Girls on the move impact statement

Since 2005, Youth Scotland’s Girls on the Move programme has been increasing young women’s physical activity levels in Scotland, by addressing the barriers that prevent their participation. The programme has been evaluated by a team from the School of Sport at Stirling University, led by John Taylor, Research Fellow. This team, in partnership with Youth Scotland, has recently published an Impact Statement to summarise the findings of the evaluation. The Impact Statement contains facts, figures and case studies which the influence Girls on the Move has had on young women across Scotland

Low-volume high-intensity interval training vs continuous aerobic cycling in patients with chronic heart failure: A pragmatic randomised clinical trial of feasibility and effectiveness

Part of this work has been presented as an oral communication at 8th World Congress of Cardiac Rehabilitation and Secondary Prevention. Dublin 23-26th May, 2004.Objectives: The health benefits of high-intensity interval training in cardiac rehabilitation warrant further research. We compared the effectiveness of low-volume high-intensity interval training vs continuous aerobic exercise training in chronic heart failure. Design/Settings: Unblinded, two arm parallel design with random assignment to exercise interventions in out-patient hospital rehabilitation gym. Methods: Patients with signs of chronic heart failure and ejection fraction < 45%, (mean age: 59.1 years (standard deviation (SD) 8.6); 3 women) completed 6 months of exercise using continuous aerobic exercise training (n = 9) or highintensity interval training (n = 8). Cardiorespiratory fitness was determined during cycle ergometry using respiratory gas exchange analysis. Functional capacity was assessed via sit-to-stand and gait speed. Quality of life was assessed using the MOS Short-Form 36 and Minnesota living with heart failure questionnaires. Cardiac autonomic regulation was assessed using Heart Rate Variability. Results: Analysis of Covariance revealed significant time effects but no group time interactions for exercise and functional capacity outcomes. Peak oxygen uptake (VO2peak) improved by a mean of 14.9% (SD 16.3%) from baseline and by 22% (SD 28.3) at ventilatory threshold in both groups. Sitto- stand (11.9 (SD 11%)) and gait speed (16.0 (SD 19%)) improved similarly in both groups. No changes in quality of life or heart rate variability were noted. Training adaptations in high-intensity interval training were achieved despite a significantly reduced time commitment and total work volume compared to continuous aerobic exercise training. Conclusion: Low-volume high-intensity interval training is a feasible and well tolerated training modality in cardiac rehabilitation settings, but is not more effective than continuous aerobic exercise training.sch_phy1. Piepoli MF, Corr U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the cardiac rehabilitation section of the European association of cardiovascular prevention and rehabilitation. Eur J Cardiov Prev Rehab 2010; 17: 1-17. 2. Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabiliattion and the Canadian Association of Cardiac Rehabilitation. J Cardiov Prev Rehab 2012; 32: 327-350. 3. Hwang CL, Wu YT, Chou CH. Effect of aerobic interval training on exercise capacity and metabolic risk factors in people with cardiometabolic disorders. A meta analysis. J Cardiop Rehab Prev 2011; 31: 378-385. 4. Kessler HS, Sisson SB, Short KR. The potential for high intensity interval training to reduce cardiometabolic disease risk. Sports Med 2012; 42: 489-509. 5. Meyer K, Lehmann M, S_nder G, Keul J, Weidemann H. Interval versus continuous exercise training after coronary bypass surgery: A comparison of training induced acute reactions with respect to the effectiveness of the exercise methods. Clin Cardiol 1990; 13: 851-861. 6. Meyer K, Samek L, Schwaibold M, Westbrool S, Hajiric R, Beneke R, et al. Interval training in patients with severe chronic heart failure: analysis and recommendations for exercise procedures. Med Sci Sports Exerc 1997; 29: 306-312. 7. Meyer K, Hajric R, Westbrook S, Haak-Wildi S, Holtkamp R, Leyk D, et al. Hemodynamic responses during leg press exercise in patients with chronic congestive heart failure. Am J Cardiol 1999; 83: 1537-1543. 8. Wislff U, Stylen A, Loennechen JP, Bruvold M, Rognmo , Haram PM, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients. Circulation 2007; 115: 3086-3094. 9. Nilsson BB, Westheim A, Risberg MA. Effects of group based high intensity aerobic interval training in patients with chronic heart failure. Am J Cardiol 2008; 102: 1361-1365. 10. Gibala MJ, Little JP, MacDonald MJ, Hawley JA. Physiological adaptations to low volume, high intensity interval training in health and disease. J Physiol 2012; 590: 1077-1084. 11. Guiraud T, Juneau M, Nigam A, Gayda M, Meyer P, Mekary S et al. Optimisation of high intensity interval exercise in coronary heart disease. Eur J Appl Physiol 2010; 108: 733-740. 12. Buchheit M, Simon C, Charloux A, Doutreleau S, Piquard F, Brandenberger G. Heart rate variability and intensity of habitual physical activity in middle aged persons. Med Sci Sports Exerc 2005; 37: 1530-1534. 