Executive dysfunction and effectiveness of physical program in older adults: which association?

BACKGROUND: Little is known about the association between executive function and the magnitude of improvement from personalised exercise interventions on gait performance among older-old adults. AIM: We examined whether the effectiveness of personalised intervention on gait performance is dependent on the patient's baseline dysexecutive syndrome, as assessed by the Frontal Assessment Battery. METHODS: A total of 175 older community-dwellers (83.57 ± 5.2 years; 70.2% female) were recruited from the day centre for after-care and rehabilitation in the Nantes Ambulatory Centre of the Clinical Gerontology (France), and were followed during a pre-post-intervention, single-arm retrospective design. The intervention consisted of an individual personalised rehabilitation program over a period of 7 weeks, with twice-weekly sessions (45 min each). Gait speed in four conditions (preferred, fast, and under two dual-task conditions), Timed Up and Go test, and handgrip strength test were assessed. RESULTS: Using a pre-post analysis of covariance, a significant increase in dual-task gait speed while counting (+ 0.10 m/s; + 15%) and in dual-fluency gait speed (+ 0.06 m/s; + 10%), and in Timed Up and Go performance (- 2.9 s; + 17.8%) was observed after the rehabilitation program, regardless the baseline executive status. DISCUSSION: An individual personalized intervention is effective to improve mobility performance and the dual-task gait speed in older-old adults. The magnitude of those effects is independent of the patient's baseline characteristics including the executive function status. CONCLUSIONS: Even the most deficient baseline characteristics of patients should not be viewed as clinical barrier for implementing a beneficial individual intervention in high-risk older adults.

A Call to Immediate Action to Support Management of Long COVID Related-Symptoms.

No Abstract Available.

Dynamics of Depressive and Psychomotor Symptoms During Electroconvulsive Therapy in Older Depressive Patients: A Case Series.

OBJECTIVE: Electroconvulsive therapy (ECT) is an effective treatment for patients experiencing a major depressive episode, especially older ones. Identification of specific responses within early ECT sessions remains an issue of debate, however. Hence, this pilot study prospectively examined the outcome in terms of depressive signs, symptom by symptom, throughout a course of ECT, concentrating particularly on psychomotor retardation symptoms. METHODS: Nine patients were clinically evaluated several times during the ECT course, before the first session and then weekly (over 3-6 weeks, according to their evolution), by completing the Montgomery-Åsberg Depression Rating Scale (MADRS), the Mini-Mental State Examination test, and the French Retardation Rating Scale for Depression for assessing the severity of psychomotor retardation. RESULTS: Nonparametric Friedman tests showed significant positive changes in mood disorders during ECT in older depressive patients (mean, -27.3% of initial MADRS total score). Fast improvement in French Retardation Rating Scale for Depression score was observed at t1 (ie, after 3-4 ECT sessions), whereas a slightly delayed improvement in the MADRS scores was found at t2 (ie, after 5-6 ECT sessions). Moreover, the scores for items linked to the motor component of psychomotor retardation (eg, gait, postural control, fatigability) were the first to significantly decrease during the first 2 weeks of the ECT course compared with the cognitive component. CONCLUSIONS: Interestingly, participants' concentration on daily functional activities, their interest and fatigability, and their reported state of sadness were the first to progress, representing possible precursor signs of positive patient outcomes after ECT.

Change in physical fitness due to the COVID-19 pandemic lockdown in French adolescents: a comparison between two independent large samples from Diagnoform battery.

