Effects of Muscular Fatigue on Position Sense in Two Phases of the Menstrual Cycle.

It is generally accepted that local muscular fatigue can negatively affect position sense. Interestingly, it has been proposed that in women, position sense and neuromuscular coordination may be affected by fluctuations of estrogen and progesterone levels. The aim of this study was to examine the possible effect of localized muscle fatigue on knee joint position sense at two phases of the menses: follicular and luteal. Twenty physically active females aged 19-30 years, with normal menses, volunteered for this study. An isokinetic dynamometer was used to evaluate proprioception and perform the fatigue protocol of the knee extensors and flexors. Knee proprioception at rest and after fatigue at three knee target angles (30°, 45°, 60°) was measured. A three-way ANOVA analysis with repeated measures was performed. The results showed that the main effect of fatigue was significant, but no main effect of the menstrual cycle phase was found. Additionally, a main effect was found for the target angle (more flexed target knee joint angles were associated with larger angular error deviations). In conclusion, localized muscle fatigue can significantly reduce the accuracy of active knee joint repositioning in both the luteal and the follicular menstrual phases in young, physically active healthy women.

How to cultivate sustainable physical health and wellness in transplant recipients: the emerging and enduring role of exercise scientists.

PURPOSE OF REVIEW: The aim of the current review is to highlight the importance of exercise training as an important section of transplant recipient rehabilitation process and explain the role of the exercise scientist in the development, implementation, and assessment of the exercise regime. RECENT FINDINGS: Transplant patients face a unique set of challenges in their recovery and rehabilitation process, often requiring a multifaceted approach to address the physical, emotional, and psychological aspects of their condition. Exercise training has emerged as a crucial component in the care of these patients, providing a means to improve functional capacity, enhance quality of life, and mitigate the adverse effects of transplant-related complications. Exercise scientists who are trained to assess patient's physical limitations, develop and deliver personalized exercise programs, and monitor their progress are uniquely positioned to play a crucial role in the treatment of patients with chronic conditions that require exercise training as a mean of improving and maintaining health and quality of life. SUMMARY: Exercise scientists are the appropriate professionals for providing transplant recipients with the recommended exercise training for maintaining and improving their health status as part of the overall plan of long-term care and support.

Skeletal Muscle Texture Assessment Using Ultrasonography: Comparison with Magnetic Resonance Imaging in Chronic Kidney Disease.

Skeletal muscle dysfunction is common in chronic kidney disease (CKD). Of interest is the concept of "muscle quality," of which measures include ultrasound-derived echo intensity (EI). Alternative parameters of muscle texture, for example, gray level of co-occurrence matrix (GCLM), are available and may circumvent limitations in EI. The validity of EI is limited in humans, particularly in chronic diseases. This study aimed to investigate the associations between ultrasound-derived parameters of muscle texture with MRI. Images of the thigh were acquired using a 3 Tesla MRI scanner. Quantification of muscle (contractile), fat (non-contractile), and miscellaneous (connective tissue, fascia) components were estimated. Anatomical rectus femoris cross-sectional area was measured using B-mode 2D ultrasonography. To assess muscle texture, first (i.e., EI)- and second (i.e., GLCM)-order statistical analyses were performed. Fourteen participants with CKD were included (age: 58.0 ± 11.9 years, 50% male, eGFR: 27.0 ± 7.4 ml/min/1.73m2, 55% Stage 4). Higher EI was associated with lower muscle % (quadriceps: ß = -.568, p = .034; hamstrings: ß = -.644, p = .010). Higher EI was associated with a higher fat % in the hamstrings (ß = -.626, p = .017). A higher angular second moment from GLCM analysis was associated with greater muscle % (ß = .570, p = .033) and lower fat % (ß = -.534, p = .049). A higher inverse difference moment was associated with greater muscle % (ß = .610, p = .021 and lower fat % (ß = -.599, p = .024). This is the first study to investigate the associations between ultrasound-derived parameters of muscle texture with MRI. Our preliminary findings suggest ultrasound-derived texture analysis provides a novel indicator of reduced skeletal muscle % and thus increased intramuscular fat.

Emotional Intelligence in Hemodialysis Patients: The Impact of an Intradialytic Exercise Training Program.

