Left ventricular mechanical, cardiac autonomic and metabolic responses to a single session of high intensity interval training.

High-intensity interval training (HIIT) produces significant health benefits. However, the acute physiological responses to HIIT are poorly understood. Therefore, we aimed to measure the acute cardiac autonomic, haemodynamic, metabolic and left ventricular mechanical responses to a single HIIT session. Fifty young, healthy participants completed a single HIIT session, comprising of three 30-s maximal exercise intervals on a cycle ergometer, interspersed with 2-min active recovery. Cardiac autonomics, haemodynamics and metabolic variables were measured pre-, during and post-HIIT. Conventional and speckle tracking echocardiography was used to record standard and tissue Doppler measures of left ventricular (LV) structure, function and mechanics pre- and post-HIIT. Following a single HIIT session, there was significant post-exercise systolic hypotension (126 ± 13 to 111 ± 10 mmHg, p < 0.05), parallel to a significant reduction in total peripheral resistance (1640 ± 365 to 639 ± 177 dyne⋅s⋅cm , p < 0.001) and significant increases in baroreceptor reflex sensitivity and baroreceptor effectiveness index (9.2 ± 11 to 24.8 ± 16.7 ms⋅mmHg and 41.8 ± 28 to 68.8 ± 16.2, respectively) during recovery compared to baseline. There was also a significant increase in the low- to high-frequency heart rate variability ratio in recovery (0.7 ± 0.48 to 1.7 ± 1, p < 0.001) and significant improvements in left ventricular global longitudinal strain (- 18.3 ± 1.2% to - 29.2 ± 2.3%, p < 0.001), and myocardial twist mechanics (1.27 ± 0.72 to 1.98 ± 0.72°·cm , p = 0.028) post-HIIT compared to baseline. A single HIIT session is associated with acute improvements in autonomic modulation, haemodynamic cardiovascular control and left ventricular function, structure and mechanics. The acute responses to HIIT provide crucial mechanistic information, which may have significant acute and chronic clinical implications. [Abstract copyright: © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Motivation communication training programme for healthcare professionals to support adherence in patients with diabetic foot ulcers: Proof of concept study

Patients with diabetic foot ulcers have poor adherence to treatment recommendations. However, the most effective way to support adherence in this population is unknown. This study aimed to assess the preliminary effectiveness of a motivation communication training programme for healthcare professionals working with these patients, using theory and evidence-based strategies.A proof-of-concept study using a non-randomised, controlled before-and-after design. Six podiatrists took part in the motivation communication training programme. Pre-training, observation was undertaken to examine the communication style currently used by podiatrists in routine consultations. Patients’ (n = 25) perceptions of podiatrist autonomy support, self-determination for limiting weight-bearing activity and average daily step count were also assessed. Post training, observations and patient measures were repeated with a different group of patients (n = 24). Observations indicated that podiatrists exhibited a more need-supportive communication style (e.g., taking time to understand patients’ perspectives) after undergoing the training programme. Patients in the post-training group reported higher levels of autonomy support, while self-determination to limit weight-bearing activity remained unchanged. Although the post-training group had a lower average daily step count, the difference was not statistically significant. This is the first study to investigate implementation of motivation communication strategies in routine consultations with patients with diabetic foot ulcers. Results suggest that training can enhance healthcare professionals’ motivation communication skills with potential for addressing adherence issues, however, a larger cluster randomised controlled trial is necessary to confirm this

The rapid development of a novel kidney-specific digital intervention for self-management of physical activity and emotional well-being during the COVID-19 pandemic and beyond: Kidney Beam

King's College Hospital; Kidney Research UK; Beam; National Institute for Health Research (NIHR) under (NIHR301893), (NIHR301593), and (ICA-CL-2017-03-020)

The Codevelopment of “My Kidneys & Me”: A Digital Self-management Program for People With Chronic Kidney Disease

