Cold dialysis and its impact on renal patients’ health: An evidence-based mini review

Chronic renal disease is associated with advanced age, diabetes, hypertension, obesity, musculoskeletal problems and cardiovascular disease, the latter being the main cause of mortality in patients receiving haemodialysis (HD). Cooled dialysate (35 °C-36 °C) is recently employed to reduce the incidence of intradialytic hypotension in patients on chronic HD. The studies to date that have evaluated cooled dialysate are limited, however, data suggest that cooled dialysate improves hemodynamic tolerability of dialysis, minimizes hypotension and exerts a protective effect over major organs including the heart and brain. The current evidence-based review is dealing with the protective effect of cold dialysis and the benefits of it in aspects affecting patients’ quality of care and life. There is evidence to suggest that cold dialysis can reduce cardiovascular mortality. However, large multicentre randomized clinical trials are urgently needed to provide further supporting evidence in order to incorporate cold dialysis in routine clinical practice

The effects of training with high-speed interval running on muscle performance are modulated by slope

© 2021 The Authors. Published by Wiley. 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/10.14814/phy2.14656We examined changes in selected muscle performance parameters after 8 weeks of interval training using two opposite running inclinations. We hypothesized that the uphill training will affect endurance muscle performance outcomes, whereas the downhill training will affect power muscle performance outcomes. Fourteen physically active volunteers were randomly assigned into either the Uphill group (UG; n = 7; uphill interval running at +10% incline) or the Downhill group (DG; n = 7; downhill interval running at -10% incline) and completed 16 training sessions. Each session consisted of ten 30 s treadmill runs at 90% of maximum aerobic speed (MAS) with a work to rest ratio of 1:2. Vertical jump performance, isometric (MVC) and isokinetic torque of knee extensors and flexors, and fatigue of knee extensors were evaluated pre and post-training. Moreover, body composition (via bioimpedance) and vastus lateralis muscle architecture (via ultrasonography) were assessed pre and post-training. Relative lean tissue mass, relative fat mass, and squat jump (cm) significantly (p < .05) changed from baseline values by +4.5 ± 4.0%, -11.5 ± 9.6%, and +9.5 ± 11.7%, respectively, only in the DG. Similarly, DG improved absolute values of knee extension rate of torque development and impulse (p < .05), whereas knee flexion peak torque angle significantly decreased in both groups (p < .05). On the other hand, the UG increased the number of repetitions achieved during the fatigue protocol and total work by 21.2 ± 32.6% and 13.8 ± 21.2%, respectively (p < .05). No differences were found between groups in muscle architecture. Introducing variations in slope during HIIT could be used to induce specific improvements toward muscle endurance or power performance characteristics.Published versio

Thermogenic capacity of human white-fat: the actual picture

Presented at the 9th Greek Conference of Biochemistry and Physiology of Exercise, Thessaloniki, Greece, 18–20 October 2019Cold exposure and exercise may increase thermogenic capacity of white adipose tissue (WAT), which could subsequently enhance energy expenditure and body weight loss. We aimed to identify possible alterations in uncoupling protein 1 (UCP1)—the main biomarker of thermogenic activation—in human WAT due to both cold exposure and exercise, as well as the link between environmental temperature and thermogenic capacity of human WAT. MATERIAL &amp; METHOD: We conducted four human experimental studies and two systematic reviews and meta-analyses—PROSPERO registration CRD42019120116, CRD42019120213. RESULTS: UCP1 mRNA was higher in winter than in summer [t(30) = 2.232, p = 0.03] in human WAT and our meta-analysis showed a main effect of cold exposure on human UCP1 mRNA [standard mean difference (Std-md) = 1.81, confidence interval (CI) = 0.50–3.13, p = 0.007]. However, UCP1 mRNA/protein expressions displayed no associations with %fat mass or BMI (p &gt; 0.05, Cohen’s f2 &lt; 0.20). Both a 2-hour cooling and a non-cooling protocol preceding the positron emission tomography/computed tomography (PET/CT) measurements revealed no association between environmental temperature and standardised uptake value (SUVmax) of human WAT, as well as no mean differences in SUVmax-WAT-activity between winter and summer. An 8-week exercise program had no effect on UCP1 of human WAT or on body composition. Our meta-analysis also revealed: (a) no effect of chronic exercise on human UCP1 mRNA, (b) a main effect of chronic exercise on UCP1 protein concentrations (Std-md = 0.59, CI = 0.03–1.16, p = 0.04) and UCP1 mRNA (Std-md = 1.76, CI = 0.48–3.04, p = 0.007) in WAT of normal diet animals, c) a main effect of chronic exercise on UCP1 mRNA (Std-md = 2.94, CI = 0.24–5.65, p = 0.03) and UCP1 protein concentrations (Std-md = 2.06, CI = 0.07–4.05, p = 0.04) of high-fat diet animals. CONCLUSIONS: Cold exposure represents a main stimulus for increased thermogenic capacity in human white adipocytes; however, this may have no impact on body weight loss. Chronic exercise may represent no major stimulus for UCP1 induced in human white adipocytes, while in animals it increases UCP1 gene independently of their diet. Therefore, evidence from animal studies regarding UCP1 gene activation in white adipocytes may not be applicable in humans. Finally, the identification of human WAT thermogenic capacity via PET/CT examination may be optimal with both a cooling and a non-cooling protocol.Published onlin

