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1.
Nephrol Dial Transplant ; 37(2): 366-374, 2022 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33983449

RESUMO

BACKGROUND: Intradialytic cycling (IDC) may provide cardiovascular benefits to individuals receiving haemodialysis, but the exact mechanism behind these improvements remains unclear. The primary aim of this study was to investigate the effect of a 6-month programme of IDC on circulating endotoxin (secondary analysis from the CYCLE-HD trial). Secondary aims were to investigate changes in circulating cytokines [interleukin-6 (IL-6), IL-10, tumour necrosis factor-α, C-reactive protein (CRP) and the IL-6:IL-10 ratio] and their associations with physical activity, fitness and cardiovascular outcomes. METHODS: Participants were randomized to either a 6-month programme of IDC (thrice weekly, moderate intensity cycling at a rating of perceived exertion of 12-14) in addition to usual care (n = 46) or usual care only (control group; n = 46). Outcome measures were obtained at baseline and then again at 6 months. RESULTS: There was no significant (P = 0.137) difference in circulating endotoxin between groups at 6 months (IDC group: 0.34 ± 0.08 EU/mL; control group: 0.37 ± 0.07 EU/mL). There were no significant between-group differences in any circulating cytokine following the 6-month programme of IDC. Higher levels of physical activity and fitness were associated with lower levels of endotoxin, IL-6, CRP and IL-6:IL-10 ratio. CONCLUSIONS: Our data show no change in circulating endotoxin or cytokines following a 6-month programme of IDC. However, higher levels of physical activity outside of haemodialysis were associated with lower levels of inflammation.


Assuntos
Endotoxinas , Diálise Renal , Exercício Físico , Humanos , Inflamação/etiologia , Aptidão Física , Diálise Renal/efeitos adversos
2.
Diabetes Obes Metab ; 24(9): 1850-1860, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35603919

RESUMO

AIM: To identify, appraise and synthesize the available evidence on the impact of the coronavirus disease 2019 (COVID-19) pandemic and lockdown (LD) on glycaemic control in people with diabetes. MATERIALS AND METHODS: We searched multiple databases up to 2 February 2021 for studies reporting HbA1c, time in range (TIR), average or fasting glucose, severe hypoglycaemia and diabetic ketoacidosis. Data were pooled using random effects meta-analysis and are presented as mean difference (MD) with 95% confidence intervals (CI). This review was preregistered on PROSPERO (CRD42020179319). RESULTS: We include 59 studies; 44 (n = 15 464) were included in quantitative syntheses and 15 were narratively synthesized. Pooled data were grouped by diabetes type. Results from 28 studies (n = 5048 type 1 diabetes [T1D] and combined diabetes participants) showed that TIR increased during LD compared with before LD (MD 2.74%, 95% CI 1.80% to 3.69%). Data from 10 studies (n = 1294 T1D participants) showed that TIR increased after LD compared with before LD (MD 5.14%, 95% CI 3.12% to 7.16%). Pooled results from 12 studies (n = 4810 T1D and type 2 diabetes participants) resulted in average glucose decreasing after LD compared with before LD (MD -6.86 mg/dl, 95% CI -8.54 to -5.18). Results for other outcomes, including HbA1c, were not statistically significantly different. CONCLUSIONS: The COVID-19 pandemic was associated with small improvements across multiple outcomes of glycaemic control, although there was insufficient evidence to suggest that this led to changes in HbA1c. Most evidence came from people with access to diabetes technologies in high-income countries; more research is needed in less advantaged populations.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Glucose , Hemoglobinas Glicadas/análise , Controle Glicêmico , Humanos , Pandemias
3.
Eur J Appl Physiol ; 122(3): 599-609, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34854982

