Nine Months of Hybrid Intradialytic Exercise Training Improves Ejection Fraction and Cardiac Autonomic Nervous System Activity.

Cardiovascular disease is the most common cause of death in hemodialysis (HD) patients. Intradialytic aerobic exercise training has a beneficial effect on cardiovascular system function and reduces mortality in HD patients. However, the impact of other forms of exercise on the cardiovascular system, such as hybrid exercise, is not clear. Briefly, hybrid exercise combines aerobic and strength training in the same session. The present study examined whether hybrid intradialytic exercise has long-term benefits on left ventricular function and structure and the autonomous nervous system in HD patients. In this single-group design, efficacy-based intervention, twelve stable HD patients (10M/2F, 56 ± 19 years) participated in a nine-month-long hybrid intradialytic training program. Both echocardiographic assessments of left ventricular function and structure and heart rate variability (HRV) were assessed pre, during and after the end of the HD session at baseline and after the nine-month intervention. Ejection Fraction (EF), both assessed before and at the end of the HD session, appeared to be significantly improved after the intervention period compared to the baseline values (48.7 ± 11.1 vs. 58.8 ± 6.5, p = 0.046 and 50.0 ± 13.4 vs. 56.1 ± 3.4, p = 0.054 respectively). Regarding HRV assessment, hybrid exercise training increased LF and decreased HF (p p > 0.05). In conclusion, long-term intradialytic hybrid exercise training was an effective non-pharmacological approach to improving EF and the cardiac autonomous nervous system in HD patients. Such exercise training programs could be incorporated into HD units to improve the patients' cardiovascular health

Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome: A six-month randomized, partially double-blind, placebo-controlled comparative study

© 2013 The Authors. Published by BMC. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/1471-2369-14-194Background: Restless Legs Syndrome is very common in hemodialysis patients however there are no comparative studies assessing the effectiveness of a non-pharmacological treatment to a classical treatment on parameters related to syndromes' severity and quality of life. Methods. In this randomized, partially double blind, placebo controlled trial, thirty two hemodialysis patients with restless legs syndrome were randomly assigned into three groups: 1) the exercise training group (N = 16), 2) the dopamine agonists group (ropinirole 0.25 mg/d) (N = 8) and 3) the placebo group (N = 8). The intervention programs lasted 6 months. Restless Legs Syndrome severity was assessed using the international severity scale, physical performance by a battery of tests, muscle size and composition by computed tomography, body composition by Dual Energy X Ray Absorptiometry, while depression score, sleep quality, daily sleepiness and quality of life were assessed through questionnaires. Results: Exercise training and dopamine agonists were effective in reducing syndrome's symptoms by 46% (P = 0.009) and 54% (P = 0.001) respectively. Within group changes revealed that both approaches significantly improved quality of life (P 0.05) in various tests. Between group changes detect significant improvements with both exercise and dopamine agonists in depression score (P = 0.003), while only the dopamine agonist treatment was able to significantly improve sleep quality, compared to exercise and placebo (P = 0.016). Conclusions: A 6-month exercise training regime was as effective as a 6-month low dosage dopamine agonist treatment in reducing restless legs syndrome symptoms and improving depression score in uremic patients. Further research is needed in order to show whether a combination treatment could be more beneficial for the amelioration of RLS. Trial registration. NCT00942253. © 2013 Giannaki et al.; licensee BioMed Central Ltd.This study was supported by the National and Community Funds of the Greek Ministry of Development-General Secretariat of Research and Technology and by the European Social Fund.Published versio

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Diastolic Doppler flow and tissue Doppler velocities during, and in recovery from, low-intensity supine exercise

Recent studies have reported evidence of both a short-term and a more sustained reduction in left ventricular diastolic function after prolonged strenuous exercise. Interpretation of this data is confounded by alterations in heart rate (HR) post-exercise. The purpose of this study was to investigate the association between HR and diastolic function during recovery from supine exercise, and to reassess the impact of increasing HR on early diastolic flow and tissue velocities during supine exercise. Repeat echocardiograms in 16 young, trained, volunteers were obtained at rest (50 ± 6 beats·min-1), during steady-state supine cycling at HR of 60, 80, and 100 beats·min-1, and then during supine recovery at HR of 80 and 60 beats·min-1. Doppler flow velocities and tissue Doppler myocardial annular velocities were recorded in early (E and E′, respectively) and late diastole (A and A′, respectively). The ratios E/A, E′/A′, and E/E′ were calculated. Data were compared via analyses of variance (ANOVA; exercise) and t tests (recovery). Peak E, A, E′, and A′ all increased in line with HR during exercise (p < 0.05) although relatively greater changes in A and A′ resulted in a significant decline in E/A and E′/A′ with increasing HR (p < 0.05). During recovery E, A, E′, and A′ all declined from peak values during exercise (p < 0.05). At 80 beats·min-1, flow and tissue Doppler data were still elevated above resting values and only A was significantly reduced compared with assessments made at the same HR during exercise. Diastolic flow and tissue velocities tended to increase (during supine exercise) and return to baseline (during recovery from exercise) in line with changes in HR. The interpretation of diastolic functional indices measured after physical exertion should be made in light of the present data. © 2008 NRC

Defining and reporting exercise intensity in interventions for older adults: a modified Delphi process