Numerous studies reported a significant decline in physical activity level in adolescents as a result of the COVID-19 lockdown. Physical fitness is recognized as a powerful marker of health in youth. The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on health-related physical fitness in French adolescents. Two cross-sectional studies were performed comparing two different groups of French adolescents, before (sample 1) and after the first lockdown (sample 2). A total of 1231 adolescents (aged to 16.5 ± 1.5 years) participated in the two cross-sectional studies. Complete data for physical fitness and anthropometrics data were obtained. Adolescents from sample 2 showed lower physical fitness levels compared to adolescents from sample 1. Regarding physical fitness for boys and girls, physical fitness levels were significantly lower in both sex between adolescents from the sample 1 and adolescents from the sample 2, except for cardiorespiratory fitness and flexibility for boys and girls, respectively. The physical fitness global score was also significantly lower between adolescents from the sample 1 and 2 for boys (-9.8%, p < 0.01) and girls (-16.2%; p < 0.01), respectively. Overall, the higher difference was found for performance in the speed body displacement test (-30%). A difference of 12.8% and 25% was observed for boys and girls, respectively.   Conclusion: COVID-19 pandemic lockdown had a negative impact on physical fitness in French youth. This study highlights the need to develop, in a near future, prevention programmes in order to improve the physical fitness in youth. What is Known: • COVID-19 pandemic deeply impacted lifestyle habits. A worrying decrease of physical activity, associated to a dramatic increase of time spent in sedentary behaviors was found in many coutries. What is New: • Our study bring first data on the health-related physical fitness consequences due to lockdown in French adolescents. Our study demonstrate the negative impact of COVID-19 pandemic lockdown on health-related physical fitness in French adolescents.

Impact of an individual personalised rehabilitation program on mobility performance in older-old people.

BACKGROUND: Studies have shown benefits of exercise interventions on preferred and fast gait speed in healthy older adults, but the impact of a personalised rehabilitation program targeting a large cohort of non-disabled older-old adults has rarely been examined. AIMS: The purpose was to determine whether personalised intervention-related improvements in gait and mobility performance in older-old adults were dependent on cognitive status and/or history of falls. METHODS: Based on a pre-post design, 483 older-old persons (mean age: 83.3 ± 5.1 years) were followed during a personalised rehabilitation program over a period of 7 weeks, with twice-weekly sessions (45 min each). Gait speed in four conditions (preferred, fast, and under two dual-task conditions), static postural sway, Timed Up and Go test, Five Times Sit to Stand test, the ability to rise from the floor, and handgrip strength test were assessed. RESULTS: Using a pre-post analysis of covariance, a significant increase in preferred gait speed (+ 20.1%), fast gait speed (+ 15.8%), and dual-task speed while counting (+ 13.4%) was observed after the rehabilitation, regardless of the baseline cognitive status and fall history. Similar improvements in TUG and maximal handgrip force were observed, with a significant reduction of performance time (-19.5%) or an increase of handgrip strength (+ 6.2%). DISCUSSION: Results suggest the effectiveness of personalised intervention to improve a battery of physical performance measures in older-old adults, even for the frailest participants. CONCLUSION: Implementing a personalised intervention for targeting the high-risk older-old adults in priority is critical regarding the clinically meaningful change in gait speed.

Does the transcranial direct current stimulation improve dual-task postural control in young healthy adults?

Some studies have suggested that postural balance improved after a single session of transcranial direct current stimulation (tDCS), whereas others have found minimal, if any, effects on postural performance. To address the issue of replication in tDCS studies, we re-tested the anodal tDCS effects of left dorsolateral prefrontal cortex while performing a dual-task by increasing the attentional demands associated with more challenging proprioceptive conditions. Twenty-four young adults (mean age: 21.3 ± 1.2 years) were randomly divided into two groups (a "real tDCS" vs. a "sham tDCS" group) were asked to maintain a quiet stance on a force platform. Eight trials were conducted, with eyes open and eyes closed, standing on a firm and foam surface and performing a simple and dual-task (backward counting). The postural performance was assessed by various centre-of-pressure parameters before and immediately after a 20-min tDCS session. No main effect of group and no interaction considering this factor were observed, regardless of the centre-of-pressure variables (all p values > 0.1). No evidence of a more efficient postural control emerged after a tDCS session. Beyond promising research on tDCS to maximize cognitive and behavioural enhancement, the current results indicate that caution needs to be taken when drawing firm conclusions, at least in young healthy adults.

Trends in the prevalence of overweight, obesity and underweight in French children, aged 4-12 years, from 2013 to 2017.