RESUMO

PURPOSE: Patients receiving haemodialysis (HD) display elevated circulating microparticle (MP) concentration, tissue factor (TF) expression and markers of systemic inflammation, though regular intradialytic cycling (IDC) may have a therapeutic effect. This study investigated the impact of regular, moderate-intensity IDC on circulating MPs and inflammatory markers in unit-based HD patients. METHODS: Patients were cluster-randomised to intervention (n = 20, age: 51.4 ± 18.1 years, body mass: 77.6 ± 18.3 kg, mean ± SD) or no-exercise control (n = 20, 56.8 ± 14.0 years, 80.5 ± 26.5 kg). Intervention participants completed 30 min of moderate intensity (rating of perceived exertion [RPE] of 12-14) IDC, thrice weekly for 6 months. Pre-dialysis venous blood samples were obtained at 0, 3 and 6 months. Circulating MP phenotypes, cytokines, chemokine and MP TF expression were quantified using flow cytometry and cytometric bead array assays. RESULTS: Despite high exercise compliance (82%), no IDC-dependent effects were observed for any MP, cytokine or chemokine measure (p ≥ 0.051, ηρ2 ≤ 0.399) other than TNF-α (p = 0.001, ηρ2 = 0.186), though no significance was revealed upon post hoc analysis. CONCLUSION: Six months of regular, moderate-intensity IDC had no effect on MPs, cytokines or chemokines. This suggests that the exercise did not exacerbate thrombotic or inflammatory status, though further functional assays are required to confirm this. TRIAL REGISTRATION: ISRCTN1129707, prospectively registered on 05/03/2015.


Assuntos
Biomarcadores/sangue , Micropartículas Derivadas de Células/metabolismo , Terapia por Exercício/métodos , Inflamação/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/reabilitação , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Fenótipo , Diálise Renal
4.
J Ren Nutr ; 32(2): 224-233, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33888409

RESUMO

OBJECTIVE: Protein-energy wasting is highly prevalent in people with end-stage kidney disease receiving regular hemodialysis. Currently, it is unclear what the optimal nutritional recommendations are, which is further complicated by differences in dietary patterns between countries. The aim of the study was to understand and compare dietary intake between individuals receiving hemodialysis in Leicester, UK and Nantong, China. METHODS: The study assessed 40 UK and 44 Chinese participants' dietary intake over a period of 14 days using 24-hour diet recall interviews. Nutritional blood parameters were obtained from medical records. Food consumed by participants in the UK and China was analyzed using the Nutritics and Nutrition calculator to quantify nutritional intake. RESULTS: Energy and protein intake were comparable between UK and Chinese participants, but with both below the recommended daily intake. Potassium intake was higher in UK participants compared to Chinese participants (2,115 [888] versus 1,159 [861] mg/d; P < .001), as was calcium (618 [257] versus 360 [312] mg/d; P < .001) and phosphate intake (927 [485] versus 697 [434] mg/d; P = .007). Vitamin C intake was lower in UK participants compared to their Chinese counterparts (39 [51] versus 64 [42] mg/d; P = .024). Data are reported here as median (interquartile range). CONCLUSION: Both UK and Chinese hemodialysis participants have insufficient protein and energy in their diet. New strategies are required to increase protein and energy intakes. All participants had inadequate daily intake of vitamins C and D; there may well be a role in the oral supplementation of these vitamins, and further studies are urgently needed.


Assuntos
Ingestão de Alimentos , Ingestão de Energia , Humanos , Inquéritos Nutricionais , Diálise Renal , Vitaminas
5.
Kidney Int ; 99(6): 1478-1486, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023029

RESUMO

Cardiovascular disease is the leading cause of death for patients receiving hemodialysis. Since exercise mitigates many risk factors which drive cardiovascular disease for these patients, we assessed effects of a program of intra-dialytic cycling on left ventricular mass and other prognostically relevant measures of cardiovascular disease as evaluated by cardiac MRI (the CYCLE-HD trial). This was a prospective, open-label, single-blinded cluster-randomized controlled trial powered to detect a 15g difference in left ventricular mass measured between patients undergoing a six-month program of intra-dialytic cycling (exercise group) and patients continuing usual care (control group). Pre-specified secondary outcomes included measures of myocardial fibrosis, aortic stiffness, physical functioning, quality of life and ventricular arrhythmias. Outcomes were analyzed as intention-to-treat according to a pre-specified statistical analysis plan. Initially, 130 individuals were recruited and completed baseline assessments (65 each group). Ultimately, 101 patients completed the trial protocol (50 control group and 51 exercise group). The six-month program of intra-dialytic cycling resulted in a significant reduction in left ventricular mass between groups (-11.1g; 95% confidence interval -15.79, -6.43), which remained significant on sensitivity analysis (missing data imputed) (-9.92g; 14.68, -5.16). There were significant reductions in both native T1 mapping and aortic pulse wave velocity between groups favoring the intervention. There was no increase in either ventricular ectopic beats or complex ventricular arrhythmias as a result of exercise with no significant effect on physical function or quality of life. Thus, a six-month program of intradialytic cycling reduces left ventricular mass and is safe, deliverable and well tolerated.