The current study aimed to investigate whether there is a relationship between emotional intelligence (EI), functional capacity, fatigue, cognitive function, and quality of life (QoL) in HD patients and to assess the effect of a 9-month intradialytic exercise training program on EI levels. Seventy-eight dialysis patients (50 M/28 F, 60.6 ± 17.2 years) participated in the cross-sectional study. Afterward, a subgroup of 18 patients (15 M/3 F, 56.7 ± 12.3 years) completed a 9-month supervised intradialytic exercise training program (three times weekly). EI was assessed by the Schutte Self Report Emotional Intelligence Test (SSEIT) and the Wong and Law Emotional Intelligence Scale (WLEIS). Functional capacity was assessed by a battery of tests. Sleep quality, depression levels, and daily sleepiness were assessed via validated questionnaires. All assessments were carried out before and after the intervention. A significant positive correlation was found between the WLEIS scores and the physical component summary of the QoL questionnaire. In contrast, the WLEIS scores were negatively associated with general and physical fatigue. The SSEIT scores were positively associated with cognitive function. After nine months of exercise training, only the group with low WLEIS scores improved their EI score significantly compared to the baseline values (98.7 ± 7.0 vs. 73.0 ± 4.0, p = 0.020), while no changes were observed in the medium or high EI groups. In conclusion, patients with higher levels of EI showed increased quality of life and lower levels of fatigue. Patients with low levels of EI are more likely to benefit from an exercise training program compared to their medium- and high-level counterparts.

The Acute, Combined, and Separate Effects of Cold Hemodialysis and Intradialytic Exercise in Insulin Sensitivity and Glucose Disposal.

Hemodialysis (HD) patients suffer from multiple health problems, including severe insulin resistance. Both cold dialysis and intradialytic exercise training could elicit health benefits; however, it is still unknown whether the combination of those two approaches could enhance overall health. The current study aimed to evaluate the separate and combined acute effects of a single session of cold dialysis and intradialytic exercise in parameters related to insulin sensitivity and glucose disposal. Ten HD patients (57.2 ± 14.9 years) participated in the study. Each patient participated in four different scenarios during HD: a) typical dialysis with dialysate temperature at 37°C (TD), b) cold dialysis with dialysate temperature at 35°C, c) typical HD combined with a single exercise bout, d) cold dialysis combined with a single exercise bout. Glucose disposal and insulin resistance were assessed immediately after the end of the HD session. None of the examined parameters significantly differed between the four scenarios ( p > 0.05). However, slight numerical changes and moderate to high effect size ( d : 0.50-0.85) were observed between TD versus cold dialysis and TD versus TD + exercise in glucose and insulin disposal rates. A single session of cold and TD with intradialytic exercise may provide an "acute" time-efficient stimulus for consecutively improving glucose disposal and insulin sensitivity.

Myokines as mediators of exercise-induced cognitive changes in older adults: protocol for a comprehensive living systematic review and meta-analysis.

Background: The world's population is aging, but life expectancy has risen more than healthy life expectancy (HALE). With respect to brain and cognition, the prevalence of neurodegenerative disorders increases with age, affecting health and quality of life, and imposing significant healthcare costs. Although the effects of physical exercise on cognition in advanced age have been widely explored, in-depth fundamental knowledge of the underlying mechanisms of the exercise-induced cognitive improvements is lacking. Recent research suggests that myokines, factors released into the blood circulation by contracting skeletal muscle, may play a role in mediating the beneficial effect of exercise on cognition. Our goal in this ongoing (living) review is to continuously map the rapidly accumulating knowledge on pathways between acute or chronic exercise-induced myokines and cognitive domains enhanced by exercise. Method: Randomized controlled studies will be systematically collected at baseline and every 6 months for at least 5 years. Literature search will be performed online in PubMed, EMBASE, PsycINFO, Web of Science, SportDiscus, LILACS, IBECS, CINAHL, SCOPUS, ICTRP, and ClinicalTrials.gov. Risk of bias will be assessed using the Revised Cochrane Risk of Bias tool (ROB 2). A random effects meta-analysis with mediation analysis using meta-analytic structural equation modeling (MASEM) will be performed. The primary research question is to what extent exercise-induced myokines serve as mediators of cognitive function. Secondarily, the pooled effect size of specific exercise characteristics (e.g., mode of exercise) or specific older adults' populations (e.g., cognitively impaired) on the relationship between exercise, myokines, and cognition will be assessed. The review protocol was registered in PROSPERO (CRD42023416996). Discussion: Understanding the triad relationship between exercise, myokines and cognition will expand the knowledge on multiple integrated network systems communicating between skeletal muscles and other organs such as the brain, thus mediating the beneficial effects of exercise on health and performance. It may also have practical implications, e.g., if a certain myokine is found to be a mediator between exercise and cognition, the optimal exercise characteristics for inducing this myokine can be prescribed. The living review is expected to improve our state of knowledge and refine exercise regimes for enhancing cognitive functioning in diverse older adults' populations. Registration: Systematic review and meta-analysis protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on the 24th of April 2023 (registration number CRD42023416996).

