95% CI [-1.38, -0.15]; p ≤ .001) and the handgrip strength test (1.16 kg; 95% CI [-2.88, 5.20]; p ≤ .001). LINKING EVIDENCE TO ACTION: Home-based exercise programs are beneficial to renal patients. These interventions are safe and effective to improve health-related quality of life and functional capacity and reduce symptoms of depression among patients with chronic kidney disease.

Effect of an aerobic and strength exercise combined program on oxidative stress and inflammatory biomarkers in patients undergoing hemodialysis: a single blind randomized controlled trial.

BACKGROUND: Chronic kidney disease patients on hemodialysis treatment are characterized by increased levels of inflammatory markers and oxidative stress, in addition to a significant deterioration in physical function. The benefits of physical exercise on the functional capacity of this patients are well known; however, it can also improve the endogenous antioxidant defense system and the inflammatory state, but still very few studies have been carried out. This is the first study to analyze the effect of a 4-month exercise program with combined aerobic and strength training in patients undergoing hemodialysis, under two modalities. METHODS: Seventy-one patients undergoing hemodialysis were enrolled and randomized in two groups, one of them performing an intra-dialysis exercise program (n = 36), and the other carrying out a home-based exercise program (n = 35). Serum levels of oxidative stress and inflammation biomarkers were determined before and after the intervention. RESULTS: IL-6 plasma levels showed a significant decrease in the intra-dialysis group after exercise (42.61 ± 9.21 to 26.40 ± 7.84, p = 0.03), while CRP levels decreased significantly in the home-based group (16.12 ± 24.18 to 8.50 ± 11.28, p = 0.03). MCP-1, TNF-α, ICAM-1 and the oxidative stress markers MDA, GSH and GSSG, did not undergo significant changes after the intervention. CONCLUSION: Four months of combined strength and aerobic endurance exercise improve the inflammatory status of hemodialysis patients by significantly reducing IL-6 levels in those subjects who perform intra-dialysis exercise and CRP levels in those who do it at home.

Impact of measurement timing on reproducibility of testing among haemodialysis patients.

Accurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intra-rater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland-Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion,  the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test-retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed.

An intradialytic non-immersive virtual reality exercise programme: a crossover randomized controlled trial.

BACKGROUND: Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise programme would affect physical function and adherence to exercise in these patients. METHODS: A total of 56 individuals participated in two 12-week periods in a crossover randomized controlled trial. Each patient underwent a functional capacity evaluation before and after each study period. The functional tests administered included the 4-m gait speed test, Short Physical Performance Battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLST) for balance, sit-to-stand 10 (STS-10) and sit-to-stand 60 (STS-60) tests and 6-min walking test (6MWT). Adherence to the exercise programme was also recorded. To assess the effect of VR exercise on the functional test outcomes over time, the patients were analysed using a two-way repeated-measures analysis of variance with time and treatment as the within-participant factors. RESULTS: By the end of the 12 weeks of exercise, compared with the control period, 33 participants showed significant change in physical function as measured through the 4-m gait speed test (0.14 m/s), SPPB (1.2 points), TUG (-1.7 s), OLST (7.1 s), STS-10 (-5.8 s), STS-60 (5 repetitions) and 6MWT (85.2 m), with adherence rates exceeding 70%. There were no changes in the biochemical data or in the medications in the period of the study. CONCLUSION: An intradialytic non-immersive VR exercise programme improves patient physical function.

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session.

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.

Exercise training during hemodialysis in Brazil: A national survey.