Assuntos
Análise de Onda de Pulso , Qualidade de Vida , Terapia por Exercício , Humanos , Estudos Prospectivos , Diálise Renal/efeitos adversos
6.
J Sports Sci ; 39(2): 219-226, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33459582

RESUMO

This study demonstrates a novel data-driven method of summarising accelerometer data to profile physical activity in three diverse groups, compared with cut-point determined moderate-to-vigorous physical activity (MVPA). GGIR was used to generate average daily acceleration, intensity gradient, time in MVPA and MX metrics (acceleration above which the most active X-minutes accumulate) from wrist-worn accelerometer data from three datasets: office-workers (OW, N = 697), women with a history of post-gestational diabetes (PGD, N = 267) and adults with ≥1 chronic disease (CD, N = 1,325). Average acceleration and MVPA were lower in CD, but not PGD, relative to OW (-5.2 mg and -30.7 minutes, respectively, P < 0.001). Both PGD and CD had poorer intensity distributions than OW (P < 0.001). Application of a cut-point to the M30 showed 7%, 17% and 28%, of OW, PGD and CD, respectively, accumulated 30 minutes of brisk walking per day. Radar plots showed OW had higher overall activity than CD. The relatively poor intensity distribution of PGD, despite similar overall activity to OW, was due to accumulation of more light and less higher intensity activity. These data-driven methods identify aspects of activity that differ between groups, which may be missed by cut-point methods alone. Abbreviations: CD: Adults with ≥1 chronic disease; mg: Milli-gravitational unit; MVPA: Moderate-to-vigorous physical activity; OW: Office workers; PGD: Women with a history of post-gestational diabetes; VPA: Vigorous physical activity.


Assuntos
Doença Crônica , Diabetes Gestacional/fisiopatologia , Exercício Físico/fisiologia , Comportamento Sedentário , Acelerometria/instrumentação , Adulto , Idoso , Feminino , Monitores de Aptidão Física , Humanos , Pessoa de Meia-Idade , Ocupações , Gravidez
7.
Am J Physiol Renal Physiol ; 318(1): F76-F85, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31736354

RESUMO

Renal transplant recipients (RTRs) and patients with nondialysis chronic kidney disease display elevated circulating microparticle (MP) counts, while RTRs display immunosuppression-induced infection susceptibility. The impact of aerobic exercise on circulating immune cells and MPs is unknown in RTRs. Fifteen RTRs [age: 52.8 ± 14.5 yr, estimated glomerular filtration rate (eGFR): 51.7 ± 19.8 mL·min-1·1.73 m-2 (mean ± SD)] and 16 patients with nondialysis chronic kidney disease (age: 54.8 ± 16.3 yr, eGFR: 61.9 ± 21.0 mL·min-1·1.73 m-2, acting as a uremic control group), and 16 healthy control participants (age: 52.2 ± 16.2 yr, eGFR: 85.6 ± 6.1 mL·min-1·1.73 m-2) completed 20 min of walking at 60-70% peak O2 consumption. Venous blood samples were taken preexercise, postexercise, and 1 h postexercise. Leukocytes and MPs were assessed using flow cytometry. Exercise increased classical (P = 0.001) and nonclassical (P = 0.002) monocyte subset proportions but decreased the intermediate subset (P < 0.001) in all groups. Exercise also decreased the percentage of platelet-derived MPs that expressed tissue factor in all groups (P = 0.01), although no other exercise-dependent effects were observed. The exercise-induced reduction in intermediate monocyte percentage suggests an anti-inflammatory effect, although this requires further investigation. The reduction in the percentage of tissue factor-positive platelet-derived MPs suggests reduced prothrombotic potential, although further functional assays are required. Exercise did not cause aberrant immune cell activation, suggesting its safety from an immunological standpoint (ISRCTN38935454).


