RESUMO
Purpose: Hemodialysis patients commonly have impaired physical performance and mental health. We studied the effects of an intradialytic exercise program on these variables. Methods: 27 patients (33% women; 68 ± 13 years) were enrolled in a 14-week intradialytic endurance-resistance training program ('exercise' group, 40 programmed sessions per patient); 40 hemodialysis patients (28% women; 68 ± 11 years) performing no exercise during the same time length were used as controls. Endpoints included physical performance (6-min walk test [6MWT], 10-repetition sit to stand [STS-10] and handgrip strength), emotional status (Beck's depression inventory and State-Trait Anxiety Inventory), and mental and physical component scores of the short-from (SF)-12 Health Survey. Results: There were no differences (p> 0.05) between groups at baseline for sex distribution, or mean age, body mass index and time spent on dialysis. Exercise benefits were observed for 6MWT (11 and -3% for the exercise and control groups, respectively; p < 0.001), STS-10 performance time (-22 and 6%; p < 0.001) and handgrip strength (4 and -4%; p < 0.02). No significant benefits (p> 0.05) were observed for emotional status endpoints or SF-12 component scores. Despite significant benefits on physical performance, the proportion of clinically meaningful responders was low (<50%). Responsiveness was dependent on baseline physical performance (p < 0.05) but not on age or sex (p > 0.05). Conclusion: A 14-week intradialytic training program induced significant improvements on physical performance. However, the rate of clinically meaningful responders observed in the present study was low, being the level of responsiveness dependent on baseline physical status. Efforts to individualize exercise prescription are needed in clinical practice.
RESUMO
This work studies the sequential execution of dilute sulfuric acid (DAP) (0.1-0.75 %, v/v) and dilute sodium hydroxide (AKP) (0.25-3 %, w/v) [i.e., DAP followed by AKP (DAP+AKP) and vice versa (AKP+DAP)] at low temperatures (<121 °C) and short reaction times (5-60 min) for maximizing sugar recovery in the enzymatic hydrolysis of wheat straw with low enzyme dosage. The pretreatment effectiveness was measured by the sum of the severity factors of both pretreatments and the saccharification yield achieved in the subsequent stage of enzymatic hydrolysis. Degradation compounds were quantified and mass balance calculations were carried out for each pretreatment sequence to verify the correct account of the input biomass and output products. Results show that sequential pretreatments (AKP+DAP and DAP+AKP) had a positive effect in enzyme accessibility thus improving monosaccharide yields compared to single DAP and AKP pretreatments. DAP+AKP achieved a high xylose yield (ca. 0.867 of theoretical) at the DAP stage, while no xylose monosaccharides were detected in the subsequent AKP. After enzyme saccharification of double-pretreated solids, the total monosaccharide yield was 0.786 (of theoretical). For AKP+DAP sequence, lower results were obtained (total monosaccharide yield 0.783 of theoretical). Sequential pretreatments total yields increased by 21 % compared to single pretreatments. AKP removed more than half of the lignin from the wheat straw in all cases. Acid and alkali concentrations played a relevant role in all pretreatment sequences, while reaction time and temperature were less important with an almost-linear effect on the total monosaccharide yields.