13. Munk PS, Butt N, Larsen A. High intensity interval exercise training improved heart rate variability in patients following percutaneous coronary intervention for angina pectoris. Int J Cardiol 2010; 145: 312-314. 14. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, et al. Prospective Study of Heart Rate Variability and Mortality in chronic heart failure. Circulation 1998; 98: 1510-1516. 15. Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail 2010; 12: 706-715. 16. Rees K, Taylor RRS, Singh S, Coats AJ, Ebrahim S. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev: 2010; (4): CD003331. 17. Mercer TH, Naish PF, Gleeson NP, Wilcock JE, Crawford C. Development of a walking test for the assessment of functional capacity in non-anemic maintenance dialysis patients. Nephrol Dial Transplant 1998; 13: 2023-2026. 18. Ware JE, Kosinski M, Keller SK. SF-36 physical and mental health summary scales: a user's manual. Boston (MA): The Health Institute; 1994. 19. Rector TS, Kubo SH, Cohn JN. Patients' self assessment of their congestive heart failure. Content reliability and validity of a new measure, the Minnesota Living with Heart Failure questionnaire. Heart Fail 1987; 198-209. 20. Centre for Evaluation and monitor. Web based resource on the internet. Durham University. (cited Jan 2014) Available from: www.cemcentre.org/attachments/EBE/EffectSizeCalculator.xls. 21. Durlak J. How to select, calculate and interpet effect sizes. J Paed Psychol. 2009; 34: 917-928. 22. Rognmo , Hetland E, Helgerud J,Hoff J, Slrdahl SA. High intensity aerobic interval exercise for increasing aerobic capacity in patients with coronary artery disease. J Cardiov Prev Rehabil 2004; 11: 216-222. 23. Moholdt TT, Amusden BH, Rustad LA,Wahba A, Lv KT, Gullikstad LR, et al. Aerobic interval training verus continuous moderate exercise after coronary artery bypass surgery: A randomised study of cardiovascular effects and quality of life. Am Heart J 2009; 158: 1031-1337. 24. Tjnna AE, Lee SJ, Rognmo , Stlen TO, Bye A, Haram PM et al. Aerobic interval training vs continuous moderate exercise as a treatment for the metabolic syndrome. Circulation 2008; 118: 346-354. 25. Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High Intensity interval training may reduce in stent restenosis following percutaneous coronary intervention with stent implantation: A randomised controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J 2009; 158: 734-741. 26. Aamot I, Forbord SH, Gustad K, Lckra V, Stensen A, Berg AT, et al. Home based versus hospital based high intensity interval training in cardiac rehabilitation: a randomised study. Eur J Prev Cardiol 2013 Apr 23 27. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. New Engl J Med 2002; 346: 739-801. 28. Laukkanen JA, Kurl S, Salonen JT, Lakka TA, Rauramaa R. Peak oxygen pulse during exercise as a predictor for coronary heart disease and all cause death. Heart 2006; 92: 1219-1224. 29. Warburton DE, McKenzie DC, Haykowsky MJ, Taylor A, Shoemaker P, Ignaszewski AP et al. Effectiveness of high intensity interval training for the rehabilitation of patients with coronary artery disease. Am J Cardiol 2005; 95: 1080-1084. 30. McKelvie RS, Teo KK, Roberts R, McCartney N, Humen D, Montague T, et al. Effects of exercise training in patients with heart failure: The exercise rehabilitation trial (EXERT). Am Heart J 2002; 144: 23-30. 31. Tyni-Lenn R, Dencker K, Gordon A, Jansson E, Sylvn C. Comprehensive local muscle training increases aerobic capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. Eur J Heart Fail 2001; 3: 47-52. 32. Gademan MG, Swenne CA, Verwey HF, van der Laarse A, Maan AC, van de Vooren H, et al. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Cardiac Fail 2007; 13: 294-303. 33. Selig SE, Carey MF, Menzies DG, Patterson J, Geerling RH, Williams AD, et al. Moderate-Intensity Resistance Exercise Training in patients with chronic heart failure improves strength, endurance, heart rate variability and forearm blood flow. J Card Fail 2004; 10: 21-30. 34. Cider A, Tygesson H, Hedberg M, Seligman L, Wennerblom B, Sunnerhagen KS. Peripheral muscle training in patients with clinical signs of heart failure. Scand J Rehab Med 1997; 29: 121-127. 35. Roche F, Pichot V, Da Costa A, Isaaz K, Costes F, Dall'Acqua T, et al. Chronotropic incompetence response to exercise in congestive heart failure, relationship with the cardiac autonomic status. Clin Physiol 2001; 21: 335-342. 36. Malfatto G, Branzi G, Riva B, Sala L, Leonetti G, Facchini M. . Recovery of cardiac autonomic responsiveness with low physical training in patients with chronic heart failure. Eur J Heart Fail 2002; 4: 159-166. 37. Larsen AI, Gjesdal K, Hall C, Aukrust P, Aarsland T, Dickstein K. Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability. Eur J Cardiov Prev Rehabil 2004; 11: 162-167. 38. Roveda F, Middlekauff HR, Rondon MU, Reis SF, Souza M, Nastari L, et al. The effects of exercise training on sympathetic neural activation in advanced heart failure. J Am Coll Cardiol 2003; 42: 854-860. 39. 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Use of a wearable accelerometer to evaluate physical frailty in people receiving haemodialysis