Assuntos
Micropartículas Derivadas de Células/fisiologia , Exercício Físico/fisiologia , Sistema Imunitário/fisiologia , Transplante de Rim , Insuficiência Renal/cirurgia , Transplantados , Adulto , Idoso , Biomarcadores , Feminino , Citometria de Fluxo , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Período Pós-Operatório , Insuficiência Renal/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia
8.
Exerc Immunol Rev ; 24: 46-58, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29461971

RESUMO

Microparticles (MPs) are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis. They are elevated in a wide variety of disease states and have been previously measured to assess both disease activity and severity. However, recent research suggests that they also possess bioeffector functions, including but not limited to promoting coagulation and thrombosis, inducing endothelial dysfunction, increasing pro-inflammatory cytokine release and driving angiogenesis, thereby increasing cardiovascular risk. Current evidence suggests that exercise may reduce both the number and pathophysiological potential of circulating MPs, making them an attractive therapeutic target. However, the existing body of literature is largely comprised of in vitro or animal studies and thus drawing meaningful conclusions with regards to health and disease remains difficult. In this review, we highlight the role of microparticles in disease, comment on the use of exercise and dietary manipulation as a therapeutic strategy, and suggest future research directions that would serve to address some of the limitations present in the research to date.


Assuntos
Micropartículas Derivadas de Células/patologia , Exercício Físico , Animais , Apoptose , Doenças Cardiovasculares/fisiopatologia , Dieta , Humanos , Inflamação/fisiopatologia , Trombose/fisiopatologia
9.
Med Sci Sports Exerc ; 54(9): 1582-1590, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35666160

RESUMO

INTRODUCTION: Higher levels of physical activity are associated with lower cardiometabolic risk. However, the relative contribution of overall activity and the intensity of activity are unclear. Our aim was to determine the relative contribution of overall activity and intensity distribution of activity to cardiometabolic risk in a cross-sectional analysis of apparently healthy office workers and in people with one or more chronic disease. METHODS: Clustered cardiometabolic risk score was calculated from mean arterial pressure, high-density lipoprotein cholesterol, triglycerides and HbA1c. Open-source software (GGIR) was used to generate average acceleration and intensity gradient from wrist-worn accelerometer data for two data sets: office-workers who did not have a self-reported medical condition ( n = 399, 70% women) and adults with one or more chronic disease ( n = 1137, 34% women). Multiple linear regression analyses were used to assess the relative contribution of overall activity and intensity of activity to cardiometabolic risk. RESULTS: When mutually adjusted, both overall activity and intensity of activity were independently associated with cardiometabolic risk in the healthy group ( P < 0.05). However, for the CD group, although mutually adjusted associations for average acceleration were significantly associated with cardiometabolic risk ( P < 0.001), intensity was not. In healthy individuals, cardiometabolic risk was lower in those with high overall activity and/or intensity of activity, and who also undertook at least 10 min brisk walking. In those with a chronic disease, risk was lower in those who undertook at least 60 min slow walking. CONCLUSIONS: These findings suggest interventions aiming to optimize cardiometabolic health in healthy adults could focus on increasing both intensity and amount of physical activity. However, in those with chronic disease, increasing the amount of activity undertaken, regardless of intensity, may be more appropriate.


Assuntos
Doenças Cardiovasculares , Comportamento Sedentário , Adulto , Pressão Sanguínea , HDL-Colesterol , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco
10.
BMJ Open ; 12(5): e061104, 2022 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508347

RESUMO

INTRODUCTION: The number of people living with multiple long-term conditions (MLTCs) is predicted to rise. Within this population, those also living with frailty are particularly vulnerable to poor outcomes, including decreased function. Increased physical activity, including exercise, has the potential to improve function in those living with both MLTCs and frailty but, to date, the focus has remained on older people and may not reflect outcomes for the growing number of younger people living with MLTCs and frailty. For those with higher burdens of frailty and MLTCs, physical activity may be challenging. Tailoring physical activity in response to symptoms and periods of ill-health, involving family and reducing sedentary behaviour may be important in this population. How the tailoring of interventions has been approached within existing studies is currently unclear. This scoping review aims to map the available evidence regarding these interventions in people living with both frailty and MLTCs. METHODS AND ANALYSIS: We will use a six-stage process: (1) identifying the research questions; (2) identifying relevant studies (via database searches); (3) selecting studies; (4) charting the data; (5) collating and summarising and (6) stakeholder consultation. Studies will be critically appraised using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION: All data in this project will be gathered through database searches. Stakeholder consultation will be undertaken with an established patient and public involvement group. We will disseminate our findings via social media, publication and engagement meetings.