Nine Months of Hybrid Intradialytic Exercise Training Improves Ejection Fraction and Cardiac Autonomic Nervous System Activity.

Cardiovascular disease is the most common cause of death in hemodialysis (HD) patients. Intradialytic aerobic exercise training has a beneficial effect on cardiovascular system function and reduces mortality in HD patients. However, the impact of other forms of exercise on the cardiovascular system, such as hybrid exercise, is not clear. Briefly, hybrid exercise combines aerobic and strength training in the same session. The present study examined whether hybrid intradialytic exercise has long-term benefits on left ventricular function and structure and the autonomous nervous system in HD patients. In this single-group design, efficacy-based intervention, twelve stable HD patients (10M/2F, 56 ± 19 years) participated in a nine-month-long hybrid intradialytic training program. Both echocardiographic assessments of left ventricular function and structure and heart rate variability (HRV) were assessed pre, during and after the end of the HD session at baseline and after the nine-month intervention. Ejection Fraction (EF), both assessed before and at the end of the HD session, appeared to be significantly improved after the intervention period compared to the baseline values (48.7 ± 11.1 vs. 58.8 ± 6.5, p = 0.046 and 50.0 ± 13.4 vs. 56.1 ± 3.4, p = 0.054 respectively). Regarding HRV assessment, hybrid exercise training increased LF and decreased HF (p < 0.05). Both conventional Doppler and tissue Doppler imaging indices of diastolic function did not change after the intervention period (p > 0.05). In conclusion, long-term intradialytic hybrid exercise training was an effective non-pharmacological approach to improving EF and the cardiac autonomous nervous system in HD patients. Such exercise training programs could be incorporated into HD units to improve the patients' cardiovascular health.

Effect of physical activity interventions on quality of life in older adults: A protocol for systematic review and meta-analysis.

INTRODUCTION: Quality of life (QoL) has been acknowledged as a fundamental concept in the field of health and is favorably improved by physical activity (PA). This systematic review aims to assess the benefits and harms of different types of PA to improve health-related QoL in both community-dwelling and diseased older adults to provide a recommendation for the minimum amount of PA needed to obtain measurable QoL benefits. METHODS AND ANALYSIS: We will search MEDLINE, Cochrane Central Register of Controlled Trials, CINHAL, Epistemonikos, Web of Science and gray literature. Randomized controlled trials enrolling healthy or diseased older adults aged > 65 years, providing any kind of physical activity intervention and having quality of life as an outcome will be included. There will be no language restriction. Two independent reviewers will screen the papers, and a third reviewer will resolve the conflicts. The quality of the included studies will be assessed through the Risk of Bias 2.0 tool. Finally, data will be extracted to create proper meta-analyses of comparisons between the different kinds of physical activity interventions or to control groups. ETHICS AND DISSEMINATION: This review does not require approval from the Ethics Committee. The results will be disseminated in peer-reviewed journals and at international conferences; moreover, the findings will be shared on social media using an accessible language.

The effect of a 9-month hybrid intradialytic exercise training program on nerve conduction velocity parameters in patients receiving hemodialysis therapy.