Thomas Mercer - ORCID: 0000-0002-5078-4769 https://orcid.org/0000-0002-5078-4769Marietta van der Linden - ORCID: 0000-0003-2256-6673 https://orcid.org/0000-0003-2256-6673Pelagia Koufaki - ORCID: 0000-0002-1406-3729 https://orcid.org/0000-0002-1406-3729Background Physical frailty is a major health concern among people receiving haemodialysis (HD) for stage-5 chronic kidney disease (CKD-5). Wearable accelerometers are increasingly being recommended to objectively monitor activity levels in CKD-5 and recent research suggests they may also represent an innovative strategy to evaluate physical frailty in vulnerable populations. However, no study has yet explored whether wearable accelerometers may be utilised to assess frailty in the context of CKD-5-HD. Therefore, we aimed to examine the diagnostic performance of a research-grade wearable accelerometer in evaluating physical frailty in people receiving HD. Methods Fifty-nine people receiving maintenance HD [age = 62.3 years (SD = 14.9), 40.7% female] participated in this cross-sectional study. Participants wore a uniaxial accelerometer (ActivPAL) for seven consecutive days and the following measures were recorded: total number of daily steps and sit-to-stand transitions, number of daily steps walked with cadence < 60 steps/min, 60–79 steps/min, 80–99 steps/min, 100–119 steps/min, and ≥ 120 steps/min. The Fried phenotype was used to evaluate physical frailty. Receiver operating characteristics (ROC) analyses were performed to examine the diagnostic accuracy of the accelerometer-derived measures in detecting physical frailty status. Results Participants classified as frail (n = 22, 37.3%) had a lower number of daily steps (2363 ± 1525 vs 3585 ± 1765, p = 0.009), daily sit-to-stand transitions (31.8 ± 10.3 vs 40.6 ± 12.1, p = 0.006), and lower number of steps walked with cadence of 100–119 steps/min (336 ± 486 vs 983 ± 797, p < 0.001) compared to their non-frail counterparts. In ROC analysis, the number of daily steps walked with cadence ≥ 100 steps/min exhibited the highest diagnostic performance (AUC = 0.80, 95% CI: 0.68–0.92, p < 0.001, cut-off ≤ 288 steps, sensitivity = 73%, specificity = 76%, PPV = 0.64, NPV = 0.82, accuracy = 75%) in detecting physical frailty. Conclusions This study provided initial evidence that a wearable accelerometer may be a useful tool in evaluating physical frailty in people receiving HD. While the total number of daily steps and sit-to-stand transitions could significantly discriminate frailty status, the number of daily steps walked with cadences reflecting moderate to vigorous intensity of walking may be more useful in monitoring physical frailty in people receiving HD.This work was supported by a British Kidney Patient Association – British Renal Society (BKPA—BRS) joint grant (grant number: 16–003) and by a Queen Margaret University PhD bursary. The funders of this study had no role in the study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.https://doi.org/10.1186/s12882-023-03143-zpubpu