To evaluate the availability and characteristics of exercise training during hemodialysis in Brazil and to identify the reported barriers to exercise program implementation and maintenance. All dialysis units were assessed for eligibility using the database of the Brazilian Society of Nephrology. Each dialysis unit was contacted by telephone and the questions were administered. In dialysis units with exercise training, questions related to personnel involved, exercise components, and program delivery were included. Additionally, the barriers to exercise program implementation and maintenance were evaluated. This study included 261 dialysis units that responded to the survey. Forty-one dialysis units reported exercise training during hemodialysis in Brazil (prevalence of 15.7%). We identified 66 physiotherapists and 10 exercise physiologists in dialysis units with exercise training. Resistance training was the most common program component (92.7%). Hypotension (90.5%) and muscle cramps (85.7%) were the most common adverse events reported. In dialysis units with exercise training, poor patients' adherence to exercise was the most commonly reported barrier. The most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs was a lack of resources. The number of dialysis units that have exercise training during hemodialysis in Brazil is low, and the most common program component is resistance training. A lack of resources was the most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs.

Bridging the gap from research to practice for enhanced health-related quality of life in people with chronic kidney disease.

Improving the health status of people with chronic kidney disease (CKD) through physical activity (PA) or exercise interventions is challenging. One of the gaps in the process of translating the general public PA activity guidelines as well as the CKD-specific guidelines into routine clinical practice is the lack of systematic recording and monitoring of PA and physical function attributes, which can also be used to develop individualized and measurable plans of action to promote PA for health. We aim to present an overview of key considerations for PA, physical function and health-related quality of life (HRQoL) evaluation in people with CKD, with the aim of encouraging health professionals to integrate assessment of these outcomes in routine practices. Physical inactivity and impaired physical function, sometimes to the extent of physical and social disability levels, and subsequently lower perceived HRQoL, are highly prevalent in this population. Enhanced PA is associated with better physical function that also translates into multiple health benefits. Breaking the vicious circle of inactivity and physical dysfunction as early as possible in the disease trajectory may confer huge benefits and enhanced life satisfaction in the longer term. With this in mind, the importance of PA/exercise interventions in CKD to improve HRQoL is also summarized.

Effects of exercise programs on physical function and activity levels in patients undergoing hemodialysis: a randomized controlled trial.

BACKGROUND: There are still many barriers when implementing exercise routines within daily dialysis care, even though benefits are well-known. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complementary therapy in dialysis. AIM: To compare several exercise programs on hemodialysis patient's functional capacity and health-related quality of life. DESIGN: This study was a 16-week follow-up, two-parallel group trial with balanced randomization. SETTING: Participants in this study belonged to a private hospitalized care center. POPULATION: Referred sample of 71 patients that suffered end-stage chronic kidney disease who underwent hemodialysis for at least 3 months and had a medical stable condition. METHODS: Thirty-six participants performed for 16 weeks an intradialytic exercise program lead by the nursing staff of the hemodialysis unit and 35 a home-based program supervised by physical therapists of the hospital. RESULTS: The main researcher and the data analyst were both blinded to participant allocation. There was a significant effect in time for both groups. Participants improved significantly in the Short Performance Physical Battery (SPPB), One-Leg Heel-Rise (OLHR) and 6 Minute-Walk Test (6MWT), and in the Physical Activity Scale for the Elderly (PASE) and Short Survey Form 36 (SF-36) questionnaires. CONCLUSIONS: Nurse-led and home-based exercise interventions produce beneficial effects involving physical function, activity levels and health-related quality of life in patients undergoing hemodialysis. CLINICAL REHABILITATION IMPACT: The study emphasizes the importance of exercise rehabilitation routines in fragile populations such as dialysis patients, and the potential to overcome barriers for its daily implementation.

Factors Associated with Functional Capacity in CKD Patients.

To evaluate the factors associated with functional capacity in patients with chronic kidney disease (CKD). All patients were submitted to six-minute walk test (6MWT), 10-repetition sit-to-stand test (STS-10) and SF-36 health-related quality of life questionnaire (HRQoL). Patients with functional capacity ≥80% exhibited higher education level, family income, body mass index, estimated glomerular filtration rate, and lower age and STS-10 time. Multiple linear regression showed that gender, age, family income, chronic kidney disease stage, STS-10 time, and physical component summary of HRQoL were significantly associated with the 6MWT distance. Functional capacity was significantly associated with gender, age, family income, CKD stage, STS-10 time, and physical component of HRQoL. The progression of CKD has an impact on the decrease in functional capacity in these patients.

