Segura Ortí, Eva

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients ( 0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.

Cardiovascular (CV) morbidity and mortality is high in patients with chronic kidney disease (CKD). Most patients reveal a high prevalence of CV risk factors such as diabetes or arterial hypertension and many have manifest cardiovascular disease (CVD), such as coronary artery disease and chronic heart failure with an increased risk of clinical events including sudden cardiac death. Diabetes mellitus and hypertension contribute to the development of CKD and the prevalence of CKD is in the range of 20–65% in diabetic and 30–50% in hypertensive patients. Therefore, prevention and optimal treatment of CV risk factors and comorbidities are key strategies to reduce CV risk and improve survival in CKD. Beyond common CV risk factors, patients with CKD are often physically inactive and have low physical function leading to subsequent frailty with muscle fatigue and weakness, sarcopenia and increased risk of falling. Consequently, the economic health burden of CKD is high, requiring feasible strategies to counteract this vicious cycle. Regular physical activity and exercise training (ET) have been shown to be effective in improving risk factors, reducing CVD and reducing frailty and falls. Nonetheless, combining ET and a healthy lifestyle with pharmacological treatment is not frequently applied in clinical practice. For that reason, this Clinical Consensus Statement reviews the current literature and provides evidence-based data regarding the role of ET in reducing CV and overall burden in patients with CKD. The aim is to increase awareness among cardiologists, nephrologists, and healthcare professionals of the potential of exercise therapy in order to encourage implementation of ET in clinical practice, eventually reducing CV risk and disease, as well as reducing frailty in patients with CKD G3–G5D.

Background: Intradialysis exercise programs in renal patients result in improved functional capacity, muscle strength, symptoms of depression, and health-related quality of life. Home-based exercise programs are an alternative to overcome logistical and human resource problems. However, the implementation of these programs is not an easy task and there is a lack of knowledge regarding the benefits associated with home-based exercise programs. Aim: To determine whether home-based exercise programs improve functional capacity, health-related quality of life, muscle strength, and symptoms of depression among patients with stage III–V chronic kidney disease. Methods: A systematic review and meta-analyses following PRISMA guidelines were utilized. Relevant articles were collected and independently assessed for their inclusion eligibility. Effects of home-based exercise were summarized by the standardized mean differences and represented by forest plots (Review Manager 5.4). Results: Eight studies were included, none of which reported any adverse effects. The intervention was usually aerobic, 76% of these programs lasted 3–6 months, and exercise adherence was 60–87.5%. Four studies measured health-related quality of life and found significant improvements in several subscales. Regarding functional capacity, five studies used the six-minute walking test (44.9 meters; 95% CI [30.45, 59.30]; p ≤ .001), three studies used the sit-to-stand-to-sit test (−0.45 seconds; 95% CI [−0.46, −0.26]; p ≤ .001), and two studies used the timed up-and-go test (−0.76 seconds; 95% CI [−1.38, −0.15]; p ≤ .001) and the handgrip strength test (1.16 kg; 95% CI [−2.88, 5.20]; p ≤ .001). LINKING EVIDENCE TO ACTION: Home-based exercise programs are beneficial to renal patients. These interventions are safe and effective to improve health-related quality of life and functional capacity and reduce symptoms of depression among patients with chronic kidney disease.

Background: Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. Aim: To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4–5 (with or without dialysis). Methods: A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. Results: Fifty-three patients were included (mean age = 67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3 s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. Linking Evidence to Action: The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Chronic dialysis patients have an increased risk of severe COVID-19 infection-related complications. The aim of this study was to quantify the impact of the COVID-19 pandemic on healthrelated quality of life (HRQoL) and physical activity levels of patients undertaking hemodialysis (HD). This was an observational study that compared data from two periods of time, before the COVID-19 pandemic vs pandemic. We used the Medical Outcomes Survey Short Form (SF-36) to measure the HRQoL and the Human Activity Profile (HAP) questionnaire was used to measure the physical activity. Data were analyzed with a mixed ordinal linear regression. A total of 27 eligible participants were interviewed during COVID-19 pandemic (median age 78 years). The linear regression model showed that the pandemic, after controlling for the covariates age, comorbidity, albumin, and hemoglobin, had a significant impact on the HRQoL. Physical function (􀀀15.7) and social functioning subscales (􀀀28.0) worsened (p = 0.001), and the physical component scale also showed a significant decrease (􀀀3.6; p = 0.05). Time had a significant impact on the Human Activity Profile, with an average activity score diminished with the pandemic (􀀀13.9; p = 0.003). The COVID-19 pandemic had a very negative impact on HRQoL and physical activity level of subjects undertaking hemodialysis. Interventions to improve HRQoL and activity levels of patients undertaking HD are recommended.