Long-term pulse wave velocity outcomes with aerobic and resistance training in kidney transplant recipients – A pilot randomised controlled trial

Supporting information: S1 Fig. study protocol.(available at https://doi.org/10.1371/journal.pone.0171063.s001 (DOCM)); S1 Table. supplementary raw data (available at: https://doi.org/10.1371/journal.pone.0171063.s002 (XLSX)); S2 Fig. Consort checklist (available at: https://doi.org/10.1371/journal.pone.0171063.s003 (DOC)).Copyright: © 2017 O’Connor et al. Background This pilot study examined long-term pulse wave velocity (PWV) and peak oxygen uptake (VO2peak) outcomes following a 12-week moderate-intensity aerobic or resistance training programme in kidney transplant recipients. Method Single-blind, bi-centre randomised controlled parallel trial. 42 out of 60 participants completed a 9-month follow-up assessment (Aerobic training = 12, Resistance training = 10 and usual care = 20). Participants completed 12 weeks of twice-weekly supervised aerobic or resistance training. Following the 12-week exercise intervention, participants were transitioned to self-managed community exercise activity using motivational interviewing techniques. Usual care participants received usual encouragement for physical activity during routine clinical appointments in the transplant clinic. PWV, VO2peak, blood pressure and body weight were assessed at 12 weeks and 12 months, and compared to baseline. Results ANCOVA analysis, covarying for baseline values, age, and length of time on dialysis pre-transplantation, revealed a significant mean between-group difference in PWV of -1.30 m/sec (95%CI -2.44 to -0.17, p = 0.03) between resistance training and usual care groups. When comparing the aerobic training and usual care groups at 9-month follow-up, there was a mean difference of -1.05 m/sec (95%CI -2.11 to 0.017, p = 0.05). A significant mean between-group difference in relative VO2peak values of 2.2 ml/kg/min (95% CI 0.37 to 4.03, p = 0.02) when comparing aerobic training with usual care was revealed. There was no significant between group differences in body weight or blood pressure. There were no significant adverse effects associated with the interventions. Conclusions Significant between-group differences in 9-month follow-up PWV existed when comparing resistance exercise intervention with usual care. A long-term between-group difference in VO2peak was only evident when comparing aerobic intervention with usual care. This pilot study, with a small sample size, did not aim to elucidate mechanistic mediators related to the exercise interventions. It is however suggested that a motivational interviewing approach, combined with appropriate transition to community training programmes, could maintain the improvements gained from the 12-week exercise interventions and further research in this area is therefore warranted. Trial registration study number: ISRCTN43892586.National Institute for Health Research (NIHR). The study was hosted in the KCH NIHR Clinical Research Facility. This paper presents independent research funded by the NIHR

Systematic review and meta-analysis: Associations of vitamin D with pulmonary function in children and young people with cystic fibrosis

This is the final version. Available on open access from Elsevier via the DOI in this recordBackground Increasing evidence suggests that vitamin D is associated with pulmonary health, which may benefit children and young people diagnosed with Cystic Fibrosis (cypCF). Therefore, the aim of this systematic review was to evaluate primary research to establish associations between 25OHD and pulmonary health in cypCF. Methods Electronic databases were searched with keywords related to CF, vitamin D, children/young people and pulmonary function. Included studies were cypCF (aged ≤21 years) treated in a paediatric setting. The primary outcome was lung function [forced expiratory volume in 1 s (FEV1% predicted)] and secondary outcomes were rate of pulmonary exacerbations, 25OHD status and growth. Evidence was appraised for risk of bias using the CASP tool, and quality using the EPHPP tool. A Meta-analysis was performed. Results Twenty-one studies were included with mixed quality ratings and heterogeneity of reported outcomes. The Meta-analysis including 5 studies showed a significantly higher FEV1% predicted in the 25OHD sufficiency compared to the deficiency group [FEV1% predicted mean difference (95% CI) was 7.71 (1.69–13.74) %; p = 0.01]. The mean ± SD FEV1% predicted for the sufficient (≥75 nmol/L) vs. deficient (<50 nmol/L) group was 94.7 ± 31.9% vs. 86.9 ± 13.2%; I2 = 0%; χ2 = 0.5; df = 4). Five studies (5/21) found significantly higher rate of pulmonary exacerbations in those who were 25OHD deficient when compared to the sufficient group and negative associations between 25OHD and FEV% predicted. The effects of vitamin D supplementation dosages on 25OHD status (10/21) varied across studies and no study (12/21) showed associations between 25OHD concentration and growth. Conclusion This systematic review suggests that 25OHD concentration is positively associated with lung function and a concentration of >75 nmol/L is associated with reduced frequency of pulmonary exacerbations, which may slow lung function decline in cypCF. Future randomised clinical trials and mechanistic studies are warranted.Centre for Health, Activity and Rehabilitation Research (CHEARR), Queen Margaret UniversitySport and Health Sciences, University of Exete

The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: study design and baseline data for a multicentre randomized controlled trial.

