title: Implementation of exercise training programs in a hemodialysis unit: effects on physical performance. A nurse-led case management program on home exercise training for hemodialysis patients: A randomized controlled trial. Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise Effects of Dehydration and Rehydration on the One‐Repetition Maximum Bench Press of Weight‐Trained Males Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data. Properties of the ‘Timed Up and Go’ Test: More than Meets the Eye Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Intradialytic protein supplementation reduces inflammation and improves physical function in maintenance hemodialysis patients. Falls and fall-related injuries in older dialysis patients. Physical performance measures in the clinical setting. Determinants of physical performance in ambulatory patients on hemodialysis. Admission Ambulation Velocity Predicts Length of Stay and Discharge Disposition Following Stroke in an Acute Rehabilitation Hospital Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis.
abstract: INTRODUCTION Exercise training is beneficial for hemodialysis patients , but it should be tailored to individual abilities and willingness to participate . This study evaluated the effects of different 6-month programs of physical activity in 18 patients of a single hemodialysis unit . METHODS Before and after a 12-month control period ( T0 ) , and following 3 ( T3 ) and 6 ( T6 ) months of training , the patients underwent the 6-minute walk test ( 6MWT ) and constant treadmill test at 3 km/hour speed and 10 % grade ; spontaneous physical activity was assessed by pedometers . All patients trained for coordination , flexibility and muscular strengthening for 30 minutes within the first 2 hours of hemodialysis sessions : 9 patients underwent home exercise walking training ( advised walking group [ AWG ] ) ; the other 9 patients underwent the advised home training program plus an additional supervised gym training session , twice weekly ( supervised walking group [ SWG ] ) . RESULTS In both AWG and SWG , no changes occurred during the control period ( 232 ± 204 m and 248 ± 187 m at T0 ) . In contrast , endurance performance at treadmill increased at T3 and T6 in the AWG ( 377 ± 272 m and 615 ± 413 m ; p<0.01 ) and in the SWG ( 424 ± 272 m and 890 ± 364 m ; p<0.001 ) . No unwanted side effects occurred . CONCLUSION This study shows that physical exercise programs can safely increase physical performance in hemodialysis patients . The training program should be continued for at least 6 months to increase muscle strength and endurance .  Intradialytic exercise and home-based , pedometer-based regimens may be a useful and easy approach , whereas supervised programs can give additional benefits in motivated , selected patients BACKGROUND Patients on maintenance hemodialysis suffer from diminished physical health . Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being . However , nurses seldom include an exercise intervention in the care plan for hemodialysis patients . OBJECTIVES The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients . DESIGN The study was a r and omized , two-parallel group trial . SETTING S Hemodialysis units in two tertiary hospitals in Nanjing , mainl and China . PARTICIPANTS One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and r and omly assigned to either the study group ( n=57 ) or the control group ( n=56 ) . METHODS Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks . The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks . The intervention was to facilitate patients in performing regular exercise at home . Outcome measures , including gait speed , 10-repetition sit-to-st and performance , and quality of life were collected at baseline , and at 6 and 12 weeks into the program . RESULTS The results revealed that patients in the study group demonstrated greater increases in normal gait speed [ F(1,111)=4.42 , p=0.038 ] than the control group . For the study group , a mean increase of 12.02 (±3.03)centimeters/second from baseline to week 12 was found . With regard to the fast gait speed , there was a marginally significant between-group effect [ F(1,111)=3.93 , p=0.050 ] . The study group showed a mean improvement of 11.08 (±3.32)cm/s , from baseline to week 12 . Patients from both groups showed improvements in their 10-repetition sit-to-st and performance . The between-group differences approached significance [ F(1,111)=3.92 , p=0.050 ] , with the study group showed greater improvement than the control group . The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88)s from baseline to week 12 . Significant improvements in quality of life across three time points were found only in the study group . CONCLUSIONS Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients Objective : To compare the effectiveness of unsupervised home and supervised group exercise on parameters related to risk of falling among older adults . Design : Prospect i ve , single-blind , r and omized and controlled trial . Setting : Nursing home . Subjects : The subjects were selected from 535 independent individuals who resided in a nursing home . Forty-two older adults , aged > 65 years , with risk of falling were recruited , and 32 of them completed the study . Intervention : The 42 subjects were divided into two groups ( unsupervised home exercise and supervised exercise group ) r and omly . Exercise sessions were performed three times a week for a period of eight weeks . Main measures : Measurements were taken at baseline and after the completion of the exercise programme . The fear of falling was evaluated using a visual analogue scale , quadriceps muscle strength was measured with a dynamometer , flexibility was assessed with the sit and reach test , functional mobility was determined using the Timed Up and Go Test , balance was evaluated using one-leg and t and em st and ing , and Berg Balance Scale and proprioception was assessed with knee position sense . Results : Thirty-two subjects ( unsupervised home exercise n = 15 , supervised group exercise n = 17 ) completed the exercise programme and all of the measurements . The unsupervised home exercise group showed significant improvement in balance , functional mobility and flexibility ( P > 0.05 ) . In addition to balance , functional mobility and flexibility , the supervised exercise group also showed significant improvements in both strength and proprioception ( P > 0.05 ) . Conclusions : Supervised group exercise is more effective at reducing the risk factors related to falling among older adults living in a nursing home than is unsupervised home exercise Dehydration , a common practice among competitive athletes in sports including weight classes , has uncertain effects on strength . This study examined the effects of passive dehydration ( D , ∼2 hours in a sauna ) followed by rehydration ( R , ∼2 hours of rest with water ad libitum ) on bench press one-repetition maximum ( 1RM ) . Ten weight-trained males ( x ± SE ; age = 25 ± 1 years ; mass = 85.5 ± 5.2 kg ; height = 173.5 ± 1.7 cm ; body fat = 17.8 ± 2.2 % ; 1RM = 118 ± 8 kg ) completed 2 testing sessions ( E1/E2 and D/R ) consisting of , respectively , 2 euhydration 1RM measurements separated by 2 hours of rest ; and D 1RM followed by R 1RM . Testing sessions were administered in counterbalanced order and separated by 1 week . D result ed in increases ( p < 0.005 ) in body temperature , urine specific gravity , hematocrit , and hemoglobin ( calculated 8 % decrease in plasma volume ) as well as decreased body mass ( p < 0.005 ) . 1RM was decreased following D ( 111.4 ± 7.2 kg ) compared to both E1 ( 118 ± 7.6 kg , p = 0.0015 ) and R ( 117.3 ± 7.8 kg , p = 0.0023 ) , with no significant difference between E1 and R. A significant association ( r = −0.67 , p < 0.05 ) was observed between percent lean body mass ( % LBM ) and the change in 1RM following D. In conclusion , passive dehydration result ing in—1.5 % loss of body mass adversely affects bench press 1RM performance . The adverse affects of dehydration seem to be overcome by a 2-hour rest period and water consumption AIM To assess the association of measured gait speed with hemodialysis ( HD ) patients ' hospitalization , in conjunction with , and apart from , recent fall history . METHODS  Gait speed was measured by a st and ard protocol and  falls during the past 12 mo were ascertained for a prevalent multi-center HD cohort ( n = 668 ) aged 20 - 92 . Hospitalization during the past 12 mo was identified in the patient 's clinic records , and the first hospitalization after gait speed assessment ( or the competing event of death ) was identified in the 2013 United States Renal Data System St and ard Analysis Files . RESULTS Slow gait speed , defined as < 0.8 m/s , characterized 34.7 % of the patients , and 27.1 % had experienced a recent fall . Patients with slow gait speed but