Results from the randomized controlled IHOPE trial suggest no effects of oral protein supplementation and exercise training on physical function in hemodialysis patients.

Few long-term studies have assessed whether changes in both diet and exercise can improve the health and quality of life (QOL) of hemodialysis (HD) patients. Here we examined whether 12 months of intradialytic protein supplementation and endurance exercise improves physical function, risk of cardiovascular disease (CVD), and QOL in HD patients in a randomized controlled trial (RCT). A total of 138 HD patients (average age 58 years) were assigned for 12 months to control, intradialytic protein, or protein plus exercise groups. The protein and protein plus exercise groups consumed an oral protein supplement (30 grams of whey) three days/week during dialysis. The protein plus exercise group cycled for 30-45 minutes during dialysis treatment. The primary outcome was change in physical function at 12 months, assessed by a shuttle walk test. Secondary outcomes included arterial stiffness, blood pressure, body composition, muscle strength, markers of nutritional status, and QOL. Assessments were conducted at baseline, 6 and 12 months. In total, 101 patients completed the intervention. There were no significant differences between groups in shuttle walk test performance from baseline to 12 months. There were trends for improvements in some secondary measures of physical function and strength in the protein and protein plus exercise groups at six or 12 months, but these did not reach statistical significance. Thus, our trial did not demonstrate significant improvements in markers of physical function, risk of CVD or QOL after one year of intradialytic oral OPS and aerobic exercise training. More comprehensive lifestyle management may be needed to uncover robust improvements in the health and QOL of HD patients.

Walking and talking in maintenance hemodialysis patients.

OBJECTIVES: To investigate whether there is a reduction in walking with the simultaneous performance of a cognitive task (ie, dual-task cost [DTC]) in persons undergoing hemodialysis (HD), and whether it is greater in persons undergoing HD compared with age-matched controls. DESIGN: Cohort. SETTING: University research laboratory. PARTICIPANTS: Persons undergoing HD (n=14; 5 women, 9 men; mean age ± SD, 50.0±11.8y) and age-matched controls (n=14; 4 women, 10 men; mean age ± SD, 48.5±10.1y) participated in the investigation. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Participants walked at a self-selected pace on an electronic pathway, which recorded spatiotemporal parameters of gait, in 4 separate trials and completed a cognitive task in the last 2 trials. The DTC was quantified as the change in spatiotemporal parameters of gait from baseline to the cognitive trials. RESULTS: The HD group had a greater decrease in walking function during the cognitive task, with DTC ranging from 6% to 14%. On average, walking velocity decreased to less than 1m/s in HD patients during the cognitive condition. Baseline walking velocity was found to be moderately correlated with the magnitude of DTC of cadence and step time (ρ=-.44 and .46; P values <.05). CONCLUSIONS: Persons undergoing HD have greater interference between walking and talking compared with controls. Difficulty walking while thinking has implications for everyday life and may be related to the risk of falls. Further work is necessary to determine other contributing factors to elevated DTC in HD patients, and whether DTC can be reduced with targeted interventions.

Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry.

This study attempted to explore the barriers to physical activity of older patients with Hypertension. It aimed to provide robust evidence produced through their eyes. First, through the data analysis of the accelerometer and the decision of the research team, 10 out of the 30 applicants were invited to participate in a photovoice study. Photovoice is one example of participatory action research. Photovoice participants can communicate their unique experiences through photographs, providing a highly realistic and authentic perspective that is not possible to be understood with traditional qualitative research. This study inductively identified four main themes; health illiteracy, distortion of health information, fear of physical activity, and rejection of any life changes. Based on a specific understanding of the population's perception of physical activity, this study attempted to provide evidence of why many elderly Korean patients with Hypertension stay inactive.

Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry.