BACKGROUND: Exercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK. METHODS: We conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team. RESULTS: At baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry. CONCLUSIONS: The results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally. TRIAL REGISTRATION: ISRCTN N83508514; registered on 17 December 2014

The effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: protocol for a feasibility study

Copyright © Author(s) (or their employer(s)) 2020. Introduction: There is consistent evidence that people with cerebral (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently, to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility. Methods and analysis: Twenty-five young people (age 5-21 yr) with CP or acquired brain injury affecting co-ordination will be included in this single arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning. Ethics and dissemination: Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, NHS trusts, and organisations for people with disabilities. Trial registration number: ClinicalTrials.gov Identifier: NCT04034342. Protocol version 1.0; pre-results.Action Medical Research and Chartered Society of Physiotherapy Charitable Trust.Joint award from Action Medical Research and Chartered Society of Physiotherapy Charitable Trust

Randomized Trial—PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis

Introduction: Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program. Methods: In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded. Results: We randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: −0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments. Conclusions: A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

BACKGROUND: Restless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival. METHOD#ENTITYSTARTX003BF;LOGY/PRINCIPAL FINDINGS: Using the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition. CONCLUSIONS: The low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep

Achieving consensus on psychosocial and physical rehabilitation management for people living with kidney disease

Data Availability Statement The data underlying this article are available in the article and in its online supplementary material.Copyright © The Author(s) 2023. Background People living with chronic kidney disease (CKD) need to be able to live well with their condition. The provision of psychosocial interventions (psychological, psychiatric, and social care) and physical rehabilitation management is variable across England, as well as the rest of the United Kingdom. There is a need for clear recommendations for standards of psychosocial and physical rehabilitation care for people living with CKD, and guidance for the commissioning and measurement of these services. The NHS England Renal Services Transformation Programme (RSTP) supported a programme of work and modified Delphi process to address the management of psychosocial and physical rehabilitation care as part of a larger body of work to formulate a comprehensive commissioning toolkit for renal care services across England. We sought to achieve expert consensus regarding the psychosocial and physical rehabilitation management of people living with CKD in England and the rest of the UK. Method A Delphi consensus method was used to gather and refine expert opinions of senior members of the kidney multi-disciplinary team (MDT) and other key stakeholders in the UK. An agreement was sought on 16 statements reflecting aspects of psychosocial and physical rehabilitation management for people living with CKD. Results Twenty-six expert practitioners and other key stakeholders, including lived experience representatives, participated in the process. The consensus (>80% affirmative votes) amongst the respondents for all 16 statements was high. Nine recommendation statements were discussed and refined further to be included in the final iteration of the ‘Systems’ section of the NHS England RSTP commissioning toolkit. These priority recommendations reflect pragmatic solutions that can be implemented in renal care and include recommendations for a holistic well-being assessment for all people living with CKD who are approaching dialysis, or who are at listing for kidney transplantation, which includes the use of validated measurement tools to assess the need for further intervention in psychosocial and physical rehabilitation management. It is recommended that the scores from these measurement tools be included in the NHS England Renal Data Dashboard. There was also a recommendation for referral as appropriate to NHS Talking therapies, psychology, counselling or psychotherapy, social work or liaison psychiatry for those with identified psychosocial needs. The use of digital resources was recommended to be used in addition to face-to-face care to provide physical rehabilitation, and all healthcare professionals should be educated to recognise psychosocial and physical rehabilitation needs and refer/sign-post people with CKD to appropriate services. Conclusion There was high consensus amongst senior members of the kidney MDT and other key stakeholders, including those with lived experience, in the UK on all aspects of the psychosocial and physical rehabilitation management of people living with CKD. The results of this process will be used by NHS England to inform the ‘Systems’ section of the commissioning toolkit and data dashboard and to inform the National Standards of Care for people living with CKD