Exercise during Hemodialysis in Patients with Chronic Kidney Failure.

Exercise during Hemodialysis in Patients with Chronic Kidney FailureThe authors report on a trial of an exercise intervention provided during dialysis sessions for patients with chronic renal failure. They found that the intervention is safe and improves physical function.

Cluster Randomized Controlled Trial on the Effects of 12 Months of Combined Exercise Training during Hemodialysis in Patients with Chronic Kidney Disease-Study Protocol of the Dialysis Training Therapy (DiaTT) Trial.

Patients with chronic kidney disease (CKD) on hemodialysis (HD) experience treatment-related immobility and physical deconditioning, which is responsible for an increased risk of frailty and a high burden of multi-morbidity. Exercise has been shown to counteract this vicious cycle; however, its effectiveness has only been investigated in small cohorts. Therefore, the objective of the Dialysis Training Therapy (DiaTT) trial will be to assess the effects of a 12-month intradialytic exercise program on physical functioning, frailty and health economics in a large cohort of HD patients in a real-world setting. DiaTT will be a prospective, cluster-randomized (1:1), controlled, multi-center, interventional clinical trial across 28 dialysis units, aiming at the recruitment of >1100 CKD patients on HD. The intervention group will receive 12 months' intradialytic exercise (combined aerobic and resistance training), whereas the usual care group will not receive intervention. The primary endpoint will be a change on the sit-to-stand test (STS60) result between baseline and 12 months. Secondary endpoints will include physical functioning, frailty, quality of life, 3-point MACE, hospitalizations, survival, quality of HD, health literacy and health care costs. By including almost as many patients as previously investigated in smaller trials, DiaTT will be the largest randomized, controlled trial assessing frailty, quality of life and mortality in the field of nephrology.

Reduced dopamine receptors and transporters but not synthesis capacity in normal aging adults: a meta-analysis.

Many theories of cognitive aging are based on evidence that dopamine (DA) declines with age. Here, we performed a systematic meta-analysis of cross-sectional positron emission tomography and single-photon emission-computed tomography studies on the average effects of age on distinct DA targets (receptors, transporters, or relevant enzymes) in healthy adults (N = 95 studies including 2611 participants). Results revealed significant moderate to large, negative effects of age on DA transporters and receptors. Age had a significantly larger effect on D1- than D2-like receptors. In contrast, there was no significant effect of age on DA synthesis capacity. The average age reductions across the DA system were 3.7%-14.0% per decade. A meta-regression found only DA target as a significant moderator of the age effect. This study precisely quantifies prior claims of reduced DA functionality with age. It also identifies presynaptic mechanisms (spared synthesis capacity and reduced DA transporters) that may partially account for previously unexplained phenomena whereby older adults appear to use dopaminergic resources effectively. Recommendations for future studies including minimum required samples sizes are provided.

Stability and change in risk-taking propensity across the adult life span.

Can risk-taking propensity be thought of as a trait that captures individual differences across domains, measures, and time? Studying stability in risk-taking propensities across the life span can help to answer such questions by uncovering parallel, or divergent, trajectories across domains and measures. We contribute to this effort by using data from respondents aged 18 to 85 in the German Socio-Economic Panel Study (SOEP) and by examining (a) differential stability, (b) mean-level differences, and (c) individual-level changes in self-reported general (N = 44,076) and domain-specific (N = 11,903) risk-taking propensities across adulthood. In addition, we investigate (d) the correspondence between cross-sectional trajectories of self-report and behavioral measures of social (trust game; N = 646) and nonsocial (monetary gamble; N = 433) risk taking. The results suggest that risk-taking propensity can be understood as a trait with moderate stability. Results show reliable mean-level differences across the life span, with risk-taking propensities typically decreasing with age, although significant variation emerges across domains and individuals. Interestingly, the mean-level trajectory for behavioral measures of social and nonsocial risk taking was similar to those obtained from self-reported risk, despite small correlations between task behavior and self-reports. Individual-level analyses suggest a link between changes in risk-taking propensities both across domains and in relation to changes in some of the Big Five personality traits. Overall, these results raise important questions concerning the role of common processes or events that shape the life span development of risk-taking across domains as well as other major personality facets. (PsycINFO Database Record

Propensity for Risk Taking Across the Life Span and Around the Globe.

Past empirical work suggests that aging is associated with decreases in risk taking. But are such effects universal? Life-history theory suggests that the link between age and risk taking is a function of specific reproductive strategies that can be more or less risky depending on the ecology. We assessed variation in the age-risk curve using World Values Survey data from 77 countries (N = 147,118). The results suggest that propensity for risk taking tends to decline across the life span in the vast majority of countries. In addition, there is systematic variation among countries: Countries in which hardship (e.g., high infant mortality) is higher are characterized by higher levels of risk taking and flatter age-risk curves. These findings suggest that hardship may function as a cue to guide life-history strategies. Age-risk relations thus cannot be understood without reference to the demands and affordances of the environment.

Age differences in risky choice: a meta-analysis.

Does risk taking change as a function of age? We conducted a systematic literature search and found 29 comparisons between younger and older adults on behavioral tasks thought to measure risk taking (N= 4,093). The reports relied on various tasks differing in several respects, such as the amount of learning required or the choice framing (gains vs. losses). The results suggest that age-related differences vary considerably as a function of task characteristics, in particular the learning requirements of the task. In decisions from experience, age-related differences in risk taking were a function of decreased learning performance: older adults were more risk seeking compared to younger adults when learning led to risk-avoidant behavior, but were more risk averse when learning led to risk-seeking behavior. In decisions from description, younger adults and older adults showed similar risk-taking behavior for the majority of the tasks, and there were no clear age-related differences as a function of gain/loss framing. We discuss limitations and strengths of past research and provide suggestions for future work on age-related differences in risk taking.