The Relationship between Physical Activity Levels and Functional Capacity in Patients with Advanced Chronic Kidney Disease.

The purpose of this study is to assess whether the functional capacity of patients with chronic kidney disease stage V (CKD-5D) is different depending on their physical activity levels. We also compared functional capacity, quality of life, and symptoms of depression depending on treatment modalities (HD vs. PD). A Cross-sectional study included 52 patients (35HD and 17PD; males 61.5%, mean age 71 years). The main measurements were physical activity level using the Human Activity Profile questionnaire (HAP), muscle strength, functional capacity, health-related quality of life (HRQoL), and depressive symptomatology. The functional tests and physical activity levels correlated significantly. Participants on HD with low physical activity levels were older (*p ≤ .039) and had worst physical function (*p ≤ .01). The HAP is a useful tool to detect subjects with low functional capacity; there were no differences between the therapy modalities in terms of functional capacity, HRQoL, or depressive symptomatology.

Resultados de un programa de ejercicio físico domiciliario en pacientes con enfermedad renal / Results of a home physical exercise program in patients with kidney disease

INTRODUCCIÓN: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. OBJETIVO: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. MATERIAL Y MÉTODO: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. RESULTADOS: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4±14,9 años. La velocidad de la marcha en 4 metros aumentó en 0,18 m/s (IC95%: 0,08-0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95%: 0,6-2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). CONCLUSIÓN: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5

INTRODUCTION: Scientific evidence is greater on the benefits of physical exercise programs to improve functional capacity and health-related quality of life of patients with chronic kidney disease. However, implementing these programs is not an easy task. OBJECTIVE: To evaluate the effectiveness of a home physical exercise program on hand grip strength, functional capacity and quality of life in patients with advanced chronic kidney disease in stages 4-5. MATERIAL AND METHOD: Prospective experimental study. The patients performed a complete home exercise program of 3 weekly sessions for 12 weeks. The main data analyzed were manual dynamometry, the Short Physical Performance Battery (SPPB) test, and the EuroQoL 5D questionnaire to assess quality of life. RESULTS: Sixty-two patients were included, 34 men and with a mean age of 67.4±14.9 years. The 4-meter gait speed increased by 0.18 m/s (95%CI: 0.08-0.28). The SPPB results increased by 1.4 points (95%CI: 0.6-2.2 points). No significant changes were observed either in manual dynamometry (from 26.1 to 26.4Kg) or in health-related quality of life (from 67.8 to 71.3 points). CONCLUSION: A 12-week home physical exercise program was safe and improved the functional capacity of patients with advanced chronic kidney disease in stages 4-5

A Random Forest Machine Learning Framework to Reduce Running Injuries in Young Triathletes.

BACKGROUND: The running segment of a triathlon produces 70% of the lower limb injuries. Previous research has shown a clear association between kinematic patterns and specific injuries during running. METHODS: After completing a seven-month gait retraining program, a questionnaire was used to assess 19 triathletes for the incidence of injuries. They were also biomechanically analyzed at the beginning and end of the program while running at a speed of 90% of their maximum aerobic speed (MAS) using surface sensor dynamic electromyography and kinematic analysis. We used classification tree (random forest) techniques from the field of artificial intelligence to identify linear and non-linear relationships between different biomechanical patterns and injuries to identify which styles best prevent injuries. RESULTS: Fewer injuries occurred after completing the program, with athletes showing less pelvic fall and greater activation in gluteus medius during the first phase of the float phase, with increased trunk extension, knee flexion, and decreased ankle dorsiflexion during the initial contact with the ground. CONCLUSIONS: The triathletes who had suffered the most injuries ran with increased pelvic drop and less activation in gluteus medius during the first phase of the float phase. Contralateral pelvic drop seems to be an important variable in the incidence of injuries in young triathletes.