Η επίδραση της θεραπευτικής άσκησης σε συνδυασμό με αλλαγές στην θεραπεία της αιμοκάθαρσης στους δείκτες ποιότητας ζωής και υγείας σε ασθενείς με τελικού σταδίου νεφρική νόσο

A Hemodialysis (HD) patients suffer from various symptoms including intradialytic hypotension, heat stress, insulin resistance, muscle atrophy and fatigue, which all these parameters leading to the lack of energy and reduce patients quality of life. Lowering the dialysate temperature from 37°C (Typical dialysis; TD) to 35°C (Cold dialysis; CD) could act as an important factor in patients’ hemodynamic stability during hemodialysis. It has recently been proposed that CD can improve many physiological factors including stabilizing body temperature, increasing the activity of sympathetic nervous system and consequently increasing the contraction power of the heart and the resistance of peripheral vessels. However many other benefits have been observed on patient’s overall health and quality of life levels during the CD. Intradialytic exercise training (IET) it is well documented that improved functional capacity in HD patients. Moreover, intradialytic exercise can improve solute removal, dialysis adequacy, intradialytic protein synthesis, muscular strength, peak oxygen consumption, nutritional status, and quality of life. However, despite a strong rationale for the implementation of IET programs and the aforementioned benefits of CD, the separate and combined effects of exercise rehabiliation regimes in combination with changes in dialysis procedures in aspects related to quality of life and health in HD patients have not been investigated to date. The aim of the current PhD thesis was to assess the acute and chronic effect of CD and IET in parameters aspects related to glucose disposal, quality of life and health in HD patients. Methodology: The present PhD thesis divided into 4 studies: Study 1: Investigate the thermoregulatory responses of hemodialysis patients under four different single bouts of hemodialysis (240 min) protocols (TD, CD, TD+EX, CD+EX) (acute phase). Participates 10 HD patients age: 57.2±14.9Study 2: To assess the separate and combined effects of CD and IET in parameters related to insulin sensitivity, health and fitness under four different single bouts of hemodialysis (240 min) protocols (TD, CD, TD+EX, CD+EX) (acute phase). Participates 10 HD patients age: 57.2±14.9Study 3: To assess the chronic effect of intradialytic exercise training and cold dialysis in parameters related to insulin resistance and exercise capacity of patients with ESRD after 7 months of intervention (chronic phase). Participates 14 HD patients were randomized into two groups (TD+EX; mean age 63.57±9.93 & CD+EX; mean age 52.71±16.84) Study 4: To assess the chronic effect of cold dialysis and 7-month of intradialytic exercise training (IET) on changes in vastus lateralis (VL) muscle architecture, functional capacity and quality of life in hemodialysis (HD) patients. In the first part of the study (data set 1) 14 HD patients randomized into a CD+EX group (N = 7) and a TD+EX group (N=7). In the second part of the study (data set 2) 44 HD patients were randomized into an Exercise Group (EG=21) and a Control Group (CG=23) using the current practice (no exercise). Results: The results of the current PhD thesis summarized below: Study 1: The TD and TD+E protocols were associated with increased body heat storage leading to moderate effect size increases in core body temperature (as high as 0.4°C). The low temperature of the dialysate during the CD and the CD+E protocols prevented the rise in body heat storage and core temperature (p>0.05), even during the period that IET took place.Study 2: None of the four different