Effects of physical exercise on functional capacity in hemodialysis patients. A systematic review

The aim of this study was to conduct a systematic review in order to evaluate the main effects of intradialytic physical exercise on different parameters of functional capacity in dialytic patients. The clinical question that guided the objective of this study was developed using the PICO method (Population, Intervention, Comparation and Outcome)." Where i) population: patients on hemodialysis; ii) intervention: physical exercise; iii) comparison: active vs sedentary patients; and iv) outcome: functional capacity. The combinations of the following keywords were used: CKD, physical exercise, exercise, physical training and hemodialysis. The selection of studies was performed using the PubMed database and only studies dating from 2011 to 2021 were selected. The search results led to 53 studies. The following steps were carefully analyzed, such as the title, abstract and the full paper description to evaluate whether they met the following inclusion criteria: i) target audience of the studies should be patients on hemodialysis; ii) outcomes that analyze different parameters of functional capacity; iii) Intervention using physical exercise; and iii) intradialytic exercise. The final results indicate that intradialytic physical exercise can cause significant changes in the evaluated outcomes of functional capacity, such as increased strength, improvement of cardiorespiratory function, and improvement of locomotor activity. It was concluded that intradialytic training protocols should be encouraged in clinical practices because they are responsible for causing beneficial changes in the functional capacity of hemodialytic patients

Efeitos do aquecimento passivo na força, hipertrofia e na dor neuropática associadas ao diabetes experimental