without a history of recent falls were 1.79 times more likely to have been hospitalized during the past 12 mo ( OR = 1.79 , 95%CI : 1.11 - 2.88 , P = 0.02 ) , and patients with slow gait speed and a history of recent falls were over two times more likely to have been hospitalized ( OR = 2.10 , 95%CI : 1.19 - 3.73 , P = 0.01 ) , compared with patients having faster gait speed and no recent fall history . Prospect i ve examination of gait speed/fall history status in relation to first hospitalization ( or death ) incurred by the end of follow-up December 31 , 2011 also showed that slow gait speed was associated with these events in conjunction with a history of falls ( HR = 1.54 , 95%CI : 1.04 - 2.30 , P = 0.03 ) . CONCLUSION The International Task Force on Nutrition and Aging reported that gait speed is a powerful predictor for older adults of adverse outcomes such as hospitalization . In our data , gait speed -- apart from , as well as in conjunction with , recent fall history -- was associated with HD patients ' hospitalization for multiple causes . Gait speed may be a sensitive health indicator among HD patients across the age spectrum Background : The  ‘ timed up and go ’ test ( TUG ) is a simple , quick and widely used clinical performance-based measure of lower extremity function , mobility and fall risk . We speculated that its properties may be different from other performance-based tests and assessed whether cognitive function may contribute to the differences among these tests in a cohort of healthy older adults . Objective : To evaluate psychometric properties of the TUG in healthy older adults in comparison to the Berg balance test ( BBT ) and the Dynamic Gait Index ( DGI ) . Methods : The  TUG , DGI and BBT  were assessed in 265 healthy older adults ( 76.4 ± 4.3 years ; 58.3 % women ) who participated in a 3-year prospect i ve study . The  Mini-Mental State Examination , digit span and verbal fluency measured cognitive function . The one- sample Kolmogorov-Smirnov test evaluated deviations from a normal distribution and Pearson ’s correlation coefficients quantified associations . Results : The mean scores of the BBT , DGI and TUG were : 54.0 ± 2.4 , 22.8 ± 1.5 , 9.5 ± 1.7 s , respectively . The BBT and the DGI were not normally distributed ( p < 0.001 ) , but the TUG was ( p = 0.713 ) . The TUG times were mildly associated ( p < 0.01 ) with digit span and verbal fluency and were related to future falls , while the BBT and the DGI were not . Conclusions : The TUG appears to be an appropriate tool for clinical assessment of functional mobility even in healthy older adults . It does not suffer from ceiling effect limitations , is normally distributed and is apparently related to executive function . The BBT and the DGI do not share these beneficial properties . Perhaps the transferring and turning components of the TUG help to convert this relatively simple motor task into a more complex measure that also depends on cognitive re sources BACKGROUND Hemodialysis patients show reduced physical function and greater risk of increased arterial stiffness because of hypertension , metabolic disturbances , and vascular calcification . Exercise interventions potentially could improve their vascular risk profile . STUDY DESIGN R and omized controlled pilot clinical study comparing the effects of 6 months of supervised intradialytic exercise training versus home-based exercise training or usual care on physical function and arterial stiffness in hemodialysis patients . SETTING & PARTICIPANTS 70 hemodialysis patients from 3 renal units . INTERVENTION Intradialytic-exercise patients trained 3 times/wk for 6 months on a cycle ergometer and home-based-exercise patients followed a walking program to achieve the same weekly physical activity . Usual-care patients received no specific intervention . OUTCOMES & MEASUREMENTS Primary outcome measures were distance traveled during a 6-minute walk test and aortic pulse wave velocity . Secondary outcome measures included augmentation index ( augmentation pressure as a percentage of central pulse pressure ) , peripheral ( brachial ) and central blood pressures ( measured noninvasively using radial tonometry ) , physical activity , and self-reported physical functioning . Measurements were made at baseline and 6 months . RESULTS At 6 months , there were no significant differences between changes in 6-minute walk test distance ( intradialytic exercise , + 14 % ; home-based exercise , + 11 % ; usual care , + 5 % ) , pulse wave velocity ( intradialytic exercise , -4 % ; home-based exercise , -2 % ; usual care , + 5 % ) , or any secondary outcome measure . LIMITATIONS Lack of medication data limited the analysis of vascular parameters in this study . CONCLUSION There were no differences between intradialytic or home-based exercise training and usual care for either physical function or vascular parameters OBJECTIVE Protein malnutrition is both a cause and consequence of inflammation and related comorbidities for maintenance hemodialysis ( MHD ) patients . This study sought to determine if oral supplementation with soy or whey protein during dialysis treatment reduces inflammation and improves physical function and body composition in MHD patients . DESIGN The design used in the study was r and omized controlled trial , and the setting used was hemodialysis clinics in Champaign and Chicago , Illinois . SUBJECTS Patients who received treatment ≥3 days/week , were ages ≥30 years did not have congestive heart failure or chronic obstructive pulmonary disease , and were receiving dialysis treatment for ≥3 months were eligible for inclusion . INTERVENTION Patients were r and omized to oral supplementation with a whey protein , soy protein , or placebo beverage . Patients ( WHEY , n = 11 ; SOY , n = 12 ; CON , n = 15 ) consumed their assigned beverage before every dialysis session for 6 months . MAIN OUTCOME MEASURES Body composition was measured by dual-energy x-ray absorptiometry , physical function by gait speed and shuttle walk test , and markers of inflammation ( C-reactive protein and interleukin 6 ) using commercially available enzyme-linked immunosorbent assay kits before and after the 6-month intervention . Dietary intake was assessed by 24-hour dietary recalls . RESULTS Six months of whey or soy supplementation significantly reduced predialysis interleukin 6 levels ( P < .05 for both ) , whereas there was a trend for a reduction in C-reactive protein when both protein groups were combined ( P = .062 ) . Gait speed and shuttle walk test performance also significantly improved in the protein groups ( P < .05 for both ) . No changes in body composition were observed . However , alkaline phosphatase , a marker of bone turnover , was significantly reduced in the protein groups . CONCLUSIONS Intradialytic protein supplementation during a 6-month intervention reduced inflammation and improved physical function and represents an affordable intervention to improve the health of MHD patients Dialysis patients are increasingly older and more disabled . In community-dwelling seniors without kidney disease , falls commonly predict hospitalization , the onset of frailty , and the need for institutional care . Effective fall prevention strategies are available . On the basis of retrospective data , it was hypothesized that the fall rates of older ( > or = 65 yr ) chronic outpatient hemodialysis ( HD ) patients would be higher than published rates for community-dwelling seniors ( 0.6 to 0.8 falls/patient-year ) . It also was hypothesized that risk factors for falls in dialysis out patients would include polypharmacy , dialysis-related hypotension , cognitive impairment , and decreased functional status . Using a prospect i ve cohort study design , HD patients who were > or = 65 yr of age at a large academic dialysis unit were recruited . All study participants underwent baseline screening for fall risk factors . Patients were followed prospect ively for a minimum of 1 yr . Falls were identified through biweekly patient interviews in the HD unit . A total of 162 patients ( mean age 74.7 yr ) were recruited ; 57 % were male . A total of 305 falls occurred in 76 ( 47 % ) patients over 190.5 person-years of follow-up ( fall-incidence 1.60 falls/person-year ) . Injuries occurred in 19 % of falls ; 41 patients had multiple falls . Associated risk factors included age , comorbidity , mean predialysis systolic BP , and a history of falls . In the HD population , the fall risk is higher than in the general community , and fall-related morbidity is high . Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required OBJECTIVES To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization , decline in health , and decline in function in primary care setting s serving older adults . DESIGN Prospect i ve cohort study . SETTING Primary care programs of a Medicare health maintenance organization ( HMO ) and Veterans Affairs ( VA ) system . PARTICIPANTS Four hundred eighty-seven persons aged 65 and older . MEASUREMENTS  Lower extremity performance Established Population for Epidemiologic Studies of the Elderly ( EPESE ) battery including  gait speed , chair st and s , and t and em balance tests ; demographics ; health care use ; health status ; functional status ; probability of repeated admission scale ( Pra ) ; and primary physician 's hospitalization risk estimate . RESULTS Veterans had poorer health and higher use than HMO members . Gait speed alone and the EPESE battery predicted hospitalization ; 41 % ( 21/51 ) of slow walkers ( gait speed < 0.6 m/s ) were hospitalized at least once , compared with 26 % ( 70/266 ) of intermediate walkers ( 0.6 - 1.0 m/s ) and 11 % ( 15/136 ) of fast walkers ( > 1.0 m/s ) ( P < .0001 ) . The relationship was stronger in the HMO than in the VA . Both performance measures remained independent predictors after accounting for Pra . The EPESE battery was superior to gait speed when both Pra and primary physician 's risk estimate were included . Both performance measures predicted decline in function and health status in both health systems . Performance measures , alone or in combination with self-report measures , were more able to predict outcomes than self-report alone . CONCLUSION Gait speed and a physical performance battery are brief , quantitative estimates of future risk for hospitalization and decline in health and function in clinical population s of older adults . Physical performance measures might serve as easily accessible " vital signs " to screen older adults in clinical setting BACKGROUND Physical performance measures , particularly  gait speed  , have been useful as predictors of loss of independence , institutionalization , and mortality in older nonuremic individuals .  Gait speed has not been evaluated as a predictor of these important outcomes in patients on hemodialysis , nor have the determinants of gait speed in the dialysis population been studied . METHODS We performed a cross-sectional analysis to determine whether demographic , clinical , or nutritional status variables were related to physical performance in a group of 46 hemodialysis patients treated at three University of California San Francisco-affiliated dialysis units . Three physical performance measures were examined , including  gait speed , time to climb stairs , and time to rise from a chair five times in succession . Forward stepwise linear-regression analysis was performed with each physical performance measure as the dependent variable and the following c and i date predictor variables : age , gender , body mass index , dialysis vintage , Kt/V , albumin , blood urea nitrogen , creatinine , hematocrit , lean body mass , phase angle , ferritin , and the following comorbidities : hypertension , diabetes mellitus , coronary artery disease , peripheral vascular disease , and cerebrovascular disease . RESULTS Subjects included 31 men and 15 women aged 22 to 87 years ( mean + /- SD , 52 + /- 17 ) . The mean gait speed for the group was 113.1 + /- 34.5 cm/s ( low compared with norms established for persons of similar age ) . Results of multivariable regression showed that age , albumin , and Kt/V were important determinants of gait speed in this population . Overall , the model explained 52 % of the variability in gait speed ( r = 0.72 , P < 0.0001 ) . Qualitatively similar results were obtained using stair-climbing time or chair-rising time as the dependent variables , except that comorbidity was more important than age for stair climbing . The addition of physical activity level to the models did not eliminate the associations of albumin or Kt/V with physical performance . CONCLUSIONS Physical performance is significantly impaired in ambulatory hemodialysis patients and is related to age , serum albumin , and dialysis dose . Prospect i ve studies are needed to determine whether modification of dialysis dose or nutritional interventions can improve physical performance in patients on hemodialysis Poststroke functional outcome and discharge disposition are influenced by age , lesion location and size , severity of neurological insult , prior functional ability , and social support . The effect of admission ambulation velocity on length of stay and discharge disposition has not been previously reported . Design . Prospect i ve , cohort study . Setting . Design ated acute stroke rehabilitation unit . Method . 