Factors associated with fear of falling in hemodialysis patients.

PURPOSE: Fear of falling (FOF) has important clinical and psychological consequences. This study evaluated the factors associated with FOF in hemodialysis patients and compared with the FOF reported by age-gender matched individuals without chronic kidney disease. METHODS: This cross sectional study included hemodialysis group (n = 60, 55.4 ± 7.6 years, 55.0% male) and control group (n = 40, 55.1 ± 7.5 years, 52.5% male). FOF was assessed by the Falls Efficacy Scale International (FES-I). Physical function was evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test, 4-m gait speed, isometric handgrip force and 10-repetition sit-to-stand test. The physical and mental components of quality of life was evaluated by 36-Item Short Form Health Survey. RESULTS: The FES-I score was higher in the hemodialysis group compared to the control group (28.2 ± 9.7 vs. 23.3 ± 5.1, p = 0.020). In addition, the prevalence of individuals with a higher concern about falling was greater in the hemodialysis group (41.7 vs. 17.5%, p = 0.033). Multiple linear regression showed that the FES-I score was associated with the Mini-BESTest score and the physical component summary of quality of life (coefficient of determination of 0.51 and an adjusted coefficient of determination of 0.46). CONCLUSION: FOF was associated with poor postural balance and reduced physical component of quality of life in patients on hemodialysis and these patients showed higher FOF compared to individuals without chronic kidney disease.

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.

Effects of long-term aerobic training and detraining on functional capacity and quality of life in hemodialysis patients: A pilot study.

Although previous studies have shown the benefits of exercise training in hemodialysis patients, little is known about the effects of long-term of exercise program on these patients. We investigated the effects and the safety of long-term aerobic training and the effects of detraining on functional capacity and quality of life in hemodialysis patients. Ten patients were allocated to two groups: training and detraining. The training group completed at least 30 months of aerobic training, and the detraining group completed at least 20 months and then discontinued the training for at least 10 months. The outcomes were analyzed at baseline, after 3 months of aerobic training and at the 30-month follow-up. The training and detraining groups performed 37 (5.5) and 24 (3.0) months of aerobic training, respectively. The detraining group discontinued the training for 11.0 (2.0) months. After 3 months of aerobic training, six-minute walking test distance increased significantly in both groups (training group = 569 (287.8) vs 635.5 (277.0) m, p = 0.04; detraining group = 454.5 (72.3) vs 515.0 (91.8) m, p = 0.04). There was no significant difference in the six-minute walking test distance in the training group (576.5 (182.5), p > 0.05) and a significant decrease (436.2 (89.6) m, p = 0.04) in the detraining group at the follow-up compared to the third month of aerobic training. No significant difference was observed in quality of life during the study. No complications were found during the protocol of the exercise. These results suggest that long-term aerobic training is safe and can maintain functional capacity in hemodialysis patients. In contrast, detraining can result in loss of functional capacity in these patients.

Exercício físico e obesidade: prescrição e benefícios / Physical exercise and obesity: prescription and benefits

A obesidade está associada a várias complicações e maior risco de mortalidade. A mudança no estilo de vida é uma das intervenções fundamentais para melhora do quadro clínico desses pacientes, sendo a prática de exercícios físicos um dos seus componentes. O objetivo do presente estudo foi realizar uma revisão de literatura sobre o exercício físico em adultos e idosos com obesidade, descrevendo os principais programas de exercício, a forma adequada de prescrição e os benefícios da sua prática regular. O exercício aeróbico é a modalidade mais indicada para a perda de peso e está associado com maiores benefícios para esses pacientes. Adicionalmente, tem sido preconizado a realização de exercício resistido como terapia complementar. Para alcançar os benefícios da prática regular de exercício físico, a literatura sugere que sejam realizados exercícios aeróbicos de moderada a alta intensidade por no mínimo 150 minutos por semana e quando possível acrescentar o treinamento resistido, 2 a 3 vezes por semana, com carga de 60-70% de uma repetição máxima. Portanto, a prescrição individualizada de exercício físico para pacientes com obesidade representa uma estratégia eficaz para a redução do peso, tratamento e controle dos fatores de risco cardiovasculares, além de promover benefícios na sintomatologia e em outras complicações.

Obesity is associated with many complications and higher risk of mortality. Changing the lifestyle is one of the fundamental interventions for improvement of the clinical condition in these patients, being the physical exercise one of the components. The objective of this study was to perform a literature review about physical exercise in adults and the elderly with obesity, describing the main exercise programs, the proper form of prescription and the benefits of its regular practice. Aerobic exercise is the most indicated modality for weight loss and is associated with higher benefits for these patients. Additionally, it has been recommended resistance training as a complementary therapy. To achieve the benefits of the regular practice of physical exercise, the literature suggests the performing of aerobic exercises from moderate to high intensity for at least 150 minutes per week and when possible, the implementation of resistance training, 2 to 3 times a week, with a load of 60-70% of one-repetition maximum. Therefore, individualized prescription of physical exercise for the obese patient represents an effective strategy for weight loss, treatment and control of cardiovascular risk factors, in addition to promotes benefits in the symptoms and other complications.