INTRODUCTION AND AIMS: Neurological complications such as peripheral neuropathy are very common in the end-stage renal disease (ESRD) patients, occurring in 60-80% of this specific population. The aim of the present study was to examine whether a 9-month hybrid intradialytic exercise training program could alter motor and sensory nerve conduction study (NCS) parameters in hemodialysis population. METHODS: Seventeen stable patients undergoing HD with no clinical evidence of uremic polyneuropathy were included in the study (15 M/2F, 59 ± 13.7 years). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training (hybrid) during HD. Functional capacity was assessed by a battery of tests, while pain levels and fatigue profile were assessed via validated questionnaires. Motor and sensory NCS on bilateral median, ulnar, peroneal and tibial nerves as well as F-wave were assessed using a full neurographic electromyography (EMG) assessment. RESULTS: After the 9-month exercise training intervention, exercise capacity was increased by 65% and functional capacity by an average of 40%. The neurological assessment showed that conduction velocity from tibial and peroneal nerves was improved by 3.7% and 4.2%, respectively, while tibial F-wave latency and peroneal and sural nerve distal latency were significantly improved by 4.2%, 4.9% and 10%, respectively. Fatigue and pain were improved after the exercise intervention while fatigue score was positively correlated with conduction velocity and amplitude values. CONCLUSIONS: The results of the current study demonstrate that 9-month hybrid exercise training induces beneficial effects on both sensory and motor NCS parameters, improving conduction velocity and F-wave latency. Improvements in neural activity were accompanied by changes in fatigue score and pain-related aspects. The parallel improvement in motor nerve conduction velocity and its correlations with functional tests supports the hypothesis that exercise could be beneficial for preventing a decline in neural function in HD patients.

The vicious circle between physical, psychological, and physiological characteristics of shift work in nurses: a multidimensional approach.

PURPOSE: To compare physical, psychological, and physiological adaptations between rotating and morning shift health workers using objective and subjective approaches. METHODS: Forty nurses [n = 20 morning shift (MS) group; n = 20 rotating shift (RS) group] were evaluated for anthropometry, body composition, and handgrip strength. Quality of life, depression, fatigue, daytime sleepiness, and sleep quality were assessed with SF-36, Zung Self-Rating Depression Scale (SDS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and triaxial accelerometers. Sleep-related data were monitored with sleep actigraphy. Salivary melatonin levels were analyzed before/after sleep, and blood lipid profiles were measured the following morning. RESULTS: The RS group had higher mean BMI and total and abdominal fat and scored lower in the SF-36 (p < 0.01). All nurses showed reduced physical activity levels, which, in the RS group, were negatively correlated with FSS (p = 0.033) and SDS scores (p = 0.025). Poor sleep was revealed in 53% of nurses. The RS group had worse sleep quality by PSQI than the MS group (p = 0.045). PSQI scores were inversely related to SF-36 scores and positively correlated with FSS, BMI, waist circumference, and body fat (p < 0.05). CONCLUSION: RS nurses showed increased body mass and total and abdominal fat along with decreased quality of life and sleep quality compared to MS counterparts. A strong relationship was found between physical, psychological, and physiological domains. Further studies should consider workplace interventions to prevent obesity, promote physical activity, and manage poor sleeping patterns in nurses.

A single bout of hybrid intradialytic exercise did not affect left-ventricular function in exercise-naïve dialysis patients: a randomized, cross-over trial.

INTRODUCTION: Cardiovascular diseases are the leading cause of mortality in end-stage renal disease (ESRD) patients, especially those receiving hemodialysis (HD) therapy. HD has many side effects that are related to patients' hearts, such as recurrent myocardial ischemia and global or segmental left-ventricular dysfunction, which is associated with intradialytic hypotension, long-term loss of systolic function, and high incidence of cardiovascular events and death. Systematic exercise training has a beneficial effect on measures of cardiovascular fitness and reducing cardiovascular risk factors in ESRD. Whether there is an acute benefit of exercise during HD on left-ventricular function is not well known. The current study aimed to investigate whether a single bout of hybrid (aerobic and resistance) intradialytic exercise could affect left-ventricular function during HD sessions. METHODS: Twenty-one exercise naïve and clinically stable HD patients participated in the study. All participants completed two different HD trials on two different days, separated by 1 week: (1) standard HD and (2) HD including a single bout of hybrid intradialytic exercise. Hybrid intradialytic training included the usual intradialytic cycling followed by resistance training using elastic bands and dumbbells. Echocardiographic assessment of left-ventricular function was completed before HD, half an hour before the end of HD, and 30 min after the end of HD. RESULTS: Cohort data for left-ventricular function indices were not different between trials and did not change across time in either the standard HD or HD plus exercise trial. Cohort data for the change in ejection fraction from baseline to during HD did mask considerable inter-individual variability (HD - 0 ± 15; HD plus exercise (- 2 ± 20). Despite this, the variability was not mediated by the addition of intradialytic hybrid exercise. CONCLUSION: A single bout of hybrid intradialytic exercise did not affect left-ventricular function during the HD therapy. It is important to determine whether chronic exercise training could beneficially affect left-ventricular function abnormalities often observed during the HD therapy. TRIAL REGISTRATION NUMBER: The study is registered at ClinicalTrials.gov (NCT01721551) as a clinical trial.