Assuntos
Fragilidade , Comportamento Sedentário , Idoso , Exercício Físico , Humanos , Encaminhamento e Consulta , Literatura de Revisão como Assunto
11.
Br J Cardiol ; 28(1): 5, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35747477

RESUMO

A trial fibrillation (AF) increases cardio-embolic stroke risk, yet AF diagnosis and subsequent prophylactic anticoagulant prescription rates are suboptimal globally. This project aimed to increase AF diagnosis and subsequent anticoagulation prescription rates in East Midlands Clinical Commissioning Groups (CCGs). This service improvement evaluation of the East Midlands AF Advance programme investigated the implementation of mobile AF detection devices (Kardia, AliveCor) into primary-care practices within East Midlands CCGs, along with audit tools and clinician upskilling workshops designed to increase AF diagnosis and anticoagulation prescription rates. AF prevalence and prescription data were collected quarterly from July to September (Q3) 2017/18 to April to June/July to September (Q2/3) 2018/19. AF prevalence increased from 1.9% (22,975 diagnoses) in Q3 2017/18 to 2.4% (24,246 diagnoses) in Q2 2018/19 (p=0.026), while the percentage of high-risk AF patients receiving anticoagulants increased from 80.5% in Q3 2017/18 to 86.9% in Q3 2018/19 (p=0.57), surpassing the Public Health England 2019 target of 85%. The East Midlands AF Advance programme increased AF diagnosis and anticoagulation rates, which is expected to be of significant clinical benefit. The mobile AF detection devices provide a more practical alternative to traditional 12-lead electrocardiograms (ECGs) and should be incorporated into routine clinical practice for opportunistic AF detection, in combination with medication reviews to increase anticoagulant prescription.

12.
Br J Gen Pract ; 71(713): e921-e930, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34725044

RESUMO

BACKGROUND: Targeted self-management programmes may improve health and increase physical activity (PA) in people with multimorbidity. AIM: To investigate the impact of a structured, theoretically driven, self-management group education programme on habitual PA levels in people with multimorbidity. DESIGN AND SETTING: Individually randomised controlled trial with 12-month follow-up, involving nine primary care practices in Leicestershire, UK. METHOD: In total, 353 adults with multimorbidity (age 67.8 years [±9 years], 161 male sex) were randomised to intervention (n = 180) or control (n = 173) groups. Intervention participants were invited to attend four group-based self-management sessions, centred primarily on increasing PA, and received motivational text-message support. The primary outcome measure was change in overall volume (time and intensity) of daily PA at 12 months, as measured by the GENEActiv wrist-worn accelerometer device. RESULTS: At baseline, the total sample achieved 22 min of moderate-vigorous intensity PA per day (mean/participant). At 12 months, in the complete-case analysis, a reduction in daily mean PA volume was seen in the intervention group relative to control (-0.80 milligravity [m g]; 95% confidence interval [CI] = -1.57 to -0.03; P = 0.04). Reductions were also seen in the intervention group in time spent in moderate-vigorous PA (-3.86 min per day; 95% CI= -6.70 to -1.03; P = 0.008) and time spent at an intensity equivalent to a slow walk (-4.66 min per day; 95% CI = -8.82 to -0.51; P = 0.028). However, the per-protocol analysis (excluding participants who did not attend at least one education session) found no between-group differences in overall daily PA at 12 months (-0.65 mg; 95% CI = -1.46 to 0.15; P = 0.11). CONCLUSION: The self-management programme elicited a slight reduction in PA levels in people with multimorbidity. Future research should identify and target subgroups of those with multimorbidity in greatest need of PA promotion in order to maximise potential capacity for benefit, and also focus on refining the intervention in order to increase efficacy in increasing PA.