Background: Many exercise studies, including older adults, do not report all relevant exercise characteristics. Especially the description of exercise intensity is missing and mostly not controlled. This leads to difficulties in interpreting study results and summarizing the evidence in systematic reviews or meta-analyses. Therefore, the aim of the present Delphi study was to gain recommendations about the categorization of exercise intensity and for the conducting and reporting of characteristics in future intervention studies with older adults by experts in exercise science and physiology. Methods: Two hundred ninety-seven international interdisciplinary participants from an EU COST action were invited to participate in three rounds of online questionnaires in April/May 2023. Up to N = 93 experts participated in each round. Round 1 included open-ended questions to solicit possible recommendations and categorizations for light, moderate, vigorous, and high intensity. In round 2, the experts rated their agreement using Likert scales (1–10) on the revealed categories and recommendations. Clusters with a higher average rating of M = 8.0 were summarized into round 3. In the final round, the results were presented for a final rating of agreement (based on a simple majority > 50%). Results: In round 1 a total of 416 qualitative statements were provided from thirteen questions. From round 1 to round 3, a total of 38 items were excluded, with 205 items retained for the final consensus. In round three 37 participants completed the whole questionnaire. The experts showed overall agreement on the final categorizations with 6.7 to 8.8 out of 10 points on the Likert scale. They also showed broad consensus on the relevance of reporting exercise intensity and the recommendations for future conducting and reporting of study results. However, exercise types such as yoga, balance, and coordination training led to conflicting results for categorization into light or moderate. Discussion and implications: The results of the current survey can be used to classify the intensity of exercise and suggest a practical approach that can be adopted by the scientific community and applied when conducting systematic reviews and meta-analysis articles when vital and objective information regarding exercise intensity is lacking from the original article

The Addition of High-Load Resistance Exercises to a High-Intensity Functional Training Program Elicits Further Improvements in Body Composition and Strength: A Randomized Trial

The current study aimed to examine the effects of adding specific high-load resistance exercises to a high-intensity functional training (HIFT) program on healthy adults’ physical fitness and body composition. Twenty recreationally active volunteers (30 ± 4 y, 12 females, 8 males) were randomly assigned to either a HIFT-control (HIFT-C, n = 10) or HIFT-power (HIFT-P, n = 10) group and trained three times per week for eight weeks. The HIFT-C protocol included four rounds of an 8-exercise circuit (30:15 s work: rest, 2 min rest after the second round). The exercises used were clean-and-press, box jump, TRX chest press, wall ball throws, burpees, repeated 10 m sprints, sumo squat-and-upright row, and abdominal crunches. The HIFT-P-group replaced TRX chest press with bench press and squat-and-upright row with squat, both at an intensity of 80% 1 RM. Before and after the intervention, participants underwent an evaluation of body composition, cardiorespiratory fitness, vertical jump, 1 RM bench press, and the maximum number of abdominal crunches in 1 min. In both groups, cardiorespiratory fitness, squat jump, countermovement jump, bench press 1 RM, and percent body fat improved significantly after the intervention (p < 0.050), while a trend towards significant time x group interaction was found for bench press 1 RM (p = 0.076), indicating a superiority of HIFT-P over HIFT-C. Muscle mass significantly increased by 3.3% in the HIFT-P group, while abdominal muscle endurance improved by 16.2% in the HIFT-C group (p < 0.050). Short-term HIFT resulted in improvements in whole-body cardiorespiratory and neuromuscular fitness and reduction of body fat. The addition of high-load resistance exercises was well tolerated and resulted in increased muscle mass and upper body maximal strength. HIFT-P programs can be suitable for individuals seeking to enhance muscle mass and physical fitness in a short time

Effects of high-intensity interval training frequency on perceptual responses and future physical activity participation

The effectiveness of high-intensity interval training (HIIT) in inducing positive physiological adaptations is well documented. However, its impact on perceptual responses and on future physical activity (PA) engagement is less evaluated. The present study aimed to examine the effects of HIIT frequency on perceptual responses, health-related quality of life (HRQOL), and its influence in future PA participation. Thirty-five inactive adults were randomly assigned to a control (CON) and to 2 training groups that performed HIIT (10 × 60 s cycling, ∼83% peak power output) for 2 (HIIT-2) or 3 (HIIT-3) times per week for 8 weeks. Following the HIIT intervention, exercise enjoyment, HRQOL, and the intention to implement HIIT in the future were evaluated. Eight weeks after cessation of training, follow-up evaluations of HRQOL and PA were performed. Following the intervention, both training frequencies induced high levels of enjoyment (HIIT-2: 6.0 ± 1.1, HIIT-3: 6.0 ± 1.1, scale 1–7), improved HRQOL (HIIT-2: p = 0.040; HIIT-3: p = 0.024), and reported intention to implement HIIT in the future (HIIT-3: 100%, HIIT-2: 93% of participants). At follow-up, HIIT-3 participants reported higher completion of HIIT compared with HIIT-2 and CON (p < 0.05). Both training groups sustained improved HRQOL and increased vigorous and total PA (p < 0.05). This study showed that performing HIIT either 2 or 3 times per week is an enjoyable exercise modality that promotes a sustainable increase in habitual PA levels and improves HRQOL. Moreover, the higher training frequency resulted in greater HIIT completion in the 8-week period following the cessation of training.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author