The effects of training with high-speed interval running on muscle performance are modulated by slope.

We examined changes in selected muscle performance parameters after 8 weeks of interval training using two opposite running inclinations. We hypothesized that the uphill training will affect endurance muscle performance outcomes, whereas the downhill training will affect power muscle performance outcomes. Fourteen physically active volunteers were randomly assigned into either the Uphill group (UG; n = 7; uphill interval running at +10% incline) or the Downhill group (DG; n = 7; downhill interval running at -10% incline) and completed 16 training sessions. Each session consisted of ten 30 s treadmill runs at 90% of maximum aerobic speed (MAS) with a work to rest ratio of 1:2. Vertical jump performance, isometric (MVC) and isokinetic torque of knee extensors and flexors, and fatigue of knee extensors were evaluated pre and post-training. Moreover, body composition (via bioimpedance) and vastus lateralis muscle architecture (via ultrasonography) were assessed pre and post-training. Relative lean tissue mass, relative fat mass, and squat jump (cm) significantly (p < .05) changed from baseline values by +4.5 ± 4.0%, -11.5 ± 9.6%, and +9.5 ± 11.7%, respectively, only in the DG. Similarly, DG improved absolute values of knee extension rate of torque development and impulse (p < .05), whereas knee flexion peak torque angle significantly decreased in both groups (p < .05). On the other hand, the UG increased the number of repetitions achieved during the fatigue protocol and total work by 21.2 ± 32.6% and 13.8 ± 21.2%, respectively (p < .05). No differences were found between groups in muscle architecture. Introducing variations in slope during HIIT could be used to induce specific improvements toward muscle endurance or power performance characteristics.

Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy.

PURPOSE: Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally "switch off" mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session. METHODS: Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period. RESULTS: Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039). CONCLUSION: The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients. TRIAL REGISTRATION NUMBER: Trial registration number The study is registered at ClinicalTrials.gov (NCT01721551, 2012) as a clinical trial.

Separate and combined effects of cold dialysis and intradialytic exercise on the thermoregulatory responses of hemodialysis patients: a randomized-cross-over study.

BACKGROUND: The separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown. This study assessed the thermoregulatory responses of hemodialysis patients under four different hemodialysis protocols: a) one typical dialysis (TD) protocol (dialysate temperature at 37 °C), b) one cold dialysis (CD) protocol (dialysate temperature at 35 °C), c) one typical dialysis protocol which included a single exercise bout (TD + E), d) one cold dialysis protocol which included a single exercise bout (CD + E). METHODS: Ten hemodialysis patients (57.2 ± 14.9 years) participated in this randomized, cross-over study. Core and skin temperatures were measured using an ingestible telemetric pill and by four wireless iButtons attached on the skin, respectively. Body heat storage (S) calculated using the thermometric method proposed by Burton. RESULTS: The TD and TD + E protocols were associated with increased S leading to moderate effect size increases in core body temperature (as high as 0.4 °C). The low temperature of the dialysate during the CD and the CD + E protocols prevented the rise in S and core temperature (p > 0.05), even during the period that IET took place. CONCLUSIONS: TD and IET are accompanied by a moderate level of hyperthermia, which can be offset by CD. We recommended that CD or with IET can prevent the excessive rise of S. TRIAL REGISTRATION: Clinical Trial Registry number: NCT03905551 ( clinicaltrials.gov ), DOR: 05/04/2019.

Effects of 12 months of detraining on health-related quality of life in patients receiving hemodialysis therapy.

