Association between physical activity level and health parameters in patients with chronic kidney disease undergoing hemodialysis

Objective:This study aimed to verify the association between physical activity level, strength, functional capacity, muscle thickness and quality and inflammatory and oxidative stress parameters in hemodialysis patients.Materials and methods:This wasa cross-sectional observational study using data previously collected in a randomized controlled trial. To be included in the study, individuals with chronic kidney diseaseshould hadhemodialysisat the nephrology reference unit of the São Francisco de Paula hospital and 18 years of age or older. The data were entered into an Excel spreadsheet and weredouble-checked to avoid errors, and the bank was later transferred to Stata statistical software.Results and discussion:The present study, after adjusted analysis, among all initial possibilities, showed an inverse association only between the variablesmuscle thickness and stress oxidative parameter TBARS. The lack of statistically significant association amongother exposures couldbe explained as a result of the great physical weakness in which individuals were, since the process of hemodialysis is known to lead to great loss of muscle mass, altering metabolic routes of protein synthesis. Conclusion:The present study found an inverse association between muscle thickness and the oxidative stress marker TBARS.The lack of association amongother exposures and outcomes suggesteda picture of evident loss of functional capacity and decreased level of physical activity and strength, probably caused by chronic kidney disease and hemodialysis treatment in individuals. Interventions to improve physical fitness, physical activity levels and muscle variables appear to be essential for chronic renal failure patients on hemodialysis.Sem bolsaObjetivo:O presente estudo tevecomo objetivo verificar a associação entre o nível de atividade física, força, capacidade funcional, espessura e qualidade muscular eparâmetros inflamatórios e de estresse oxidativoem pacientes em hemodiálise (HD). Materiais e métodos:Trata-se de um estudo de cunho observacional transversal, utilizando dados já coletados anteriormente através um ensaio clínico randomizado.Para serem incluídos no estudo,os indivíduos com doença renal crônicadeveriam realizar HD na unidade de referência em nefrologiado hospital São Francisco de Paulae ter idade igual ou superior a 18 anos.Os dados, foram digitados em planilha Excel eforam duplamente confrontados afim de evitar erros, sendo o banco posteriormentetransferido para o software estatístico Stata. Resultados e discussão: O presente estudo mostrou associação inversa somente entre as variáveis espessura muscular e o marcador de estresse oxidativo TBARS. A falta de associaçõesestatisticamente significantes com as demais exposiçõespode ser explicada em consequência da grande debilidade física em que os indivíduos se encontravam, tendo em vistagrande a perda de massa muscular ealteração derotas metabólicas de síntese proteicaproduzidas pela hemodiálise. Conclusão: O presente estudo encontrou associação inversa entre a exposição espessura muscular e o marcador de estresse oxidativo TBARS. A falta de associação entre as demais exposições e desfechos sugere um quadro de evidente perda de capacidade funcional e diminuído nível de atividade física e força, provavelmente causado pela doença renal crônica e pelo tratamento hemodialítico nos indivíduos. Intervenções para melhorar aptidão física, níveis de atividade física e variáveis musculares, parecem essenciais para indivíduos doentes renais crônicos em hemodiálise

Effects of a remotely supervised physical training program combined with cognitive training for older individuals at increased risk of clinical-functional vulnerability: study protocol for a randomized clinical trial

Abstract Background Despite the robust body of evidence for the benefits of home-based physical exercise, there is still a paucity of data on the benefits of home-based cognitive training for older adults, especially in those at increased risk of clinical-functional vulnerability. As such, the present study aims to compare the chronic effects of a telehealth-delivered physical training intervention alone or combined with a cognitive training program in older adults at increased clinical-functional vulnerability risk. Methods A randomized clinical trial will be conducted including 62 sedentary older individuals classified as at increased risk of clinical-functional vulnerability based on their Clinical-Functional Vulnerability Index score. Participants will be randomly allocated in a 1:1 ratio to one of two groups, an intervention group including physical training combined with cognitive training, or an active control group including physical training alone. Both groups will receive home-based supervised training remotely for 12 weeks and will be assessed for the primary and secondary outcomes of the study before and after the training period. Primary outcomes include cognitive function and dynamic balance with a dual task. Secondary outcomes encompass physical, cognitive, and occupational performance, functional capacity, quality of life, and anxiety and depression symptoms, as well as hemodynamic measures. Data analysis will be performed by intention-to-treat and per protocol using mixed linear models and Bonferroni’s post hoc (α = 0.05). Discussion Our conceptual hypothesis is that both groups will show improvements in the primary and secondary outcomes. Nevertheless, we expect physical combined with cognitive training to improve cognitive function, dual task, and occupational performance to a greater degree as compared to physical training alone. Trial registration NCT05309278. Registered on April 4, 2022