PURPOSE: This study attempted to understand the life, pain, and barriers to physical activity in the daily life of patients with panic disorder (PD). It aimed to provide specific evidence to promote physical activity for patients, suggesting that suitable physical activity strategies for patients with PD would be of value. METHODS: Seven patients were invited to participate in a photovoice study. Photovoice is one example of participatory action research. RESULTS: This study inductively identified two main themes: the life and pain of patients with PD and perceived barriers to participate in physical activity by patients with panic disorder. CONCLUSION: Based on a specific understanding of the population, this study attempted to provide evidence why patients with panic disorder need appropriate physical-activity-promoting strategies.

The Associations between Physical Fitness, Complex vs Simple Movement, and Academic Achievement in a Cohort of Fourth Graders.

This study analyzed the correlation between elementary school students' body composition, physical activity, physical fitness, movement ability, and academic achievement. Movements ranged from simple actions to complex movements requiring executive functioning. In total, 110 fourth graders (60 boys, 50 girls) participated in this experiment. Body composition (BMI, % of body fat), physical activity (pedometer), physical fitness (muscular strength, endurance, power, flexibility, and VO2max), and complex movement abilities (Illinois Agility test, soda pop hand test, and soda pop foot test) were measured. Regression modeling of body composition and fitness/activity variables was able to account for 30.5% of the variation of total academic scores in females, but only 4.3% in males. No individual tests were reliably correlated with multiple academic outcomes in males. However, hand and foot soda pop times, as well as Illinois Agility scores, were repeatedly correlated with academic outcomes in females, each correlating with 4 of the 6 academic scores. Body composition and physical activity level did not correlate with academic achievement, and simple physical fitness showed a low correlation with academic achievement in both boys and girls. On the other hand, complex, cognitively demanding movements such as the Illinois Agility, soda pop hand, and soda pop foot tests had consistent correlations with academic achievement in girls, but not in boys.

Macrophages from alpha 7 nicotinic acetylcholine receptor knockout mice demonstrate increased cholesterol accumulation and decreased cellular paraoxonase expression: a possible link between the nervous system and atherosclerosis development.

OBJECTIVE: The parasympathetic nervous system regulates inflammation in peripheral tissues through a pathway termed the "cholinergic anti-inflammatory reflex" (CAIR). Mice deficient in the alpha 7 nicotinic acetylcholine receptor (alpha7(-/-)) have an impaired CAIR due to decreased signaling through this pathway. The purpose of this study was to determine if the increased inflammation in alpha7(-/-) mice is associated with enhanced serum and macrophage atherogenicity. METHODS: We measured serum markers of inflammation and oxidative stress, and macrophage atherogenicity in mouse peritoneal macrophages harvested from alpha7(-/-) mice on the background of C57BL/6 mice, as well as on the background of the atherosclerotic Apolipoprotein E-deficient (ApoE(-/-)) mice. RESULTS: alpha7-Deficiency had no significant effects on serum cholesterol, or on markers of serum oxidative stress (TBARS and paraoxonase1 activities). However, alpha7-deficiency significantly increased serum CRP and IL-6 (p<0.05) levels in atherosclerotic mice, confirming an anti-inflammatory role for the alpha7 receptor. Macrophage cholesterol mass was increased by 25% in both normal and atherosclerotic mice in the absence of the alpha7 receptor (p<0.05). This was accompanied by conditional increases in oxidized LDL uptake and in macrophage total peroxide levels. Furthermore, alpha7-deficiency reduced macrophage paraoxonase2 mRNA and activity by 50-100% in normal and atherosclerotic mice (p<0.05 for each), indicating a reduction in macrophage anti-oxidant capacity in the alpha7(-/-) mice. CONCLUSION: The above results suggest an anti-atherogenic role for the macrophage alpha7nAchr, through a mechanism that involves attenuated macrophage oxidative stress and decreased uptake of oxidized LDL.

Effects of Pomegranate Extract Supplementation on Cardiovascular Risk Factors and Physical Function in Hemodialysis Patients.