PURPOSE: Limited data exist regarding the effects of detraining on functional capacity and quality of life (QoL) in the hemodialysis population. The aim of the current study was to assess whether the discontinuation from a systematic intradialytic exercise training program will affect aspects of health-related QoL and functional capacity in hemodialysis patients. METHODS: Seventeen hemodialysis patients (12 Males/5 Females, age 60.8 ± 13.6 year) participated in this study. Patients were assessed for functional capacity using various functional capacity tests while QoL, daily sleepiness, sleep quality, depression and fatigue were assessed using validated questionnaires at the end of a 12-month aerobic exercise program and after 12 months of detraining. RESULTS: The detraining significantly reduced patients' QoL score by 20% (P = 0.01). More affected were aspects related to the physical component summary of the QoL (P < 0.001) rather than those related to the mental one (P = 0.096). In addition, the performance in the functional capacity tests was reduced (P < 0.05), while sleep quality (P = 0.020) and daily sleepiness scores (P = 0.006) were significantly worse after the detraining period. Depressive symptoms (P = 0.214) and the level of fatigue (P = 0.163) did not change significantly. CONCLUSIONS: Detraining has a detrimental effect in patients' QoL, functional capacity and sleep quality. The affected physical health contributed significantly to the lower QoL score. It is crucial for the chronic disease patients, even during emergencies such as lockdowns and restrictions in activities to maintain a minimum level of activity to preserve some of the acquired benefits and maintain their health status.

Cardiac autonomic function during intradialytic exercise training.

Objectives: Cardiac autonomic nervous system (ANS) dysfunction is a common feature in patients receiving hemodialysis (HD) therapy, whilst is associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The aim of this study is to investigate and compare the hemodynamic changes and responses of ANS function in HD patients using pupillometry and Heart Rate Variability (HRV) parameters. Methods: Sixteen chronic kidney diseases (CKD) patients receiving HD (52.18 ± 17.7 years) underwent both pupillometric measurements using a portable handheld pupil-measuring device and standard HRV analysis pre HD, every hour and 30 min post-HD session under two different scenarios: at rest while the patient resting at HD bed and when the patient performed a single bout of intradialytic aerobic exercise lasting for 45 min during the second hour of the HD therapy. Results: No significant changes in ANS values were observed in neither of the pupillometric and the HRV values pre HD, for each hour and post-HD session. HRV parameters were significantly correlated with pupillometric parameters at pre HD and immediately after the single bout of intradialytic exercise. ANS activity did not differ during the conventional HD session and during the session included intradialytic exercise. Moreover, sympatho-vagal balance indices deriving from pupillometric assessment showed beneficial changes after the exercise event. Conclusion: Pupillometry is a promising and robust technique with fewer artifacts compared to HRV especially in studies involving exercise sessions. Thus, pupillometry can be used as a complementary tool in the evaluation of cardiac autonomic dysfunction.

Evidence of Blood and Muscle Redox Status Imbalance in Experimentally Induced Renal Insufficiency in a Rabbit Model.

Chronic kidney disease (CKD) is accompanied by a disturbed redox homeostasis, especially in end-stage patients, which is associated with pathological complications such as anemia, atherosclerosis, and muscle atrophy. However, limited evidence exists about redox disturbances before the end stage of CKD. Moreover, the available redox literature has not yet provided clear associations between circulating and tissue-specific (muscle) oxidative stress levels. The aim of the study was to evaluate commonly used redox status indices in the blood and in two different types of skeletal muscle (psoas, soleus) in the predialysis stages of CKD, using an animal model of renal insufficiency, and to investigate whether blood redox status indices could be reflecting the skeletal muscle redox status. Indices evaluated included reduced glutathione (GSH), oxidized glutathione (GSSG), glutathione reductase (GR), catalase (CAT), total antioxidant capacity (TAC), protein carbonyls (PC), and thiobarbituric acid reactive substances (TBARS). Results showed that blood GSH was higher in the uremic group compared to the control (17.50 ± 1.73 vs. 12.43 ± 1.01, p = 0.033). In both muscle types, PC levels were higher in the uremic group compared to the control (psoas: 1.086 ± 0.294 vs. 0.596 ± 0.372, soleus: 2.52 ± 0.29 vs. 0.929 ± 0.41, p < 0.05). The soleus had higher levels of TBARS, PC, GSH, CAT, and GR and lower TAC compared to the psoas in both groups. No significant correlations in redox status indices between the blood and skeletal muscles were found. However, in the uremic group, significant correlations between the psoas and soleus muscles in PC, GSSG, and CAT levels emerged, not present in the control. Even in the early stages of CKD, a disturbance in redox homeostasis was observed, which seemed to be muscle type-specific, while blood levels of redox indices did not seem to reflect the intramuscular condition. The above results highlight the need for further research in order to identify the key mechanisms driving the onset and progression of oxidative stress and its detrimental effects on CKD patients.

Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study.

