Immediate blood pressure-lowering effects of aerobic exercise among patients with chronic kidney disease.

AIM: The current study was designed to determine the effect of moderate-intensity aerobic exercise on blood pressure responses within the laboratory for 60 min post exercise and in the subsequent 24 h period in patients with chronic kidney disease. METHODS: Twenty-four subjects with stages 2-4 chronic kidney disease (age = 54.5 +/- 15.2 years, body mass index = 32.0 +/- 5.9 kg/m(2)) on antihypertensive medication completed this study. In random counterbalanced order, subjects were asked to either walk for 40 min at 50-60% VO(2peak) (oxygen consumption) or, on a separate day, to sit quietly in the laboratory for the same length of time. Following exercise or the non-exercise period, blood pressure was taken at 10 min intervals for 60 min. Subjects then wore an ambulatory blood pressure monitor for the next 24 h. RESULTS: Systolic blood pressure (mmHg) was reduced by 6.5 +/- 10.8 compared with the pre-exercise baseline value (130.3 +/- 21.1) in the laboratory after exercise and this was greater than after the control period (0.73 +/- 10.3, P < 0.05). Diastolic blood pressure (mmHg) was reduced following exercise (2.5 +/- 6.4) compared with the control period (2.1 +/- 4.9, P < 0.05). The mean 24 h readings did not differ between exercise or non-exercise days. CONCLUSION: Acute aerobic exercise leads to reduced blood pressure for at least 60 min within the laboratory in chronic kidney disease patients.

Substance-use screening and interventions in dental practices: survey of practice-based research network dentists regarding current practices, policies and barriers.

BACKGROUND: Dental visits represent an opportunity to identify and assist patients with unhealthy substance use, but little is known about how dentists are addressing patients' use of tobacco, alcohol and illicit drugs. The authors surveyed dentists to learn about the role their practices might play in providing substance-use screening and interventions. METHODS: The authors distributed a 41-item Web-based survey to all 210 dentists active in the Practitioners Engaged in Applied Research and Learning Network, a practice-based research network. The questionnaire assessed dental practices' policies and current practices, attitudes and perceived barriers to providing services for tobacco, alcohol and illicit drug use. RESULTS: One hundred forty-three dentists completed the survey (68 percent response rate). Although screening was common, fewer dentists reported that they were providing follow-up counseling or referrals for substance use. Insufficient knowledge or training was the most frequently cited barrier to intervention. Many dentists reported they would offer assistance for use of tobacco (67 percent) or alcohol or illicit drugs (52 percent) if reimbursed; respondents who treated publicly insured patients were more likely to reply that they would offer this assistance. CONCLUSIONS: Dentists recognize the importance of screening for substance use, but they lack the clinical training and practice-based systems focused on substance use that could facilitate intervention. Practical Implications. The results of this study indicate that dentists may be willing to address substance use among patients, including use of alcohol and illicit drugs in addition to tobacco, if barriers are reduced through changes in reimbursement, education and systems-level support.