OBJECTIVE: To assess the prevalence of underweight, overweight and obesity in French children from 2013 to 2017. DESIGN: Cross-sectional study performed in fourteen regions of France. Physical measures included weight, height and BMI. Underweight, overweight and obesity were defined according to age- and sex-specific BMI cut-off points from the International Obesity Task Force. SETTING: France. SUBJECTS: Children (10 159 boys, 9757 girls) from the voluntary, non-representative Diagnoform programme between 2013 and 2017, at the age of 4-12 years. RESULTS: The prevalence of overweight and obesity was higher in girls compared with boys (P < 0·001). Underweight was also more prevalent in girls (P < 0·05). Although there were no significant changes in the prevalence of obesity in boys or girls from 2013 to 2017, a significant decrease in overweight among boys and girls was found (P < 0·001) during the same time period. In contrast, the prevalence of underweight increased in girls and boys (from 10·0 to 20·0 %, P < 0·0001) between 2013 and 2017. CONCLUSIONS: Results of the current study show that the prevalence of obesity was stable, while the prevalence of overweight decreased significantly, despite high in French children. Findings suggest also that thinness is becoming an important phenomenon in children. Developing preventive and nutritional programmes in order to modify the lifestyle might help control underweight and obesity in children.

Normative health-related fitness values for French children: The Diagnoform Programme.

The primary objective of this study was to establish sex- and age-specific physical fitness percentiles for French children. The secondary aim was to assess sex, weight status, and age differences for physical fitness levels in French children. A sample of 31 484 children (16 023 boys, 15 461 girls) aged 6-11 years participated in the Diagnoform programme. Cardiorespiratory fitness, muscular endurance, speed, flexibility, and agility were assessed in this national programme. Percentile values were estimated as a function of age stratified by sex using a parametric method providing smooth centile curves and explicit formulae for the centile estimates. Values from the 10th to the 90th percentile are reported. The influence of body weight according to sex on the physical fitness level was also examined using an analysis of covariance adjusted for age. Physical fitness levels were slightly better in boys, except for agility and flexibility, in which girls performed better (Cohen's coefficient, 0.20-0.45; P < .001). All physical fitness tests were significantly associated with age (P < .0001). In general, overweight and obese children had a significantly poorer physical fitness level compared with their normal-weight counterparts (P < .05). No difference was found between thin and normal-weight boys and girls, except for agility (P < .05). Reference values provide normative data for French children, and these data should be useful for identifying special needs for appropriate intervention programmes.

Do individual differences in the distribution of activation between synergist muscles reflect individual strategies?

Individual differences in the distribution of activation between synergist muscles have been reported during a wide variety of tasks. Whether these differences represent actual individual strategies is unknown. The aims of this study were to: (i) test the between-day reliability of the distribution of activation between synergist muscles, (ii) to determine the robustness of these strategies between tasks, and to (iii) describe the inter-individual variability of activation strategies in a large sample size. Eighty-five volunteers performed a series of single-joint isometric tasks with their dominant leg [knee extension and plantarflexion at 25% of maximal voluntary contraction (MVC)] and locomotor tasks (pedalling and walking). Of these participants, 62 performed a second experimental session that included the isometric tasks. Myoelectrical activity of six lower limb muscles (the three superficial heads of the quadriceps and the three heads of the triceps surae) was measured using surface electromyography (EMG) and normalized to that measured during MVC. When considering isometric contractions, distribution of normalized EMG amplitude among synergist muscles, considered here as activation strategies, was highly variable between individuals (15.8% < CV < 42.7%) and robust across days (0.57 < ICC < 0.82). In addition, individual strategies observed during simple single-joint tasks were correlated with those observed during locomotor tasks [0.37 < r < 0.76 for quadriceps (n = 83); 0.30 < r < 0.66 for triceps surae (n = 82); all P < 0.001]. Our results provide evidence that people who bias their activation to a particular muscle do so during multiple tasks. Even though inter-individual variability of EMG signals has been well described, it is often considered noise which complicates the interpretation of data. This study provides evidence that variability results from actual differences in activation strategies.

Changes in elbow joint's musculo-articular mechanical properties do not alter reaching-related action-perception coupling.