Orientador: Prof. Dr. Raul OsieckiCoorientadores: Prof. Dr. Geoffrey Minett, Prof(a). Dr(a). Joice Maria da CunhaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Educação Física. Defesa : Curitiba, 30/09/2021Inclui referências: p. 73-83Resumo: O objetivo desse estudo foi avaliar os efeitos do aquecimento passivo, através da imersão em água quente (42°C) na dor neuropática e nas adaptações musculares em ratos com diabetes experimental induzido quimicamente por estreptozotocina. Para tanto, 71 ratos, linhagem Wistar, foram divididos randomicamente em 8 grupos experimentais, DTI2 e DTI4 (diabéticos tratados por duas ou quatro semanas); DC2 e DC4 (diabéticos controle avaliados após duas ou quatro semanas); NTI2 e NTI4 (normoglicêmicos tratados por duas ou quatro semanas); NC2 e NC4 (normoglicêmicos controle avaliados após duas ou quatro semanas). As imersões foram realizadas 5 vezes na semana durante 30 minutos cada sessão. Semanalmente foram avaliados a glicemia sanguínea, peso corporal e alodinia mecânica. Ao final de duas ou quatro semanas foram realizados os testes de campo aberto para atividade locomotora e teste de carga máxima para aferição da força máxima. Em seguida, os animais foram anestesiados e eutanasiados. O músculo sóleo e gastrocnêmio, de ambos os membros, foram dissecados cirurgicamente e pesados. A análise de normalidade dos dados foi averiguada através do teste de Shapiro-Wilk. Quando confirmada, foi realizado uma análise de variância de medidas repetidas (ANOVA) de três vias para verificar a diferença entre os tempos de coleta (basal, semana 1, 2, 3 e 4), entre os grupos experimentais (tratamento vs. controle) e entre as condições (diabéticos vs. normoglicêmicos) para as análises de glicemia, peso corporal, dor neuropática e temperatura do core. Uma ANOVA de uma via foi realizada para verificar a diferença entre os grupos para os desfechos de força máxima, atividade locomotora e peso muscular. Quando identificada alguma diferença, foi utilizado o post-hoc de Bonferroni para comparações múltiplas. Em todas as análises o nível de significância adotado foi de p menor ou igual a 0,05. Os resultados demonstraram que houve interação entre condição vs. tratamento vs. semanas, para o desfecho de alodinia mecânica (F(4,13)=4,30; p=0,003; Eta p2=0,11), no qual os diabéticos do grupo controle tiveram uma diminuição progressiva do limiar mecânico ao longo das semanas (p<0,01). Para a força muscular, houve um efeito principal do tratamento, no qual a carga máxima foi maior entre os animais tratados comparados ao grupo controle (F(1,61)=16; p=0,01; Eta p2= 0,21), independente da condição. Sendo que, o ganho de força foi evidente em animais diabéticos tratados durante duas semanas, com aumento de 14,61% (p=0,02), quatro semanas, com aumento de 14,29% (p=0,21) e animais normoglicêmicos tratados durante quatro semanas, com aumento de 14,4% (p=0,15). Em relação à atividade locomotora houve efeito do tratamento entre os diabéticos avaliados após duas semanas de intervenção, no qual a atividade locomotora foi maior nos animais tratados quando comparados ao grupo controle, com um aumento de 36,61% (p=0,01). Houve um efeito principal do tratamento no peso corporal, no qual os animais tratados tiveram uma redução no ganho de peso semanal quando comparados ao grupo controle (F(1,33)=6,22; p=0,02; Eta p2=0,16). Não houve interação ou efeito principal do tratamento para os desfechos de peso muscular e glicemia sanguínea. A partir dos resultados encontrados, concluímos que o aquecimento passivo foi responsável por atenuar e atrasar o aparecimento da dor neuropática em animais diabéticos e causar alterações nas adaptações musculares de animais diabéticos e normoglicêmicos.Abstract: The aim of this study was to evaluate the effects of passive heating, through hot water immersion (42°C) on neuropathic pain and muscle adaptations in rats with experimental diabetes induced chemically by streptozotocin. Therefore, 71 Wistar rats were randomly divided into 8 experimental groups, DTI2 and DTI4 (diabetics treated for two or four weeks); DC2 and DC4 (control diabetics evaluated after two or four weeks); NTI2 and NTI4 (normoglycemic treated for two or four weeks); NC2 and NC4 (normoglycemic control assessed after two or four weeks). The immersions were performed 5 times a week for 30 minutes each session. Blood glucose, body weight and mechanical allodynia were evaluated weekly. At the end of two or four weeks, open field tests were performed for locomotor activity and maximum load test to measure maximum strength. Then, the animals were anesthetized and euthanized. The soleus and gastrocnemius muscles of both limbs were surgically dissected and weighed. Data normality analysis was verified using the Shapiro-Wilk test. When confirmed, a three-way repeated measures analysis of variance (ANOVA) was performed to verify the difference between treatment duration (baseline, week 1, 2, 3 and 4) between the experimental groups (treatment vs. control) and between conditions (diabetic vs. normoglycemic) for the analysis of blood glucose, body weight, neuropathic pain and core temperature. A one-way ANOVA was performed to verify the difference between the groups for the outcomes of maximal strength, locomotor activity and muscle weight. When differences were identified, the Bonferroni post-hoc was used for multiple comparisons. In all analyses, the significance level adopted was p less than or equal to 0.05. The results showed that there was an interaction between condition vs. treatment vs. weeks, for the outcome of mechanical allodynia (F(4.13)=4.30; p=0.003; Eta p2=0.11), in which the diabetics in the control group had a progressive decrease in the mechanical threshold over the weeks (p<0.01). For muscle strength, there was a main effect of the treatment, in which the maximum load was higher among the treated animals compared to the control group (F(1.61)=16; p=0.01; Eta p2= 0.21), regardless of condition. The strength gain was evident in diabetic animals treated for two weeks, with an increase of 14.61% (p=0.02), four weeks, with an increase of 14.29% (p=0.21) and normoglycemic animals treated for four weeks, with an increase of 14.4% (p=0.15). Regarding locomotor activity, there was an effect of treatment among diabetics evaluated after two weeks of intervention, in which locomotor activity was greater in treated animals when compared to the control group, with an increase of 36.61% (p=0.01) . There was a main effect of treatment on body weight, in which treated animals had a reduction in weekly weight gain when compared to the control group (F(1.33)=6.22; p=0.02; Eta p2=0. 16). There was no interaction or main treatment effect for muscle weight and blood glucose outcomes. From the results found, we concluded that passive heating was responsible for attenuating and delaying the onset of neuropathic pain in diabetic animals and causing changes in muscle adaptations in diabetic and normoglycemic animals