373 patients consecutively admitted to a design ated inpatient stroke rehabilitation unit were studied . The study sample was divided into 2 groups , based on admission ambulation velocity ( meters/second ) during a 2-min timed walk test . Fast ambulators had an ambulation velocity of greater than 0.15 m/s , whereas slow ambulators had an ambulation velocity of 0.15 m/s or less , and also included nonambulators . Interventions . None . Outcome Measures . Primary outcome measures were length of stay and discharge disposition . Secondary outcome measures were change in the Functional Independence Measure ( FIM ) scores and change in ambulation velocity per week . Continuous , ordinal , and nominal variables were analyzed using the Student t test , Mann-Whitney U test , and chi-square test , respectively . Sensitivity , specificity , and positive and negative predictive values assessed admission ambulation velocity as a predictor of discharge disposition . Results . Patient variables for slow ambulators ( n = 226 ) versus fast ambulators ( n = 147 ) were as follows : age ( 68 ± 13 SD vs. 69 ± 12 , P = 0.32 ) , male-female ratio ( 100:126 vs. 78:69 , P = 0.09 ) , admission total FIM score ( 52 ± 17 vs. 77 ± 16 , P < 0.0001 ) , change in total FIM score ( 20 ± 12 vs. 16 ± 12 , P < 0.003 ) , change in ambulation velocity per week ( 0.05 ± 0.06 vs. 0.13 ± 0.30 , P < 0.0001 ) , length of stay in days ( 30 ± 28 vs. 17 ± 19 , P < 0.0001 ) , and discharge disposition : home/skilled nursing facility ( 133/91 vs. 133/13 , P < 0.0001 ) . Sensitivity , specificity , and positive and negative predictive values ( based on chi-square analyses ) for admission fast ambulators as a predictor of home discharge were 0.5 , 0.87 , 0.91 , and 0.41 , respectively . Admission ambulation velocity alone correctly identified discharge disposition in 78 % of the patient population , based on logistic regression analysis ( P < 0.0001 ) . Conclusion . Admission ambulation velocity can predict length of stay and discharge disposition poststroke . This effect is independent of age and admission total FIM score Skeletal muscle wasting is common and insidious in patients who receive maintenance hemodialysis treatment for the management of ESRD . The objective of this study was to determine whether 12 wk of high-intensity , progressive resistance training ( PRT ) administered during routine hemodialysis treatment could improve skeletal muscle quantity and quality versus usual care . Forty-nine patients ( 62.6 + /- 14.2 yr ; 0.3 to 16.7 yr on dialysis ) were recruited from the outpatient hemodialysis unit of the St. George Public Hospital ( Sydney , Australia ) . Patients were r and omized to PRT + usual care ( n = 24 ) or  usual care control only  ( n = 25 ) . The PRT group performed two sets of 10 exercises at a high intensity ( 15 to 17/20 on the Borg Scale ) using free weights , three times per week for 12 wk during routine hemodialysis treatment . Primary outcomes included thigh muscle quantity ( cross-sectional area [ CSA ] ) and quality ( intramuscular lipid content via attenuation ) evaluated by computed tomography scan . Secondary outcomes included muscle strength , exercise capacity , body circumference measures , proinflammatory cytokine C-reactive protein , and quality of life . There was no statistically significant difference in muscle CSA change between groups . However , there were statistically significant improvements in muscle attenuation , muscle strength , mid-thigh and mid-arm circumference , body weight , and C-reactive protein in the PRT group relative to the nonexercising control group . These findings suggest that patients with ESRD can improve skeletal muscle quality and derive other health-related adaptations solely by engaging in a 12-wk high-intensity PRT regimen during routine hemodialysis treatment sessions . Longer training duration s or more sensitive analysis techniques may be required to document alterations in muscle CSA
target: Conclusions : Compared to age-matched population s , people with ESKD/HD had significantly slower GS and reduced walk distances ; with intervention , the change in the distance walked was significant .
background: Background : People with end-stage kidney disease ( ESKD ) on hemodialysis ( HD )  commonly have functional impairments .
  The purpose of this systematic review was to evaluate the effect of HD on spatio-temporal characteristics of gait , and effect of exercise on these parameters .