sessions have shown any statistical significant differences in glucose disposal (p>0.05). However, slightly numerical changes and moderate to high effect size (d:0.50-0.85) observed between TD vs CD and TD vs TD+EX in the rate of glucose and insulin disposal during the oral glucose tolerance test (OGTT). In addition, the systolic blood pressure observed statistically significant increased at the end of CD compared to TD. No statistical significant improvement observed in any aspect of functional capacity and fatigue parameters after an acute single session of CD and IETStudy 3: Insulin sensitivity index was improved by 32% in CD+EX group compared to TD+EX group. In addition, rate of glucose and insulin disposal during OGTT was improved in CD+EX group compered to TD+EX group. Functional capacity and indices of quality of life improved in both groups (P0.05) however, muscle thickness decreased in CG (p=0.02, p 0.05), ακόμη και κατά την περίοδο της ενδοσυνεδριακής άσκησης.Μελέτη 2: Δεν παρατηρήσαμε στατιστικά σημαντικές διαφορές μεταξύ των πειραματικών συνθηκών (p> 0.05). Ωστόσο, παρατηρήσαμε μικρές αριθμητικές μεταβολές και ένα μέτριο προς υψηλό effect size (d: 0,50-0,85) μεταξύ της TD και της CD, όπως επίσης και μεταξύ της TD και της TD+EX στον ρυθμό αύξησης της γλυκόζης και της ινσουλίνης στο αίμα κατά τη δοκιμασία OGTT. Επιπλέον, η συστολική αρτηριακή πίεση παρουσίασε στατιστικά σημαντική αύξηση μετά το τέλος της CD σε σύγκριση με την TD. Ωστόσο καμία στατιστικά σημαντική διαφορά δεν παρατηρήθηκε στη λειτουργική ικανότητα και στους δείκτες κόπωσης μετά από μια συνεδρία κρύας αιμοκάθαρσης και ενδοσυνεδριακής κόπωσης.Μελέτη 3: Παρατηρήθηκε βελτίωση του δείκτη ευαισθησίας στην ινσουλίνη κατά 32% στην ομάδα CD+EX σε σύγκριση με την ομάδα TD+EX. Επιπλέον, ο ρυθμός αύξησης της γλυκόζης και της ινσουλίνης στο αίμα κατά τη διάρκεια της OGTT βελτιώθηκε στην ομάδα CD+EX συγκριτικά με την ομάδα TD+EX. Η λειτουργική ικανότητα και οι δείκτες ποιότητας ζωής βελτιώθηκαν και στις δύο ομάδες (p 0.05) ωστόσο το πάχος των έξω πλατύ μηριαίου μυός μειώθηκε στην ομάδα CG (p=0.02, p<0.05) ενώ παρέμεινε αμετάβλητο στην ομάδα EG. Η λειτουργική ικανότητα και οι δείκτες ποιότητας ζωής αυξήθηκαν στατιστικά σημαντικά μόνο στην ομάδα EG (Data set 2).Συμπέρασμα: Η μείωση της θερμοκρασίας του διαλύματος της αιμοκάθαρσης κατά 2°C προκάλεσε ευνοϊκές αλλαγές στις παραμέτρου που σχετίζονται με την ευαισθησία στην ινσουλίνη, τη διάθεση της γλυκόζης, την αρχιτεκτονική του μυός και το βαθμό της θερμικής επιβάρυνσης. Η κρύα αιμοκάθαρση παρέχει σημαντικές αιμοδυναμικές αλλαγές κατά τη διάρκεια της αιμοκάθαρσης, μειώνοντας έτσι τα πιθανά συμπτώματα ενδοσυνεδριακής υπότασης που παρουσιάζουν οι ασθενείς. Η ενδοσυνεδριακή άσκησης βελτιώνει τη συνολική ικανότητα των ασθενών για άσκηση καθώς επίσης και τους δείκτες ποιότητας ζωής, ανεξάρτητα από τη θερμοκρασία του διαλύματος, ωστόσο, δεν παρουσιάζει μεγάλες αλλαγές στην αρχιτεκτονική δομή του έξω πλατύ μηριαίου μυός μεταξύ των συνθηκών CD και TD. Η κρύα αιμοκάθαρση και η ενδοσυνεδριακή άσκηση αυξάνουν τα οφέλη για την υγεία βελτιώνοντας τη συνολική ποιότητα ζωής των ασθενών. Συνιστούσαμε ότι η CD με ή χωρίς ενδοσυνεδριακή άσκηση μπορεί να αποτρέψει την υπερβολική αύξηση της συσσώρευσης θερμότητας στο σώμα των ασθενών και μπορεί επίσης να προσφέρει ένα "οξύ" χρονικό ερέθισμα για τη βελτίωση της αυξημένης γλυκόζης στο αίμα τους. Επιπλέον, η ενδοσυνεδριακή άσκηση παρέχει ένα σημαντικό ερέθισμα για την αύξηση της λειτουργικής ικανότητας των αιμοκαθαρόμενων ασθενών ενώ μεγαλύτερες μεταβολές στην αρχιτεκτονική δομή του έξω πλατύ μηριαίου μυός ίσως απαιτούν υψηλότερα φορτία άσκησης ή συμπληρωματική άσκηση αντιστάσεων για να παρατηρηθούν κλινικά σημαντικές αλλαγές