The purpose of this study was to evaluate the effects of oral supplementation with pomegranate extract on cardiovascular risk, physical function, oxidative stress, and inflammation in hemodialysis (HD) patients. Thirty-three HD subjects were randomized to the pomegranate (POM) or placebo (CON) group. Patients in POM ingested a 1000 mg capsule of a purified pomegranate polyphenol extract 7 days/week for 6 months. Individuals in CON ingested a noncaloric placebo capsule using the same protocol. Measurements were conducted at baseline and repeated 6 months following the start of the intervention. Brachial blood pressure (BP) was obtained using an automatic digital BP monitor. Cardiovascular risk was assessed using ultrasound and arterial tonometry. Blood samples were collected for the measurements of circulating markers of inflammation, oxidative stress, and antioxidant capacity. Muscle strength and physical function were assessed by isokinetic dynamometry, a validated shuttle walk test, and a battery of tests to assess functional fitness. Systolic blood pressure and diastolic blood pressure were reduced by 24 ± 13.7 and 10 ± 5.3 mmHg, respectively, in POM (P < .05). However, the BP differences in POM were no longer significant after controlling for baseline BP. The paraoxonase-1 activity increased by 26.6% (P < .05) in POM, compared to no significant change in CON. However, pomegranate supplementation had no effect on other markers of cardiovascular disease risk, inflammation and oxidative stress, or measures of physical function and muscle strength. While pomegranate extract supplementation may reduce BP and increase the antioxidant activity in HD patients, it does not improve other markers of cardiovascular risk, physical function, or muscle strength.

Postural control in hemodialysis patients.

The current investigation examined whether patients undergoing hemodialysis (HD) have reduced standing postural control performance during simultaneous cognitive task performance (i.e. dual task cost (DTC)) compared to age-gender matched controls. 19 persons undergoing HD and 19 age, gender, and body mass index (BMI) matched controls participated in the investigation. All participants performed 2 trials of quiet standing balance and 2 postural trials in which they performed a cognitive task. Postural control was indexed with various measures of the center of pressure (COP) trajectory. The change in postural control with a cognitive task (e.g. dual task cost DTC) was quantified as a change in the center of COP parameters of postural control from quiet standing to the cognitive condition. The primary observations were that (1) HD patients had significantly greater postural sway than age, gender, BMI matched controls (p's < 0.05); (2) HD patients had a greater DTC than the controls during quiet standing (p's < 0.05). The observations highlight that HD participants have poor postural control that is further exacerbated by a simultaneous performance of a cognitive task. It is possible that this impaired postural control places HD participants at elevated fall risk. Further study is necessary to determine contributing factors to an increased DTC in this population and whether targeted interventions such as exercise can reduce DTC.

Effect of muscle strength on gait in hemodialysis patients with and without diabetes.

There is minimal data on the gait of hemodialysis (HD) patients with and without diabetes. This investigation examined spatiotemporal parameters of gait in HD patients with and without diabetes compared with age-matched, sex-matched, and BMI-matched controls. The effect of muscle weakness on gait in HD patients was also examined. Eighteen HD patients and 18 age-matched, sex-matched, and BMI-matched controls completed two walking trials along a 7.9 m long pressure sensitive pathway. The HD participants were divided into groups based on their diabetic status (eight patients without diabetes and 10 with diabetes). Spatiotemporal markers of gait, including variability metrics, were determined. Knee strength was quantified only in the HD groups. Overall HD patients had a worse gait compared with controls (P<0.01). Furthermore, HD patients with diabetes had an elevated gait variability compared with those without diabetes, even after controlling for muscle strength (P<0.05). Further research is warranted to explore whether increases in lower extremity strength lead to improvements in gait in this population.

In situ and ex situ observations of the growth dynamics of single perylene nanocrystals in water.

The growth dynamics of fluorescent perylene nanocrystals, which are fabricated by the reprecipitation method, was investigated using in situ and ex situ single-particle fluorescence measurements. A red shift in the emission maxima as the aging time increased was observed by single-particle fluorescence spectral measurements. The number and size of the nanocrystals increased with the increasing aging time in water. It was concluded that the metastable intermediates, such as clusters and initial nanoparticles, are relevant for the early stages of nucleation and growth of the perylene nanocrystals.