Assuntos
Autogestão , Adulto , Idoso , Exercício Físico , Humanos , Masculino , Motivação , Multimorbidade , Caminhada
13.
Open Heart ; 8(1)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33637567

RESUMO

AIM: To assess the effectiveness of a low-cost pragmatic intervention (structured education and ongoing text message support) to increase daily physical activity in participants 12-48 months after a coronary heart disease cardiac event (myocardial infarction, angina or acute coronary syndrome) diagnosis. METHODS: A single-centre randomised controlled trial of 291 adults randomised to a structured education programme (n=145) or usual care (n=146). The programme consisted of two 2.5 hour sessions delivered 2 weeks apart, followed by supplementary text message support. The GENEActiv accelerometer assessed the primary outcome at 12 months (change in overall physical activity (expressed in milli gravitational (mg) units) from baseline). Secondary outcomes included anthropometric, physical function, cardiovascular, biochemical and patient-reported outcome measures. Linear regression was used to compare outcome measures between groups on a modified intention-to-treat basis. RESULTS: Participants' mean age was 66.5±9.7 years, 84.5% males, 82.5% white British and 15.5% south Asian. At 12 months, there was no difference between the groups in terms of change in overall physical activity (-0.23 mg (95% CI -1.22 to 0.75), p=0.64) and the programme was well accepted (88% attendance). Exploratory analyses showed that average moderate to vigorous physical activity (MVPA) levels increased in individuals not meeting physical activity guidelines (≥150 min per week) on enrolment compared with those who did, by 8 minutes per day (8.04 (95% CI 0.99 to 15.10), p=0.03). CONCLUSION: The programme was well attended but showed no change in physical activity levels. Results show high baseline MVPA levels and suggest that Physical Activity after Cardiac EventS education may benefit cardiac patients not currently meeting activity guidelines. TRIAL REGISTRATION NUMBER: ISRCTN91163727.


Assuntos
Doença das Coronárias/fisiopatologia , Exercício Físico/fisiologia , Educação de Pacientes como Assunto , Envio de Mensagens de Texto , Idoso , Doença das Coronárias/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos
14.
Kidney Int Rep ; 6(6): 1548-1557, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34169195

RESUMO

INTRODUCTION: No formal cost-effectiveness analysis has been performed for programs of cycling exercise during dialysis (intradialytic cycling [IDC]). The objective of this analysis is to determine the effect of a 6-month program of IDC on health care costs. METHODS: This is a retrospective formal cost-effectiveness analysis of adult participants with end-stage kidney disease undertaking in-center maintenance hemodialysis enrolled in the CYCLE-HD trial. Data on hospital utilization, primary care consultations, and prescribed medications were extracted from medical records for the 6 months before, during, and after a 6-month program of thrice-weekly IDC. The cost-effectiveness analysis was conducted from a health care service perspective and included the cost of implementing the IDC intervention. The base-case analyses included a 6-month "within trial" analysis and a 12-month "within and posttrial" analysis considering health care utilization and quality of life (QoL) outcomes. RESULTS: Data from the base-case within trial analysis, based on 109 participants (n = 56 control subjects and n = 53 IDC subjects) showed a reduction in health care utilization costs between groups, favoring the IDC group, and a 73% chance of IDC being cost-effective compared with control subjects at a willingness to pay of £20,000 and £30,000 per quality-adjusted life year (QALY) gained. When QoL data points were extrapolated forward to 12 months, the probability of IDC being cost-effective was 93% and 94% at £20,000 and £30,000 per QALY gained. Sensitivity analysis broadly confirms these findings. CONCLUSION: A 6-month program of IDC is cost-effective and the implementation of these programs nationally should be a priority.