Επίδραση της άσκησης κατά τη διάρκεια της θεραπείας ενζυμικής υποκατάστασης σε ασθενείς με νόσο Pompe ενήλικης μορφής

Η νόσος Pompe είναι μια σπάνια κληρονομική αυτοσωμική υπολειπόμενη διαταραχή η οποία οφείλεται στην ανεπάρκεια του λυσοσωμικού ενζύμου όξινη α- γλυκοσιδάση. Τα κλινικά συμπτώματα της νόσου Pompe ποικίλουν ανάλογα με την ηλικία έναρξης, τα όργανα στόχους που έχουν υποστεί τη βλάβη καθώς και το ρυθμό εξέλιξης της διαταραχής, με αποτέλεσμα να υπάρχει μεγάλη φαινοτυπική ποικιλομορφία όσον αφορά τη βαρύτητα και την ταχύτητα εξέλιξής της. Στην ενήλικη μορφή της νόσου, το κύριο σύμπτωμα είναι η δυσλειτουργία των σκελετικών μυών η οποία δυσχεραίνει την κινητικότητα και την αναπνευστική λειτουργία των ασθενών με συνέπεια την αδυναμία εκτέλεσης καθημερινών δραστηριοτήτων. Οι ασθενείς καταλήγουν, συνήθως, από την ανεπάρκεια των αναπνευστικών μυών. Πριν από έξι χρόνια εγκρίθηκε η μοναδική μέχρι σήμερα θεραπεία ενζυμικής υποκατάστασης (Myozyme, Genzyme, USA) με την οποία φαίνεται ότι, τουλάχιστον, σταθεροποιείται η κατάσταση αυτών των ασθενών. Η θεραπεία λαμβάνεται με ενδοφλέβια έγχυση του φαρμάκου κάθε 2 εβδομάδες. Ωστόσο, μελέτες σε πειραματόζωα έδειξαν ότι η απορρόφηση του φαρμάκου από τους σκελετικούς μυς δεν είναι επαρκής, κάτι που ίσως συνδέεται με τη χαμηλή αιματική ροή στους σκελετικούς μυς κατά τη διάρκεια της ενδοφλέβιας έγχυσης του φαρμάκου. Η σωματική άσκηση προκαλεί αύξηση της αιματικής ροής στους ασκούμενους μυς. Συνεπώς, είναι εύλογη η διατύπωση της υπόθεσης ότι η ήπια σωματική άσκηση κατά τη διάρκεια της ενδοφλέβιας έγχυσης του φαρμάκου ίσως βοηθά στην καλύτερη απορρόφηση του φαρμάκου από τους εργαζόμενους μύ, και επομένως, ίσως βελτιώνει τη λειτουργική ικανότητα των ασθενών. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση της επίδραση της ήπιας σωματικής άσκησης κατά τη διάρκεια της ενδοφλέβιας έγχυσης του φαρμάκου ενζυμικής υποκατάστασης στη μυϊκή δύναμη, τη σωματική σύσταση και την ικανότητα βάδισης σε 6 λεπτά, σε ασθενείς με νόσο Pompe ενήλικης μορφής. Στη μελέτη συμμετείχαν 5 ασθενείς (50% του ελληνικού πληθυσμού διαγνωσμένων με νόσο Pompe), οι οποίοι ήταν ενταγμένοι σε πρόγραμμα ενζυμικής θεραπείας και συστηματικής σωματικής άσκησης τουλάχιστον για 12 μήνες, και είχαν σταθερές τιμές μυϊκής δύναμης, σωματικής σύστασης και λειτουργικής ικανότητας, τουλάχιστον τις τελευταίες 6 εβδομάδες πριν την έναρξη της παρέμβασης (Τ1). Οι ασθενείς αυτοί εκτελούσαν ποδηλασία 30΄ και ασκήσεις με αντιστάσεις κατά τη διάρκεια της έγχυσης του φαρμάκου (κάθε δύο εβδομάδες), για 26 εβδομάδες, ενώ παράλληλα συνέχιζαν να ασκούνται με επίβλεψη, συστηματικά, 3 φορές την εβδομάδα. Πριν (Τ2) και μετά (Τ3) από την παρεμβατική περίοδο αξιολογήθηκε η ισομετρική μυϊκή δύναμη σε μυϊκές ομάδες των άνω και κάτω άκρων, η ικανότητα βάδισης σε 6 λεπτά καθώς και η σωματική σύσταση. Από την αξιολόγηση των αποτελεσμάτων με ανάλυση διασποράς επαναλαμβανόμενων μετρήσεων, προέκυψε ότι η εξάμηνη προπονητική παρεμβατική περίοδος κατά τη διάρκεια της ενδοφλέβιας έγχυσης του φαρμάκου δεν επιφέρει καμία στατιστικά σημαντική αλλαγή στην μυϊκή δύναμη των άνω (π.χ. καμπτήρες αγκώνα Τ2: 15,9 ± 4,5kg - Τ3: 16,1 ± 6,1kg) και κάτω άκρων (π.χ. εκτείνοντες γόνατος Τ2: 8,4 ± 1,9kg - Τ3: 8,8 ± 2,5kg), στην εξάλεπτη δοκιμασία βάδισης (Τ2: 519 ± 68m - T3: 529 ± 66m) καθώς και στη σωματική σύσταση των ασθενών (π.χ. άλιπη μάζα Τ2: 41,21 ± 11,12kg - Τ3: 40,64 ± 10,80kg). Τα αποτελέσματα αυτά υποδηλώνουν ότι η άσκηση κατά τη διάρκεια της θεραπεία ενζυμικής υποκατάστασης ίσως δεν επιφέρει λειτουργικές αλλαγές στους ασθενείς με νόσο Pompe ενήλικης μορφής οι οποίοι ακολουθούν συστηματικό πρόγραμμα άσκησης και είναι ενταγμένοι σε θεραπεία ενζυμικής υποκατάστασης