BACKGROUND-AIMS: Phosphorus nutritional knowledge level of hemodialysis patients and renal nurses has been found to be low, while respective knowledge of nephrologists has not been studied yet. There are equivocal results regarding the association of phosphorus nutritional knowledge level and serum phosphorus values. The aim of this study was to assess phosphorus nutritional knowledge of hemodialysis patients, nephrologists and renal nurses and seek potential interventions to improve patients' adherence to phosphorus and overall nutritional guidelines. METHODS: This cross-sectional observational study was conducted on sixty eight hemodialysis patients, 19 renal nurses and 11 nephrologists who were recruited from 3 hemodialysis units in Greece. Phosphorus nutritional knowledge of the participants was assessed by a 25-item item questionnaire (CKDKAT-N) which included 15 questions on phosphorus and 10 questions on protein, sodium, and potassium knowledge. RESULTS: Nephrologists had higher CKDKAT-N total (19.1 ± 3.6 vs 14.1 ± 2.8 and 13.2 ± 2.8, P < 0.01) and phosphorus knowledge scores (10.6 ± 2.7 vs 7.6 ± 2.2 and 7.3 ± 2.0, P < 0.01) compared to renal nurses and patients respectively. There were no differences in total and phosphorus knowledge scores between nurses and patients. Patients and nurses answered correctly significantly less questions regarding phosphorus compared with the rest of the questions (P < 0.01) while no such difference was found in nephrologists. Serum phosphorus was positively correlated with phosphorus knowledge score (r = 0.31, P = 0.02), and negatively correlated with patient age (r = -0.34, P < 0.05). None of the patients, 11% of the nurses and 27% of the nephrologists answered correctly all three questions regarding P, K and Na dietary recommendations (P < 0.01). CONCLUSIONS: The study confirms that hemodialysis patients have low renal nutrition knowledge while higher nutritional phosphorus knowledge does not lead to lower serum phosphorus values. Alarmingly, renal nurses have been found to have a similar level of knowledge with hemodialysis patients, something that needs to be taken into account when training the new dialysis staff. Nephrologists have superior knowledge; however they are still lacking essential nutritional knowledge that could affect patients' and nurses' overall understanding. Continuing education on nutrition of nephrologists and renal nurses could improve nutrition care of hemodialysis patients.

Nocturnal Activity Is Not Affected by a Long-Duration, Low-Intensity Single Exercise Bout.

The aim of the current study was to examine whether prolonged low-intensity aerobic exercise could affect nocturnal activity in healthy individuals. Twenty-one healthy adults (24 ± 3.7 years; 9 females) were enrolled in this study. All participants participated in a 3-h low-intensity walking exercise protocol. Standard biochemical indices were assessed before the exercise protocol and at 72 h. Nocturnal activity and various indices of health were recorded for five consecutive days. The score of muscle pain peaked the night after the exercise protocol (p < 0.05) and returned to baseline two days after. No statistical differences were found in any of the parameters examined, including nocturnal activity. Prolonged low-intensity exercise does not affect nocturnal activity. The anecdotal reports suggesting that exercise or/and physical activity could worsen symptoms of motor restlessness during sleep in sleep disorders, such as restless legs syndrome and periodic limb movements, are not supported by this study. However, these findings need to be verified in clinical populations, as well as by using protocols with different forms of exercise.

Sleep Abnormalities in Multiple Sclerosis.

PURPOSE OF REVIEW: This review summarizes the most well-documented sleep disorders seen in patients with multiple sclerosis (MS), with a special focus on the impact on quality of life. RECENT FINDINGS: Sleep abnormalities in patients with MS are a multifactorial and relatively complex issue affecting approximately 60% of the patients while the pathophysiology of these symptoms is not fully understood. Circadian rhythm disorders and increased levels of pro-inflammatory cytokines have been recognized as potential players in affecting sleep homeostasis in MS patients. Medication-related side effects such as in immunotherapy and other factors such as lesion load can contribute to the disruption of normal sleep patterns. Most frequently encountered sleep disorders are insomnia, sleep-related movement disorders, sleep-related breathing disorders, and circadian rhythm disorders affecting both adults and paediatric MS populations. Aetiology still remains unknown with treatment options focusing on behavioural cognitive therapy and lifestyle modification including improvement in sleep hygiene as well as melatonin supplementation. Given MS prevalence is still rising affecting millions of people, more personalized medicine applications should possibly form the key approach for improving patients' quality of life and quality years.