15.
BMJ Open ; 10(11): e041227, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33148767

RESUMO

OBJECTIVES: Frailty is highly prevalent in haemodialysis (HD) patients, leading to poor outcomes. This study aimed to determine whether a randomised controlled trial (RCT) of intradialytic exercise is feasible for frail HD patients, and explore how the intervention may be tailored to their needs. DESIGN: Mixed-methods feasibility. SETTING AND PARTICIPANTS: Prevalent adult HD patients of the CYCLE-HD trial with a Clinical Frailty Scale Score of 4-7 (vulnerable to severely frail) were eligible for the feasibility study. INTERVENTIONS: Participants in the exercise group undertook 6 months of three times per week, progressive, moderate intensity intradialytic cycling (IDC). OUTCOMES: Primary outcomes were related to feasibility. Secondary outcomes were falls incidence measured from baseline to 1 year following intervention completion, and exercise capacity, physical function, physical activity and patient-reported outcomes measured at baseline and 6 months. Acceptability of trial procedures and the intervention were explored via diaries and interviews with n=25 frail HD patients who both participated in (n=13, 52%), and declined (n=12, 48%), the trial. RESULTS: 124 (30%) patients were eligible, and of these 64 (52%) consented with 51 (80%) subsequently completing a baseline assessment. n=24 (71% male; 59±13 years) dialysed during shifts randomly assigned to exercise and n=27 (81% male; 65±11 years) shifts assigned to usual care. n=6 (12%) were lost to follow-up. The exercise group completed 74% of sessions. 27%-89% of secondary outcome data were missing. Frail HD patients outlined several ways to enhance trial procedures. Maintaining ability to undertake activities of daily living and social participation were outcomes of primary importance. Participants desired a varied exercise programme. CONCLUSIONS: A definitive RCT is feasible, however a comprehensive exercise programme may be more efficacious than IDC in this population. TRIAL REGISTRATION NUMBERS: ISRCTN11299707; ISRCTN12840463.


Assuntos
Fragilidade , Acidentes por Quedas , Adulto , Exercício Físico , Terapia por Exercício , Estudos de Viabilidade , Feminino , Humanos , Masculino , Qualidade de Vida , Diálise Renal
16.
Med Sci Sports Exerc ; 51(9): 1935-1943, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30889043

RESUMO

PURPOSE: Microparticles (MP) are shed extracellular vesicles that express the prothrombotic tissue factor (TF). Aerobic exercise may reduce MP count and TF expression. This study investigated the impact of acute running or rest followed by standardized meal consumption on MP phenotypes and TF expression. METHODS: Fifteen males (age, 22.9 ± 3.3 yr; body mass, 81.9 ± 11.4 kg; V˙O2max, 54.9 ± 6.5 mL·kg·min; mean ± SD) completed 1 h of running (70% V˙O2max) or rest at 9:00 AM and consumed a standardized meal (1170 kcal, 43% CHO, 17% PRO, 40% fat) at 10:45 AM. Venous blood samples were taken at 9:00 AM, 10:00 AM, and 11:30 AM. The MP concentration, diameter, phenotypes, and TF expression were assessed using nanoparticle tracking analysis and flow cytometry. RESULTS: Nanoparticle tracking analysis identified no changes in MP concentration or diameter in response to time or trial. Flow cytometry revealed total MP count increased from 9:00 AM to 10:00 AM (1.62 ± 2.28 to 1.74 ± 2.61 × 10 L, P = 0.016, effect size (η) = 0.105), but was unaffected by trial. TF platelet-derived MP % reduced from 9:00 AM to 10:00 AM (44.0% ± 21.2% to 21.5% ± 9.3%, P = 0.001, η = 0.582) after exercise only (control, 36.8% ± 18.2% to 34.9% ± 11.9%; P = 0.972). TF neutrophil-derived MP percentage reduced from 9:00 AM to 11:30 AM (42.3% ± 17.2% to 25.1% ± 14.9%; P = 0.048, η = 0.801) in the exercise trial only (control, 28.5% ± 15.7% to 32.2% ± 9.6%; P = 0.508). CONCLUSIONS: Running induced a significant reduction in %TF platelet and neutrophil MP, suggesting a transient reduction in cardiovascular risk via reduced TF-stimulated thrombosis. This requires further investigation over longer periods in cardiovascular disease populations.


Assuntos
Micropartículas Derivadas de Células/metabolismo , Exercício Físico/fisiologia , Refeições , Tromboplastina/metabolismo , Adulto , Doenças Cardiovasculares/prevenção & controle , Estudos Cross-Over , Citometria de Fluxo , Humanos , Masculino , Fatores de Risco , Adulto Jovem
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