Triceps Brachii Muscle Strength and Architectural Adaptations with Resistance Training Exercises at Short or Long Fascicle Length

The aim of this study was to investigate whether resistance training at short or long triceps brachii fascicle length induces different muscular strength and architectural adaptations. Nine young, novice, female participants, were trained for 6 weeks (two sessions/week) performing 6 sets &times; 6-RM (repetition maximum) unilateral cable exercises either with push-downs at short fascicle length (S) or overhead extensions with the contralateral arm at long fascicle length (L) of triceps brachii. Before and after training, 1-RM elbow extension and triceps brachii muscle architecture were evaluated. Muscle architecture was analyzed at 50% and 60% of the upper-arm length. Two-dimensional longitudinal muscle area of the triceps long head was also analyzed. The results indicated that 1-RM increased 40.1 &plusmn; 21.3% and 44.5 &plusmn; 20.1% (p &lt; 0.01) after S and L, respectively. Muscle thickness at 50% length was increased 10.7 &plusmn; 15.3% (p &lt; 0.05) and 13.7 &plusmn; 9.0% (p &lt; 0.01) after S and L, while at 60% it was increased 15.5 &plusmn; 18.8% (p &lt; 0.05) and 19.4 &plusmn; 16.3% (p &lt; 0.01), respectively. Longitudinal muscle area increased similarly after S and L (p &lt; 0.01). Fascicle angle and length were not altered with training. These results indicate that muscle strength and architecture of elbow extensors adapt similarly during the first six weeks of resistance training at either long or short fascicle length

Effects Of Tapering With Light Vs. Heavy Loads On Track And Field Throwing Performance