PURPOSE: Perception of action capabilities can be altered by changes in sensorimotor processes, as showed in previous works in populations dealing with regular and pathological sensorimotor deficits. Misestimating changes in performance ability could lead to risky behavior, injury, and/or reduced performance. However, the relationship between sensorimotor processes, the action-perception coupling, and the related anatomical structures is still a matter of debate. We investigated whether changes in the muscle-tendon system's mechanical properties experimentally induced by eccentric contractions could alter the action-perception coupling (APC) in a reaching-to-grasp task, in which the participants estimated the maximal distance they predicted that they would able to reach a glass. METHODS: Based on their repartition, volunteers performed a conditioning session the first day: a series of isokinetic elbow extension in passive condition (control group, n = 11) or when performing elbow flexors eccentric contractions (eccentric group, n = 11). Performance estimates and actual performances in a reaching-to-grasp task were completed before, and immediately, 24 hours and 48 hours after the conditioning session. Alterations of musculo-articular mechanical properties were assessed through global joint stiffness (joint passive torque through load/unload cycles) and local stiffness (muscle elastography). RESULTS: The results showed that the APC related to reaching-to-grasp performance was not impacted by post-exercise changes in mechanical properties of the musculo-articular system. CONCLUSION: These findings emphasize the central dimension of sensorimotor processing instead of peripheral structures to investigate the APC for an altered sensorimotor environment.

Cognitive component of psychomotor retardation in unipolar and bipolar depression: Is verbal fluency a relevant marker? Impact of repetitive transcranial stimulation.

AIMS: In the literature, psychomotor retardation (PMR) is increasingly highlighted as a relevant marker for depression. Currently, we chose to focus on the fluency capacities as an evaluation of the frontal lobes functioning to reach a better understanding of cognitive and neurobiological mechanisms involved in PMR in depression. The aims of this study were: (i) to explore the cognitive component of PMR through the analysis of verbal fluency (VF) performance in unipolar and bipolar depression; and (ii) to examine whether a repetitive transcranial magnetic stimulation treatment could improve concomitantly the PMR and VF capacities, as a relevant marker characteristic of the cognitive component of PMR. METHODS: Fifteen unipolar and 15 bipolar patients were compared to 15 healthy adults. Before treatment, the results showed VF deficits, particularly marked in the bipolar group. The investigation of the interplay between PMR, VF performance, Montgomery-Åsberg Depression Rating Scale scores, and Montreal Cognitive Assessment scores showed that the deficits in these various dimensions were not homogeneous. RESULTS: The absence of correlation between the psychomotor retardation scale (the French Retardation Rating Scale for Depression) and VF, and the correlation with MoCA raise the hypothesis of a more global cognitive impairment associated with PMR in the BD group. The repetitive transcranial magnetic stimulation treatment had a positive impact on depression, PMR, and fluency scores. CONCLUSION: Correlations between the Retardation Rating Scale for Depression and VF performances appeared after treatment, showing the cognitive role of psychomotor functioning in depression. Further analyses, including other cognitive measures in an objective evaluation of PMR, are required for a better understanding of these complex relationships.

Effect of Repetitive Transcranial Magnetic Stimulation on Psychomotor Retardation in Major Depression: A Pilot Feasibility Study.

This pilot study investigated the feasibility of a comprehensive battery of tests assessing psychomotor retardation after a 3-week protocol of repetitive transcranial magnetic stimulation for depression. In addition to the beneficial effect of this treatment on depression, the results showed positive changes in psychomotor retardation.

Combining intra-dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: Towards better quality of life and autonomy.