Background: Health care self-management is important for people living with nondialysis chronic kidney disease (CKD). However, the few available resources are of variable quality. Objective: This work describes the systematic codevelopment of “My Kidneys & Me” (MK&M), a theory-driven and evidence-based digital self-management resource for people with nondialysis CKD, guided by an established process used for the successful development of the diabetes education program MyDESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed, DESMOND). Methods: A multidisciplinary steering group comprising kidney health care professionals and researchers and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behavior change. A patient and public involvement group helped identify the needs and priorities of MK&M and co-design the resource. MK&M was developed in 2 sequential phases. Phase 1 involved the codevelopment process of the MK&M resource (content and materials), using Intervention Mapping (IM) as a framework. The first 4 IM steps guided the development process: needs assessment was conducted to describe the context of the intervention; intervention outcomes, performance objectives, and behavioral determinants were identified; theory- and evidence-based change methods and practical strategies to deliver change methods were selected; and program components were developed and refined. Phase 2 involved the adoption and adaptation of the existing MyDESMOND digital platform to suit the MK&M resource. Results: The needs assessment identified that individuals with CKD have multiple differing needs and that delivering a self-management program digitally would enable accessible, tailored, and interactive information and support. The intended outcomes of MK&M were to improve and maintain effective self-management behaviors, including physical activity and lifestyle, improve knowledge, promote self-care skills, increase self-efficacy, and enhance well-being. This was achieved through the provision of content and materials designed to increase CKD knowledge and patient activation, reduce health risks, manage symptoms, and improve physical function. Theories and behavior change techniques selected include Self-Management Framework, Capability, Opportunity, Motivation Behavior model components of Behaviour Change Wheel and taxonomy of behavior change techniques, Health Action Process Approach Model, Common Sense Model, and Social Cognitive Theory. The program components developed comprised educational and behavior change sessions, health trackers (eg, monitoring blood pressure, symptoms, and exercise), goal-setting features, and forums for social support. The MyDESMOND digital platform represented an ideal existing platform to host MK&M; thus, the MyDESMOND interface and features were adopted and adapted for MK&M. Conclusions: Applying the IM framework enabled the systematic application of theory, empirical evidence, and practical perspectives in the codevelopment of MK&M content and materials. Adopting and adapting a preexisting platform provided a cost- and time-efficient approach for developing our digital intervention. In the next stage of work, the efficacy of MK&M in increasing patient activation will be tested in a randomized controlled trial

Home-based exercise in chronic kidney disease: Exploring the feasibility and effect of a digitally delivered physical activity and exercise content

Background People living with non-dialysis dependant chronic kidney disease are susceptible to declining physical function. Physical function is considered an important phenotype of syndromes such as sarcopenia and frailty. Physical activity is a well-established way to counteract declining function. However, physical activity levels in this population are low. Digital health interventions (DHIs) provide a novel and potentially accessible way to provide lifestyle education. Aims To develop a physical activity and exercise content as part of a larger complex DHI (My Kidneys and Me (MK&M)). To explore the measurement properties of the 12-Item Short-Form Health Survey (SF-12), which was used as a self-reported outcome measure to assess effect. To assess the feasibility of delivering remote physical activity and exercise content as part of the MK&M. To investigate the effect of the MK&M programme on self-reported physical function, sarcopenia risk, and physical activity levels. Methods A scoping review and patient and public involvement supported the co-development of the physical activity resources. Measurement properties of the SF-12 were investigated by the COSMIN guidelines. Usage behaviours were investigated to assess the feasibility of the MK&M programme. Finally, a preliminary analysis was performed to assess differences between groups (intervention versus control) and associations between usage and effect. Results The development procedures highlighted that patients may require multiple resources to aid home-based exercise. The SF-12 and its subscales are adequate to assess lower body mobility. Usage behaviours suggested that patients preferred to use the MK&M programme in shorter bouts. Associations between MK&M usage and physical function were observed, however, this result is subject to limitations. Discussion The MK&M programme has the potential to preserve physical function. Results suggested that refinement to the programme may be required. The thesis highlights the importance of outcome measure choice, development procedures, and the application of usage behaviours when examining the effect(s) of complex DHIs.</p

Perceptions and experiences of a progressive resistance exercise training programme in people with CKD

Muscle wasting is highly prevalent in chronic conditions, such as chronic kidney disease (CKD), and can result in decreased physical functioning and strength, and impaired ability to perform daily tasks, thus impacting quality of life. Exercise, particularly resistance training, promotes a multitude of benefits, including prevention and management of muscle dysfunction; however, engagement in resistance training is poor. The aim of this study was to understand the views of people with CKD who participated in a research study evaluating a progressive resistance exercise program

Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease

Chronic kidney disease (CKD) patients have poor cardiorespiratory fitness. Although cardiopulmonary exercise testing (CPET) is a universal assessment of cardiorespiratory fitness, values taken at 'peak' effort are strongly influenced by motivation and the choice of test endpoint. The oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal, and respiratory function into a single index to provide a more pragmatic and safer alternative to maximal testing. No research has explored whether exercise can improve the OUES in CKD patients.info:eu-repo/semantics/publishedVersio