The purpose of the study was to investigate the effects of power training with light vs. heavy loads during the tapering phases of a double periodized training year on track and field throwing performance. Thirteen track and field throwers aged 16-26 years followed 8 months of systematic training for performance enhancement aiming at 2 tapering phases during the winter and the spring competition periods. Athletes performed tapering with 2 different resistance training loads (counterbalanced design):7 athletes used 30% of 1 repetition maximum (1RM) light-load tapering (LT), and 6 athletes used the 85% of 1RM heavy-load tapering (HT), during the winter tapering. The opposite was performed at the spring tapering. Before and after each tapering, throwing performance, 1RM strength, vertical jumping, rate of force development (RFD), vastus lateralis architecture, and rate of perceived exertion were evaluated. Throwing performance increased significantly by 4.8 ± 1.0% and 5.6 ± 0.9% after LT and HT, respectively. Leg press 1RM and squat jump power increased more after HT than LT (5.9 ± 3.2% vs. 23.4 ± 2.5%, and 5.1 ± 2.4% vs. 0.9 ± 1.4%, respectively, p ≤ 0.05). Leg press RFD increased more in HT (38.1 ± 16.5%) compared with LT (22.9 ± 6.7%), but LT induced less fatigue than HT (4.0 ± 1.5 vs. 6.7 ± 0.9, p ≤ 0.05). Muscle architecture was not altered after either program. These results suggest that performance increases similarly after tapering with LT or HT in track and field throwers, but HT leads to greater increases in strength, whole body power, and RFD. © 2014 National Strength and Conditioning Association

The Effect of Cold Dialysis in Motor and Sensory Symptoms of RLS/WED Occurring During Hemodialysis

Restless legs syndrome/Willis–Ekbom disease (RLS/WED) is a common sensorimotory disorder affecting almost 30% of hemodialysis (HD) patients. RLS/WED induces discomfort during rest hours, and its symptoms have also been observed during HD sessions. Anecdotal reports suggest that cooling the dialysate solution during dialysis could help patients overcome those symptoms and improve restlessness. The aim of this double-blind study was to assess whether a reduction of the dialysate temperature by 1°C could reduce motor and sensory symptoms of RLS/WED occurring during HD. Thirty-two HD patients participated in the study. Patients were divided into two groups: the RLS (N=16) and the non-RLS groups (N=16). Patients were studied on two different scenarios for two consecutive HD sessions, 1 week apart: 1) standard temperature of the dialysate (37°C) and 2) low temperature of the dialysate (36°C cold dialysis scenario). In all sessions, motor (leg movement per hour of HD [LM/hHD]) and sensory symptoms were assessed. The reduction of dialysate temperature by 1°C was effective in reducing motor symptoms as they assessed the LM/hHD by 36% only in patients with RLS, while a significant interaction was found between “LM/hHD affected by temperature” and “RLS status” (p = 0.039). Sensory symptoms also reduced by 10% after the reduction of the dialysate temperature. The reduction of the dialysate temperature by 1°C reduced motor symptoms by 36–54% and sensory symptoms by 10% in HD patients with RLS/WED. Cold dialysis could be considered a safe nonpharmacological approach for the amelioration of RLS/WED symptoms occurring during HD

Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy

Purpose: Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally “switch off” mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session. Methods: Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period. Results: Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039). Conclusion: The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients

Effects of 12 months of detraining on health-related quality of life in patients receiving hemodialysis therapy

Purpose: Limited data exist regarding the effects of detraining on functional capacity and quality of life (QoL) in the hemodialysis population. The aim of the current study was to assess whether the discontinuation from a systematic intradialytic exercise training program will affect aspects of health-related QoL and functional capacity in hemodialysis patients. Methods Seventeen hemodialysis patients (12 Males/5 Females, age 60.8 ± 13.6 year) participated in this study. Patients were assessed for functional capacity using various functional capacity tests while QoL, daily sleepiness, sleep quality, depression and fatigue were assessed using validated questionnaires at the end of a 12-month aerobic exercise program and after 12 months of detraining. Results:The detraining significantly reduced patients’ QoL score by 20% (P = 0.01). More affected were aspects related to the physical component summary of the QoL (P < 0.001) rather than those related to the mental one (P = 0.096). In addition, the performance in the functional capacity tests was reduced (P < 0.05), while sleep quality (P = 0.020) and daily sleepiness scores (P = 0.006) were significantly worse after the detraining period. Depressive symptoms (P = 0.214) and the level of fatigue (P = 0.163) did not change significantly. Conclusions: Detraining has a detrimental effect in patients’ QoL, functional capacity and sleep quality. The affected physical health contributed significantly to the lower QoL score. It is crucial for the chronic disease patients, even during emergencies such as lockdowns and restrictions in activities to maintain a minimum level of activity to preserve some of the acquired benefits and maintain their health status