Protein-energy wasting (PEW), defined as a loss of body protein mass and fuel reserves, is a powerful predictor of adverse outcomes in haemodialysis (HD) patients. Robust arguments suggest that intra-dialytic exercise, combined with oral/parenteral nutrition, enhances the effect of nutritional interventions in HD patients. This pilot randomized controlled trial investigated the feasibility and the effects of a 6 month intra-dialytic cycling program combined to a nutritional support on PEW, physical functioning (gait, balance, muscle strength) and quality of life (QoL) in older HD patients (mean age 69.7 ± 14.2 years).Twenty-one patients fulfilling diagnostic criteria of PEW were randomly assigned to Nutrition-Exercise group (GN-Ex , n = 10) or Nutrition group (GN , n = 11). Both groups received nutritional supplements in order to reach recommended protein and energy intake goals. In addition GN-Ex completed a cycling program. No significant difference between groups was found in the number of patients having reached remission of PEW. Likewise, no change was observed in serum-albumin, -prealbumin, C-reactive protein, body mass index, lean- and fat-tissue index, or quadriceps force. Interestingly, we found positive effects of exercise on physical function and QoL for the GN-Ex , as evidenced by a significant improvement in the 6-min walk test (+22%), the absence of decline in balance (unlike the GN ), and a noteworthy increase in QoL (+53%). Combining intra-dialytic exercise and nutrition in HD patients is feasible, and well accepted, improves physical function and QoL but it appears not to have the potential to reverse PEW.

An enhanced experimental procedure to rationalize on the impairment of perception of action capabilities.

It is well documented that changes in the physiological states of the perceiver-actor influence the perception of action capabilities. However, because experimental procedures of most studies involved a limitless availability for stimuli visual encoding and perceptual strategies, it remains difficult to adopt a single position among the large range of alternative interpretations for impaired perception. A reaching-to-grasp paradigm under breathing restriction was adapted from Graydon et al. (Cogn Emot 26:1301-1305, 2012) to standardize the time for encoding of stimuli information and narrowed the involvement of perceptual strategies. In the present study, we propose a highly controlled environment where the discrete information is presented during 300 ms, congruently with neurophysiological studies focused on visuomotor transformation. An underestimation of the perception of action capabilities is found under breath restriction, suggesting that 300 ms for stimuli encoding is sufficient to induce altered visuomotor brain transformations when limiting the involvement of perceptual strategies. This result suggests that such behavior could refer to an impaired brain potentiation of the perceptual occurrence, providing strong hypotheses on the brain dynamics of sensorimotor integration that underlie impaired perception of action capabilities in stressful situations.

Effects of total sleep deprivation on the perception of action capabilities.

Changes in a subject's state have been shown to modulate the perceptual update of his or her action capabilities. In parallel, sleep deprivation impairs in cognitive functions. It involves common neural structures that support the perception of successfully achieving a motor task. Thus, the study investigated the effect of 24 h of sleep deprivation on the perception of action capabilities. Twenty-four healthy participants were randomly separated into two groups (control group vs. 24 h sleep deprivation group). Participants in the control group slept at home according to their habitual sleep-wake schedule. The 24-h sleep deprivation group stayed awake in the laboratory. Participants estimated the limit of their maximal height of stepping-over a bar before and after the sleep intervention. These estimations were compared to each participant's actual maximal stepping-over height. Physical performance (measured by maximal voluntary quadriceps contraction and repetitive vertical jumping tests) and perceptual inhibition tests (measured by choice reaction time tasks) were also performed for three sessions at three time points t 0, t +12h, and t +24h with t 0 = 8:00 a.m. for all participants. Participants in the 24-h sleep deprivation group showed impairments in perceived over-stepping performance and impaired cognitive functioning (higher reaction time), while no changes were observed in actual performance in the over-stepping, voluntary quadriceps contraction, or jumping tasks. The cognitive processing of inputs that specify the estimated consequences of motor action is discussed as the main explanation for the inability to successfully update the perception of action capabilities after sleep deprivation.

Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review.

BACKGROUND: Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it. MATERIALS AND METHODS: We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified. RESULTS: Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher. DISCUSSION: We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.

The International Fitness Scale (IFIS): A valid tool to assess physical fitness in French children.