Background: Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise programme would affect physical function and adherence to exercise in these patients. Methods: A total of 56 individuals participated in two 12-week periods in a crossover randomized controlled trial. Each patient underwent a functional capacity evaluation before and after each study period. The functional tests administered included the 4-m gait speed test, Short Physical Performance Battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLST) for balance, sit-to-stand 10 (STS-10) and sit-to-stand 60 (STS-60) tests and 6-min walking test (6MWT). Adherence to the exercise programme was also recorded. To assess the effect of VR exercise on the functional test outcomes over time, the patients were analysed using a two-way repeated-measures analysis of variance with time and treatment as the within-participant factors. Results: By the end of the 12 weeks of exercise, compared with the control period, 33 participants showed significant change in physical function as measured through the 4-m gait speed test (0.14 m/s), SPPB (1.2 points), TUG (−1.7 s), OLST (7.1 s), STS-10 (−5.8 s), STS-60 (5 repetitions) and 6MWT (85.2 m), with adherence rates exceeding 70%. There were no changes in the biochemical data or in the medications in the period of the study. Conclusion: An intradialytic non-immersive VR exercise programme improves patient physical function.

Introducción: Uno de los factores contribuyentes en la cronificación de la migra˜na son los trastornos del sue˜no que pueden actuar como un factor precipitante y/o perpetuador en estos sujetos. El objetivo primario de este estudio fue identificar los factores predictores relacionados con la calidad del sue˜no en pacientes con migra˜na crónica (MC) y el objetivo secundario fue identificar si existían diferencias en variables psicológicas y de discapacidad entre los pacientes con MC que presentaban menor o mayor calidad del sue˜no. Métodos: Se llevó a cabo un estudio observacional, transversal, formado por 50 participantes con MC. Se registraron una serie de variables demográficas, psicológicas y de discapacidad mediante cuestionarios de autorregistro. Resultados: Se observaron correlaciones directas, moderadas-fuertes, entre las diferentes variables de discapacidad y psicológicas analizadas (p < 0,05). En la regresión, se estableció como variable criterio la calidad del sue˜no y las variables predictores fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y el catastrofismo ante el dolor que, en conjunto, explican el 33% de la varianza. En cuanto a la comparación de los grupos de mayor y menor afectación del sue˜no, se encontraron diferencias estadísticamente significativas en la variable de síntomas depresivos (p = 0,016) y catastrofismo ante el dolor (p = 0,036). Conclusiones: Los factores predictores de la calidad del sue˜no en pacientes con MC fueronlos síntomas depresivos, la discapacidad relacionada con la cefalea y, en menor medida, elcatastrofismo ante el dolor. Los sujetos con peor calidad de sue˜no presentaron mayores nivelesde catastrofismo ante el dolor y síntomas depresivos.

Each year, 50% of runners su er from injuries. Consequently, more studies are being published about running biomechanics; these studies identify factors that can help prevent injuries. Scientific evidence suggests that recreational runners should use personalized biomechanical training plans, not only to improve their performance, but also to prevent injuries caused by the inability of amateur athletes to tolerate increased loads, and/or because of poor form. This study provides an overview of the di erent normative patterns of lower limb muscle activation and articular ranges of the pelvis during running, at self-selected speeds, in men and women. Methods: 38 healthy runners aged 18 to 49 years were included in this work. We examined eight muscles by applying two wearable superficial electromyography sensors and an inertial sensor for three-dimensional (3D) pelvis kinematics. Results: the largest di erences were obtained for gluteus maximus activation in the first double float phase (p = 0.013) and second stance phase (p = 0.003), as well as in the gluteus medius in the second stance phase (p = 0.028). In both cases, the activation distribution was more homogeneous in men and presented significantly lower values than those obtained for women. In addition, there was a significantly higher percentage of total vastus medialis activation in women throughout the running cycle with the median (25th–75th percentile) for women being 12.50% (9.25–14) and 10% (9–12) for men. Women also had a greater range of pelvis rotation during running at self-selected speeds (p = 0.011). Conclusions: understanding the di erences between men and women, in terms of muscle activation and pelvic kinematic values, could be especially useful to allow health professionals detect athletes who may be at risk of injury.

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.

The aim of this study was to determine the extent to which poor physical functioning, low participation in physical activity and muscle atrophy observed among patients on hemodialysis are evident in the earlier stages of chronic kidney disease (CKD). We enrolled adults in three groups: no CKD, stage 3-4 CKD, and hemodialysis. Outcomes measured were physical activity, muscle size, thigh muscle strength, physical performance, and self-reported physical function. Patients with CKD had muscle area intermediate between the no CKD and hemodialysis groups, but they had low levels of physical activity that were similar to the hemodialysis group. Physical activity and muscle size were significantly associated with all outcomes. Kidney function was not significantly associated with muscle strength or physical performance after adjustment for physical activity and muscle size. In conclusion, interventions aimed to increase muscle mass and energy expenditure might have an impact on improving physical function of CKD patients.