BACKGROUND: The need for monitoring regularly physical fitness in youth is well established for public health issues. The aim of this study was to assess the validity and reliability of the International Fitness Scale questionnaire (IFIS) to assess physical fitness in French children in the school context. METHODS: A sample of 2 060 children (1054 boys), aged 10.6 ± 0.9 years, participated in the validation study while an independent sample of 366 children (175 boys), aged 9 to 11 years, participated in the assessment of reliability. Physical fitness was measured by a self-report of 5 questions with a 5-point Likert-scale (from very poor to very good) (IFIS), and also measured objectively by 4 field tests: cardiorespiratory fitness, muscular strength, speed/agility and flexibility. For the test-retest reliability assessment, children were instructed to complete the questionnaire twice, 1 week apart. RESULTS: For all physical fitness components studied, children reporting a good or a very good physical fitness in the IFIS had better results in objective measurements of physical fitness tests compared to children reporting a very poor to an average physical fitness (p<0.001) without or with adjustments for sex, age and weight status. The reliability coefficients were acceptable for all components of physical fitness (0.59-0.72). CONCLUSIONS: These results suggest that IFIS appears to be a useful instrument for teachers to estimate physical fitness levels of French children, possibly on a large scale.

Consistency of muscle activation signatures across different walking speeds.

BACKGROUND: Using a machine learning algorithm, individuals can be accurately identified from their muscle activation patterns during gait, leading to the concept of individual muscle activation signatures. RESEARCH QUESTION: Are muscle activation signatures robust across different walking speeds? METHODS: We used an open dataset containing electromyographic (EMG) signals from 8 lower limb muscles in 50 asymptomatic adults walking at 5 speeds (extremely slow, very slow, slow, spontaneous, and fast). A machine learning approach classified the EMG profiles based on similar (intra-speed classification) or different (inter-speed classification) walking speeds as training and testing conditions. RESULTS: Intra-speed median classification rates of muscle activation profiles increased with walking speed, from 92 % for extremely slow, to 100 % for self-selected fast walking conditions. Inter-speed median classification rates increased when the speed of the training condition was closer to that of the testing condition. Higher median classification rates were found across slow, spontaneous, and fast walking speed conditions, from 56 % to 96 %, compared with classification rates involving extremely and very slow walking speed conditions, from 6 % to 62 %. SIGNIFICANCE: Our findings reveal that i) muscle activation signatures are detectable for a large range of walking speeds, even those involving different gait strategies (intra-speed median classification rates from 92 % to 100 %), and ii) muscle activation signatures observed during very low walking speeds are not consistent with those observed at higher speeds, suggesting a difference in motor control strategy. Caution should therefore be exercised when assessing gait deviations of a slow walking patient against a normative database obtained at higher speed. Identifying the robustness of individual muscle activation signatures across different movements could help in detecting changes in motor control, otherwise difficult to detect on classical time-varying EMG patterns.

Effects of a six-month intradialytic physical ACTIvity program and adequate NUTritional support on protein-energy wasting, physical functioning and quality of life in chronic hemodialysis patients: ACTINUT study protocol for a randomised controlled trial.

BACKGROUND: Protein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of PEW in hemodialysis patients, actual management by nutritional interventions is not always able to correct PEW. Some investigators suggest that physical exercise may increase the anabolic effects of nutritional interventions, and therefore may have a potential to reverse PEW. The aim of this study is to investigate the effect of intra-dialytic progressive exercise training and adequate nutritional supplementation on markers of PEW, functional capacities and quality of life of adult hemodialysis patients. METHODS AND DESIGN: Fifty end-stage renal disease patients undergoing hemodialysis, who meet the diagnostic criteria for PEW, will be randomly allocated into an exercise or control group for 6 months. The exercise consists of a progressive submaximal individualized cycling exertion using an adapted cycle ergometer, during the three weekly dialysis sessions. Biological markers of nutrition (albumin, prealbumin) will be followed monthly and all patients will be assessed for body composition, walk function, muscle strength, postural stability and quality of life at baseline and during the eighth week (t+2), the sixteenth week (t+4) and the twenty-fourth week (t+6) of the 6-month adapted rehabilitation program. DISCUSSION: The successful completion of this current trial may give precious clues in understanding PEW and encourage nephrologists to extend prescription of exercise programs as well as therapeutic and as preventive interventions in this high-risk population. TRIAL REGISTRATION: The protocol for this study was registered with the France Clinical Trials Registry NCT01813851.